***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the efficacy of behavioral management counseling in the treatment of persistent , excessive infant crying ( > 3 hours per day ) . DESIGN Two treatments , one no treatment control group . Infants were group-matched according to baseline fuss/cry levels , sociodemographic , and infant variables . Treatments were carried out sequentially by the same counselors . SETTING Telephone counseling by volunteers ( mothers ) of CRY-SIS , a national support group for the parents of crying infants . PATIENTS AND INTERVENTIONS Sequential sample of 27 mother-infant pairs receiving treatment 1 ( Tr1 , empathy : talking through the problem ) , 21 receiving treatment 2 ( Tr2 , behavioral management : specific care taking suggestions ) and 44 receiving no treatment ( C , controls ) . Infants were between 1 to 5 months of age . MEASUREMENTS AND RESULTS Mother-infant pairs had a pretreatment baseline assessment and a posttreatment follow-up ( 3 months after baseline ) using 1-week diaries . Total fuss/cry duration reduced significantly more in the behavioral management group ( by 51 % ) than the empathy group ( 37 % ) or the control group ( 35 % ) . This was mainly due to significantly reduced evening fussing/crying in Tr2 ( 67 % ) compared with Tr1 ( 45 % ) and C ( 42 % ) . No differences in total number of fuss/cry bouts/day were found . However , the number of fuss/cry bouts reduced significantly more in the evening in Tr2 ( by 55 % ) compared with Tr1 ( 27 % ) and C ( 32 % ) . Behavioral management mothers evaluated the same counselors as more sympathetic , knowledgeable , and underst and ing . Tr2 was also perceived by mothers to have helped them more in reducing the crying problem , coping with the infant , and improving the relationship with their infant than Tr1 . No effects of treatment on infant difficult temperament were found . CONCLUSIONS Behavioral management was more effective in reducing fussing/crying than spending time with the mother talking through the problem or just waiting for spontaneous remission . Treatment by suitably but briefly trained lay counselors is an inexpensive and successful treatment option Because infants with colic appear to have  abdominal pain  similar to that of adults with irritable bowel syndrome , who may benefit from the addition of fiber to their diet , we tested whether fiber added to infant formula would alleviate colic .  Twenty-seven normal , term infants ( aged 2 to 8 weeks ; 14 girls ) with colic , defined as crying plus fussing for more than 3 hours a day for at least 3 days of a 6-day baseline period , were enrolled . Infants were r and omly assigned in 9-day periods to a sequence of placebo ( Isomil formula ) followed by fiber-supplemented formula ( Isomil plus soy polysaccharide ) ( n = 12 ) or the reverse ( n = 15 ) . Daily diaries of crying , fussing , sleeping , formula , intake , and stooling were kept . Twenty-two infants completed three lactulose breath hydrogen tests at the end of the baseline period and after each study period . The crossover trial was followed by 30 to 35 days of use of the study formula chosen by the parents as most beneficial but unknown to the investigators . Growth was monitored throughout . Serum cholesterol , calcium , phosphate , albumin , iron , and zinc concentrations were measured at the conclusion . There were no significant differences in average daily time spent by the infants in fussing and crying during ingestion of the fiber-supplemented formula . However , parents of 18 of 27 infants chose fiber-supplemented formula as most beneficial in ameliorating symptoms of colic . While the infants were consuming fiber-supplemented formula , stool frequency increased , and breath hydrogen excretion increased significantly , in response to lactulose . Growth and serum biochemical measurements were normal in all infants . Supplementation of infant formula with the level of soy polysaccharide used in this study may have reduced crying and fussing in some infants but did not affect colicky behavior in the majority of infants , who continued to cry and fuss excessively During five years , 97 young infants with colic were studied . One of us ( J. C. O'D. ) compared homatropine methylbromide plus phenobarbital in a 20 % alcohol solution , and all of the individual components of that solution , to see which was most effective in the symptomatic relief of colic . Regardless of the child 's age on entry into the study , conditions in no treatment group improved more rapidly than in those treated with a placebo We evaluated the effect of an herbal tea preparation on  infantile colic  in a prospect i ve double-blind study . The use of tea eliminated the colic in 19 ( 57 % ) of 33 infants , whereas