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Colic is
one of the mysteries of nature. Nobody knows what it really is, but everyone has
an opinion. In the typical situation, the baby starts to have crying periods
about two to three weeks after birth. These occur mainly in the evening, and
finally stop when the baby is about 3 months of age (occasionally older). When
the baby cries, he is often inconsolable, though if he is walked, rocked or
taken for a drive, he may settle temporarily. For a baby to be called colicky,
it is necessary that he be gaining weight well and be otherwise healthy.
The
notion of colic has been extended to include almost any fussiness or crying in
the baby, and this may be valid, since we do not really know what colic is.
There is no treatment for colic, though many medications and behavior strategies
have been tried, without any proven benefit. It is admitted that everyone knows
someone whose baby was cured of colic by a particular treatment. It is also
admitted that almost every treatment seems to work—for a short time, anyhow.
The
Breastfeeding Baby with Colic
Aside
from the colic that any baby may have, there are three known situations in the
breastfed baby that may result in fussiness or colic. Once again, it is assumed
that the baby is gaining adequately and that the baby is healthy.
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Feeding Both Breasts at Each Feeding
Human milk changes during a feeding. One of the ways in which it
changes is that the amount of fat increases as the baby nurses
longer at the breast. If the mother automatically switches the baby from
one breast to the other during the feed, before the baby has "finished"
the first side, the baby may get a relatively low amount of fat during
the feeding. This may result in the baby getting fewer calories, and
thus feeding more frequently. If the baby takes in a lot of milk (to
make up for the reduced concentration of calories), he may spit up.
Because of the relatively low fat content of the milk, the stomach
empties quickly, and a large load of milk sugar (lactose) arrives in the
intestine all at once. The protein which digests the sugar (lactase) may
not be able to handle so much milk sugar at one time and the baby will
have the symptoms of lactose intolerance--crying, gas, and explosive,
watery, greenish bowel movements. This may occur even during the
feeding. These babies are not lactose intolerant. They have
problems with lactose because of the sort of information women get about
breastfeeding. This is not a reason to switch to lactose free
formula.
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Do not time feedings. Mothers all
over the world have breastfed babies successfully without being
able to tell time. Breastfeeding problems are greatest in
societies where everyone has a watch and least where no one has
a watch.
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The mother should feed the baby on
one breast, as long as the baby breastfeeds, until the baby
comes off himself, or is asleep at the breast. If the baby feeds
for only a short time only, the mother can compress the breast
(Breast Compression) to keep the baby
nursing. Please note that a baby may be on the breast for two
hours, but may actually feed for only a few minutes. In that
case the milk taken by the baby may still be relatively low in
fat. This is the rationale for compressing the breast. If, after
"finishing" on the first side, the baby still wants to feed,
offer the other side.
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The next feeding, the mother
should start the baby on the other breast in the same way.
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The mother's body will adjust
quickly to the new method, and she will not become engorged or
lop sided.
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Just as there should be no
"rule" for feeding both breasts at each feeding, there should be
no rule for one breast per feeding. Let the baby finish on one
breast (compress milk into his mouth if necessary to keep him
swallowing longer) but if he wants more, then offer the other
side.
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In some cases, it may be helpful
to feed the baby two or more feedings on one side before
switching over to the other side for two or more feedings.
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This problem is made worse if the
baby is not well latched on to the breast. A proper latch is the
key to easy breastfeeding.
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Overactive Letdown Reflex
A baby who gets too much milk too quickly, may become very fussy,
very irritable at the breast and may be considered "colicky". Typically,
the baby is gaining very well. Typically, also, the baby starts nursing,
and after a few seconds or minutes, starts to cough, choke or struggle
at the breast. He may come off, and often, the mother's milk will spray.
After this, the baby frequently returns to the breast, but may be fussy
and repeat the performance. He may be unhappy with the rapid flow, and
impatient when the flow slows. This can be a very trying time for
everyone. On rare occasions, a baby may even start refusing to take the
breast after several weeks, typically around three months of age.
What can be done?
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If you have not already done so,
try feeding the baby one breast/feed. In some situations,
feeding even two or three feedings on one breast before changing
to the other breast may be helpful. If you experience
engorgement on the unused breast, express just enough to feel
comfortable.
