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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 three 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 behaviour 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.
1.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
drains more milk from 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, explosive, watery, green 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.
a.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.
b.The
mother should feed the baby on one breast,
as long as the baby actually gets milk
from the breast (see videos)
until the baby comes off himself, or is
asleep at the breast. If the baby feeds
for a short time only, the mother can
compress the breast (handout #15 Breast
Compression) to keep the baby feeding,
not just sucking. 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. Do not prevent the
baby from taking the other side if he
is still hungry.
c.The next feeding, the
mother should start the baby on the other
breast in the same way.
d.The mother's body will
adjust quickly to the new method, and
she will not become engorged or lop sided.
e.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 (use
compression to keep him feeding longer)
but if he wants more, then offer the other
side.
f.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.
g.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.
2.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.
a.If you have not already
done so, try feeding the baby one breast
per 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.
b.Feed the baby before
he is ravenous. Do not hold off the feeding
by giving water (a breastfed baby does
not need water even in very hot weather)
or a pacifier. A ravenous baby will “attack”
the breast and may 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.
c.Feed the baby in a
calm, relaxed atmosphere, if possible.
Loud music, bright lights are not conducive
to a good feeding.
d.Lying down to nurse
sometimes works very well. If lying sideways
to feed does not help, try lying flat,
or almost flat, on your back with the
baby lying on top of you to nurse. Gravity
helps decrease the flow rate.
e.If you have time, express
some milk (an ounce or so) before you
feed the baby. Not the first thing to
try.
f.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 (handout #15
Breast
Compression).
g.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.
h.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.
i.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. This is a second
last resort.
j.As a last resort, rather
than switching to formula, give the baby
your expressed milk by bottle.
3.Foreign proteins in
the mother's milk
Sometimes, proteins present in the mother's
diet may appear in her milk and may affect
the baby. 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 usually a bad thing. Indeed, it is usually
good, helping to desensitize your baby to
these proteins. 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 or other foods, but only one type
of food at a time. Dairy products include
milk, cheese, yoghurt, ice cream and anything
else that 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.
If eliminating certain
foods from the mother’s diet does not
work, the mother can take pancreatic enzymes,
starting with 1 capsule at each meal, to
break down proteins in her intestines so
that they cannot be absorbed into her body
and appear in the milk.
Please note: Intolerance
to milk protein has nothing to do with lactose
intolerance, a completely different issue.
Also, a mother who is lactose intolerant
herself should also still breastfeed her
baby.
Suggested method:
a.The mother should eliminate
all milk products for 7-10 days.
b.If there has been no
change, the mother can reintroduce milk
products.
c.If there has been a
change for the better, the mother can
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.
d.If there is concern
about your calcium intake, calcium can
be obtained without taking dairy products.
But, 7-10 days off milk products will
not cause any nutritional problems. Actually,
evidence suggests that breastfeeding may
protect the woman against the development
of osteoporosis even if she does not take
extra calcium. The baby will get all he
needs.
e.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.
Be patient, the problem
usually gets better no matter what. Formula
is not the answer, but, 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.
See
our videos
showing how to latch a baby on, how to know
a baby is getting milk, how to use compression.
Questions? (416) 813-5757
(option 3) or drjacknewman@sympatico.ca
or my book Dr. Jack Newman’s Guide
to Breastfeeding (called The Ultimate Breastfeeding
Book of Answers in the USA)
Handout #2 Colic in the
Breastfed Baby. Revised January 2005
Written by Jack Newman MD, FRCPC. ©
2005
This handout may be
copied and distributed without further permission,
on the condition that it is not used in
any context in which the WHO code on the
marketing of breastmilk substitutes is violated
1. Breastfeeding:
Starting out right
a) The
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
b) Treatments
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
b) You
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
myths
14. More and more breastfeeding
myths
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
b) Domperidone
2
20. Fluconazole
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
mastitis
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
latch on
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Candida protocol
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
When latching
Protocols for Induced Lactation
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