placebo was helpful in only 9 ( 26 % ) of 35 ( p < 0.01 ) . The mean colic score was significantly improved in tea-treated infants . No significant differences were noted between groups regarding number of night wakings ABSTRACT . The effect of Simethicone on  “ colicky ” ( n=27 ) infants was tested in a double‐blind cross‐over study . Three different parameters were used to measure the efficiency of the treatment : interviews , 24‐hour records and behavioral observations . No effects of Simethicone on the symptoms of infantile colic could be demonstrated . However , 67 % of the infants improved during the treatment , which could be ascribed to a high‐ grade placebo‐effect The possible role of cows milk intolerance in the aetiology of infant colic was evaluated in 19 babies presenting to their health visitor or general practitioner in one town . Over a three week period a st and ard modified cows milk formula was compared with a soya milk formula on a double blind basis . The duration of colic symptoms was significantly reduced during the week on soya milk ( P less than 0.01 ) , with 11 out of 19 babies fulfilling the diagnostic criteria for cows milk intolerance . Four babies whose symptoms failed to improve either spontaneously or with soya milk were given a hydrolysed protein milk with a positive response in two , confirmed by challenge testing . Thus in 13 out of 19 babies ( 68 % ) the symptoms of infant colic resolved almost completely with dietary change We performed a prospect i ve , r and omized , double-blind , placebo-controlled clinical trial of dicyclomine hydrochloride using specific diagnostic criteria for infantile colic : spells of unexplained irritability , agitation , fussiness or crying lasting greater than or equal to 3 hours/day , occurring greater than or equal to 3 days/week , and continuing for greater than or equal to 3 weeks .  Dicyclomine eliminated colic in 15 of 24 ( 63 % ) infants , whereas placebo was effective in six of 24 ( 25 % ) ( corrected X2 = 5.42 , P = 0.02 ) . The study also addressed the hypothesis that parental distress caused by infantile colic affects subsequent temperament and sleep patterns . The data fail to document easier temperaments or longer sleep duration s at 4 months in infants whose colic ceased during treatment This study evaluated the enduring effectiveness of a skill-based training program to enhance  maternal sensitivity between 6 and 9 months of age . 82 mothers and their toddlers were evaluated at 18 and 24 months , and 79 at 31/2 years on the bases of observations of free play , everyday interaction , problem solving , and peer interaction . Most of the significant behavioral changes noted in the second year pertain to attachment security , indices of maternal sensitivity across situations , and child cooperation . Some enduring effects on indices of sensitivity appear to be attachment-mediated . In the third year , results revealed direct enduring intervention effects on parental responsiveness and child cooperation . Attachment-mediated effects were evident for maternal assistance , child security , and positive peer contact . Attachment pattern also predicted differences in attractiveness of the focal child as an interactive partner This study investigated the effect of changing the formulas of colicky infants and addressed the method ologic flaws of earlier studies . Attention was paid to issues of design ing a blind study , providing a washout period , and measuring and reproducing the effect . In this r and omized , double-blind trial , three changes of formula were made : for each of four 4-day periods , colicky infants alternately received a casein hydrolysate formula ( Nutramigen ) and a formula containing cow milk . Mothers recorded crying in diaries and indicated which crying episodes they considered to have been caused by colic . Nine infants were started on Nutramigen and eight on the cow milk formula .  With the first formula change there was significantly less crying and colic in infants when they were fed Nutramigen than when they were fed cow milk ( p less than 0.01 ) ; with the second change there was less colic when infants were fed Nutramigen ( p less than 0.05 ) but not significantly less crying . By the third change there were no significant differences between formulas . Further analyses demonstrated that there were more clinical ly meaningful positive responses ( a change in crying by at least one third ) to Nutramigen than to cow milk ( p less than 0.05 ) . However , only one subject had a clinical ly meaningful response in colic to all three formula changes . These results demonstrate that in some instances , colic improves with elimination of cow milk formula . However , the effect diminishes with time , and only infrequently is the effect reproducible This study examined 120 infants , aged 3–12 weeks , with severe colics and compared the results of a specific hypoallergenic diet ( group A ) with those of pharmacological treatment ( group B ) . Non‐breastfed group A infants  received soy milk and if unresponsive , hydrolyzed milk formulas ;  mothers of breast‐fed infants  received a diet without cow 's milk , eggs or fish .  