|
Online Guide to Breastfeeding
"Colic in the Breastfed Baby"
By Jack Newman, MD, FRCPC
Colic in the Breastfed Baby
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 proved 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
which 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 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.
- 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 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 (see 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.
- 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 (compress milk into his mouth
if necessary to keep him swallowing 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 proper 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.
What can be done?
- 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.
- 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.
- 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.
- 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.
- If you have time, express some milk (an ounce or so) before you feed the baby.
- 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 (see 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 gotten
good help without any relief.
- 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. 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 should be considered a good thing. 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:
- 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 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.
- 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.
- 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, 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.
| Previous | Next |
Reprinted with permission. The information contained on these pages is provided as a courtesy to My ParenTime's visitors. My ParenTime makes no representations or guarantees concerning the effectiveness of such information. In no event shall My ParenTime be held liable for any failure of such safety information.
|