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Colic in the Breastfed Baby
Handout #2 Colic in the breastfed baby. Revised
January 2005
Written by Jack Newman MD, FRCPC. © 2005
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.
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.
- 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.
- The mother should feed the baby on one breast, as long as the
baby actually gets milk from the breast (see videos at
www.thebirthden.com/Newman.html)
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.
- The next feeding, the mother should start the baby on the other
breast in the same way.
- The mother's body will adjust quickly to the new method, and
she will not become engorged or lop sided.
- 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.
- 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.
- 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.
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.
- 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.
- 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.
- Feed the baby in a calm, relaxed atmosphere, if possible. Loud
music, bright lights are not conducive to a good feeding.
- 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.
- If you have time, express some milk (an ounce or so) before
you feed the baby. Not the first thing to try.
- 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).
- 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.
- 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.
- 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.
- As a last resort, rather than switching to formula, give the
baby your expressed milk by bottle.
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:
- The mother should eliminate all milk products for 7-10 days.
- If there has been no change, the mother can reintroduce milk
products.
- 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.
For videos showing how to latch a
baby on, how to know a baby is getting milk, how to use compression,
go to www.thebirthden.com/Newman.html
Questions?
see
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