Breast‐fed and non‐breast‐fed group B infants received dicyclomine hydrochloride 3 mg/kg/day . Results , based on quantitative measurements of crying . indicated that in breast‐fed infants there was no significant improvement between group A ( 62.5 % ) and group B ( 66.6 % ) infants . Among formula‐fed infants , comparison of positive results using soy milk ( 65.9 % ) with positive results using dicyclomine ( 53.3 % ) was not significant ; positive results using soy milk and hydrolyzed milk formulas in non‐responders to soy milk , provided an improvement in 95.4 % of cases . Pharmacological treatment provided an improvement in 53.3 % ) of cases . The diffcrence was significant ( p<0.01 ) OBJECTIVE To determine the efficacy of simethicone in the treatment of infant colic . DESIGN R and omized , double blind , placebo-controlled . SETTING Three general pediatric practice s in distinct geographic regions . PATIENTS Eighty-three infants between 2 and 8 weeks of age with infant colic . INTERVENTIONS Treatment with simethicone and placebo in double blind crossover fashion . RESULTS A total of 166 treatment periods , ranging from 3 to 10 days , were evaluated in the 83 infants . Compared to baseline , improvement in symptoms was reported for 54 % of the treatment periods , worsening was reported for 22 % , and , for 24 % , there was no change . The likelihood of the treatment period being rated as showing improvement , worsening , or no change was the same whether the infant was receiving placebo or simethicone . Twenty-eight percent of he infants responded only to simethicone , 37 % only to placebo , and 20 % responded to both . No statistically significant differences were noted among these three groups of responders . No difference could be shown even when infants with " gas-related symptoms " ( by parental report ) were separated out as a group . CONCLUSION Although both produced perceived improvements in symptoms , simethicone is no more effective than placebo in the treatment of infantile colic The observation that babies with troublesome crying  improve quickly in hospital suggested that , if true , a common , quickly reversible , factor may operate . Histories from parents of such babies suggest that much work goes into trying to console them . It is hypothesised that this may lead to excessive stimulation and the improvement seen in hospital reflects a reduction in stimulation . Two studies were undertaken . ( 1 ) Carers were asked to agree to r and omisation of their infants to hospital or home management . Those at home were advised to reduce stimulation . A 10 point question naire was used to describe distress in mothers of subjects and age matched controls . ( 2 ) A r and omised controlled study compared advice to reduce stimulation with an empathic interview  using a + 5 to -5 scale to chart change . In the first study too few subjects agreed to r and omisation and thus a rigorous study to vali date the observation could not proceed . There was good evidence , however , that crying improved . Results from the home group justified the second study . The median distress score for subjects was 7/10 and for controls 3/10 ( p less than 0.001 ) . In the second study at seven days , 18/22 subjects given advice scored + 2 or better on the change chart for crying , compared with 7/20 of those who did not receive advice ( p less than 0.01 ) . After the latter received advice 79 % improved ( 95 % confidence interval 61 to 97 % ) . For babies under 12 weeks , the customary upper limit for a diagnosis of colic , 14/15 subjects advised improved compared with 6/12 who were not advised ( p less than 0.02 ) . These studies have shown that infants with troublesome crying admitted to hospital seem to improve quickly as do those whose carers are advised to reduce stimulation Summary A double-blind crossover trial was carried out in 25 babies with infant colic to compare the symptom 
    Output:
    
The effectiveness of substitution by soy formula milks was unclear when only trials of good method ological quality were considered .
The advice to reduce stimulation was beneficial ( effect size 0.48 ( 0.23 to 0.74 ) ) , whereas the advice to increase carrying and holding seemed not to reduce crying .
No benefit was shown for simethicone .
Uncertainty remained about the effectiveness of low lactose formula milks .