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Feed the baby before he is
ravenous. Do not hold off the feeding by giving water (a
breastfeeding baby does not need water even in very hot weather)
or a pacifier. A ravenous baby will "attack" the breast and
cause a very active letdown reflex. Feed the baby as soon as he
shows any sign of hunger. If he is still half asleep, all the
better.
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Feed the baby in a calm, relaxed
atmosphere, if possible. Loud music, bright lights and lots of
action are not conducive to a successful feeding.
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Lying down to nurse sometimes
works very well. If lying sideways to feed does not help, try
lying flat on your back with the baby lying on top of you to
nurse. Gravity helps decrease the flow rate.
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If you have time, express some
milk (an ounce or so) before you feed the baby.
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The baby may dislike the rapid
flow, but also become fussy when the flow slows too much. If you
think the baby is fussy because the flow is too slow, it will
help to compress the breast to keep up the flow
(Breast Compression).
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This problem is made worse if the
baby is not well latched on to the breast. A good latch is the
key to easy breastfeeding.
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On occasion giving the baby
commercial lactase (the enzyme that metabolizes lactose), 2-4
drops before each feeding, relieves the symptoms. It is
available without prescription, but fairly expensive, and works
only occasionally.
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A nipple shield may help, but use
this only if nothing else has helped and only if you have got
good help without any relief.
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As a last resort, rather than
switching to formula, give the baby your expressed milk by
bottle.
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Foreign Proteins in the mother's milk
It has been shown that some proteins present in the mother's diet may be
excreted into her milk and may affect the baby. It would seem that the
most common of these is cow's milk protein. Other proteins have also
been shown to be excreted into some mothers' milk. The fact that
these proteins and other substances appear in the mother's milk is not
necessarily a bad thing. Indeed, it is good. Ask about this if you
have any questions.
Thus, in the treatment of the colicky breastfed baby, one step would be
for the mother to stop taking dairy products. These includes milk,
cheese, yogurt, ice cream and anything else which may contain milk.
When the milk protein has been changed (denatured), as in cooking for
example, there should be no problem. Ask if you have any questions.
Please note: Intolerance to milk protein has nothing to do with
lactose intolerance. A mother who is herself lactose intolerant should
also still breastfeed her baby.
Suggested Method:
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The mother should eliminate all
milk products for 7-10 days.
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If there has been no change, the
mother can reintroduce milk products.
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If there has been a change for the
better, the mother should then slowly reintroduce milk products
into her diet, if these are normally part of her diet. (There is
no need to drink milk in order to make milk). Some babies
tolerate absolutely no milk products in the mother's diet. Most
tolerate some. The mother will learn what amount of dairy
products she can take without the baby reacting.
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If there is concern about your
calcium intake, calcium can be had without taking dairy
products. Ask if you have any questions. One week off milk
products will not cause any problems. Actually, evidence
suggests that breastfeeding may protect the woman against the
development of osteoporosis even if she does not take extra
calcium. And the baby will get all he needs.
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The mother should be careful about
eliminating too many things from her diet. Everyone will know
someone whose baby got better when the mother stopped broccoli,
beef, bananas, bread etc. The mother may find that she is eating
white rice only. Our diets are too complex to be sure exactly
what, if anything, is affecting the baby.
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Be
patient, the problem usually gets better no matter what. Formula is not the
answer, though, because of the more regular flow, some babies do improve on it.
But formula is not breastmilk. In fact, the baby would also improve on
breastmilk from the bottle because of the regularity of the flow. Even if
nothing works, time usually helps. The days and nights may seem eternal, but the
weeks will fly by.
About The Author: Dr. Jack Newman is a Toronto
pediatrician who has practiced medicine since 1970. In 1984 he established the
first hospital based breastfeeding clinic in Canada, at the Hospital for Sick
Children in Toronto. He now holds breastfeeding clinics in several Toronto area
hospitals. Jack has been a consultant with UNICEF's Baby Friendly Hospital
Initiative and has spoken at conferences around the world. He is the father of
three children, all breastfed.
Dr. Newman is the author of
"The Ultimate Breastfeeding Book of Answers"
NOTE: The article above titled "Colic
in the Breastfed Baby" was written by Dr. Jack Newman and is the opinion of its author. "The New Parents Guide" does not guarantee the information to
be factual. Always use the guidance of your personal
doctor or your child's doctor over information you read on this site or elsewhere; your doctors know what is
best for you and your baby.
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