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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.
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.
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