Is gripe water baby-friendly?

Sir,

WHO recommends mothers worldwide to exclusively breastfeed infants for the child's first six months to achieve optimal growth, development and health. The “Ten Steps to Successful Breastfeeding” are the foundation of the WHO/UNICEF Baby Friendly Hospital Initiative (BFHI). According to the sixth step of BFHI, newborn infants should not be given food or drink other than breast milk, unless medically indicated.[1] Though WHO guidelines on infant and young child feeding do exist, in reality they are often not practiced. The beliefs and customs of people have a greater impact on the child rearing practices pushing the aforementioned guidelines to the back seat. One such irrational practice is the use of gripe water for infants on a routine basis and for colic.[2] Anything (including gripe water) other than breast milk administered to a baby during the first six months may increase the risk of introducing bacteria, causing allergies and irritating the baby's intestines. Gripe water just like any other prelacteal given soon after birth may cause delay in establishment of breastfeeding and reduce breast milk supply.

Woodward borrowed the formula, a combination of dill seed oil, sodium bicarbonate and alcohol, among other substances from physicians who were using solution in the 1840s to treat babies with “fen fever,” a form of malarial illness. It is serendipitous that a treatment Woodward designed for malaria is today a popular treatment for colic with an enormous commercial value.[3] A survey of 200 mothers in Sheffield revealed that babies were given gripe water by 64% of mothers within the first month.[4] According to a study from Nigeria, 30% of mothers used gripe water as self-medication to treat infants with colic while 43% doctors prescribed the same.[5] It is very obvious that gripe water has crossed borders and socioeconomic strata and is being liberally used by doctors and mothers.

It has been hypothesized that the alcohol content of gripe water provides a soothing effect.[3] In some of the other commercial gripe waters, the alcohol content has been as high as 9% making even adults to get addicted.[36] Though previously gripe water had alcohol in its composition, this is no longer a common constituent. A net search revealed that most brands of gripe water in Indian market are alcohol free but contain sodium bicarbonate, varying combinations of herbs or dill oil [Table 1]. Sodium bicarbonate in gripe water has no role as hyperacidity is not a cause for colic. Moreover, if given continuously and in large doses, it may cause alkalosis and milk alkali syndrome. One cannot presume that all herbal preparations are safe and free from side effects. The other possibility of the soothing effect of gripe water could be due to its sweet taste. The high sugar content of gripe water can harm the erupting teeth.[7] Pseudomonas aeruginosa septic shock secondary to “gripe water” ingestion has been reported in a nine-month-old girl.[8] In 2007, FDA confirmed the presence of cryptosporidium after investigating the illness of a six-week-old infant in Minnesota who consumed Baby's Bliss Gripe Water, apple flavor and advised consumers to throw away bottles of the product.[9]

Table 1

Common gripe water brands available in Indian market

To foster a strong belief in this product, attractive advertisements including endorsements are prominently placed in the media. “Trusted by generations of mothers in India” and “Granny gave mother and mother gave me” are examples of slogans for a popular brand. These advertisements need to be curbed and we should ensure that no promotion for infant foods or drinks other than breast milk is done. Allopathic doctors should stop prescribing these non allopathic medications and laws should be made stringent to prevent over the counter access of the same.[10]