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Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses
  1. Dawn Carnes1,2,3,
  2. Austin Plunkett1,3,
  3. Julie Ellwood3,
  4. Clare Miles1
  1. 1 Barts and The London School of Medicine and Dentistry, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
  2. 2 Faculty of Health, Universtiy of Applied Sciences, Western Switzerland, Fribourg, Switzerland
  3. 3 National Council for Osteopathic Research, London, UK
  1. Correspondence to Dr Dawn Carnes; d.carnes{at}


Objective To conduct a systematic review and meta-analyses to assess the effect of manual therapy interventions for healthy but unsettled, distressed and excessively crying infants and to provide information to help clinicians and parents inform decisions about care.

Methods We reviewed published peer-reviewed primary research articles in the last 26 years from nine databases (Medline Ovid, Embase, Web of Science, Physiotherapy Evidence Database, Osteopathic Medicine Digital Repository , Cochrane (all databases), Index of Chiropractic Literature, Open Access Theses and Dissertations and Cumulative Index to Nursing and Allied Health Literature). Our inclusion criteria were: manual therapy (by regulated or registered professionals) of unsettled, distressed and excessively crying infants who were otherwise healthy and treated in a primary care setting. Outcomes of interest were: crying, feeding, sleep, parent–child relations, parent experience/satisfaction and parent-reported global change.

Results Nineteen studies were selected for full review: seven randomised controlled trials, seven case series, three cohort studies, one service evaluation study and one qualitative study.

We found moderate strength evidence for the effectiveness of manual therapy on: reduction in crying time (favourable: −1.27 hours per day (95% CI −2.19 to –0.36)), sleep (inconclusive), parent–child relations (inconclusive) and global improvement (no effect). The risk of reported adverse events was low: seven non-serious events per 1000 infants exposed to manual therapy (n=1308) and 110 per 1000 in those not exposed.

Conclusions Some small benefits were found, but whether these are meaningful to parents remains unclear as does the mechanisms of action. Manual therapy appears relatively safe.

PROSPERO registration number CRD42016037353.

  • Manual Therapy
  • Paediatrics
  • ’colic'
  • Excessive Crying
  • Infants

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  • Contributors DC conceptualised and designed the study, contributed to the data selection, extraction and analysis, drafted the initial manuscript, reviewed and revised the manuscript and approved the final manuscript submitted. CM managed the data, contributed to the data selection and extraction and did the meta-analyses, reviewed and revised drafts of the manuscript and approved the final manuscript submitted. AP and JE contributed to the data selection and extraction, reviewed and revised drafts of the manuscript and approved the final manuscript submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CM had financial support from the National Council for Osteopathic Research from crowd-funded donations.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Full datasets, analyses and all full searches are available on request from the corresponding author at No individual patient level data was used in this study.

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