Colic in the Breastfed Baby

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Via mybabyneedthis.com

Normal Crying & Fussing

‘High needs’ fussy babies respond well to lots of closeness and holding (for colicky babies, many times it seems like absolutely nothing can give the child peace). Normal babies cry and fuss a lot — because they’re wet, poopy, tired, hungry, thirsty, bored, scared, letting off steam, hot, cold, in pain, or just because they’re confused about why the sky is blue.

There are a few things you should know about what to expect with normal, healthy breastfed babies and crying:

Cluster Feeding

Yep, young babies do have ‘witching hours’ (also called the “arsenic hour”) and unfortunately, like some sick hocus pocus, these tend to peak in the evenings after the family has already logged a long, hard day of work and child-rearing.

Is your young baby in a constant state of irritability from supper to sleep time, and you’re literally stuck on the couch nursing seemingly non-stop for hours because each session blends into the next? Yet at all other hours your babe is more of a hoot and less of a howler? Hello, cluster feeding!

Many breastfed babies act this way especially during the first few months, often accompanying a physical growth spurt (this does NOT mean you don’t have enough milk; it just means your baby is priming the supply, so don’t let your confidence take a blow), preempting a long stretch of sleep (overnight), or simply because they’ve just about HAD IT with a day crammed full of strange and new stimuli.

Read more about it from Kelly Bonyata, IBCLC, Debbi Donovan, IBCLC, and this article at Lactivist.

The Fourth Trimester

Read about the Fourth Trimester and learn about exterogestation or “exterior gestation” – that is, your baby’s continued development outside the womb and why being closely held is a vital need. Neglect of this need can result in stress and failure to thrive emotionally and physically.

Wonder Weeks

You might find that learning about The Wonder Weeks is helpful for tracking your baby’s mental developmental leaps as most milestone trackers only pay attention to physical and behavioral changes. This knowledge may prepare you for especially fussy periods in advance. It’s not a one-size-fits-all resource like it claims, but if you can adjust to your own baby’s mental leap ‘routine’ then it can be a solid go-to for newbie parents who don’t know what the heck is going on otherwise.

(Oh my, did the baby get loose in NYC during fuss time again? —>)

So, what can you do to calm a crier after making sure all of his needs are fully met first?

  • Try singing or humming.
  • Offer something to suck, such as your nipple or a finger (try to avoid pacifiers to keep the human connection during colic episodes).
  • Swaddle with a muslin cloth, wrap carrier, or sling and keep her close. Babywearing or holding skin-to-skin is always best when possible.
  • Put a few drops of relaxing essential oils in her bath. Only if baby is past infant stage (3+ months) though!
  • Baby massage. Associate your touch with peace.
  • Try baby dancing! Learn how here.

Colicky Crying & Fussing

Infantile colic is defined as an otherwise perfectly healthy two-to-twelve week old baby crying for at least three hours per day for more than three days a week for three weeks.

The problem usually disappears on its own at three to four months but can last up to a year. Though it hasn’t been shown to cause long-term harm in babies, colic can create a lot of stress and anxiety in families and lead to postpartum depression, early cessation of breastfeeding, and bonding problems for mothers.

Everyone has a theory about why some babies are colicky, but in truth no one really knows. Stressful or complicated deliveries have been connected to colic. And there’s even the proposition by some theorists that colic is “an evolutionary strategy of deception,” a way for a baby who needs more attention to make sure he gets it.

“If every infant had these genes for colic, it would not work. But if it’s rare enough so that parents don’t know if they’re being honest or not, it works.” – Dr. Maestripieri, a University of Chicago primatologist

(Sorry Mom and Dad, perhaps my colicky baby-self was just manipulating you all those years ago!). Generally though, colic is believed to be associated with unattributed pain and discomfort.

To make sure the crying is true colic, the baby should be gaining weight normally and you must rule out other health conditions that would make the baby irritable such as thrush, ear infection, acid reflux, vitamin overdose, migraine, hair wrapped around a toe/finger/genitals, recent circumcision or other surgery, and really anything else you can think of.

Both formula-fed and breastfed babies can suffer from colic, but there are three possible causes of colic that are exclusive to a breastfed baby: only feeding on one breast per nursing session or always feeding from both, overactive letdown reflex, and foreign proteins in breast milk (though these are the same proteins that can cause irritation in formula, too).

Finding the Cause

  • It’s important to let the baby finish one breast before turning to the other. Read about foremilk/hindmilk imbalance here.
  • Read in this post about how an overactive letdown can result in an over-fussy baby.
  • Eliminate dairy (including whey and casein) from mom’s diet and avoid dairy-based formulas if supplementing. This is the most obvious and effective solution if the cause is foreign protein in the milk.
  • Ditch the bottles if you’ve been using them as they can result in gas build-up. If you must feed with bottles, at least avoid big, infrequent feedings. Slow down at mealtimes.
  • Could the colic be caused by an undiagnosed vitamin/mineral imbalance? Read more here.
  • If the colic is caused by Transient Lactase Deficiency (TLD), try adding lactase to expressed milk. Read more about TLD and colic here.
  • Was he recently circumcised? Many baby boys experience post-traumatic stress disorder (PTSD) following circumcision surgery. Mothers have reported that their babies regressed from “calm before the circumcision to inconsolable crying after the circumcision. These circumcisions were performed at least a week after birth, allowing the mothers to become familiar with their son’s temperament. The extended crying after the circumcision lasted for hours each day and persisted up to a year.” Learn more about infant responses to circumcision here.

Remedies if Baby’s Abdomen is Tense (via Dr. Sears)

  • Belly kneading!

“Sit baby on your lap and place the palm of your hand over baby’s navel, and let your fingers and thumb encircle baby’s abdomen. Let baby lean forward, pressing her tense abdomen against your warm hand. Dad’s bigger hands provide more coverage. Or, with baby lying on her back, picture an upside down ‘U’ over the surface of your baby’s abdomen and using warm massage oil on your hands and kneading baby’s abdomen in a circular motion with your flattened fingers, massage from left to right along the lines of the imaginary ‘U.'”

  • Warm bottle under belly!

“Place a rolled-up cloth diaper or a warm (not hot) water bottle enclosed in a cloth diaper under baby’s tummy. To further relax a tense tummy, lay baby stomach-down on a cushion with her legs dangling over the edge while rubbing her back. Turn her head to the side so her breathing isn’t obstructed.”

  • Rolling on a beach/birth ball!

“While laying a securing hand on baby’s back, drape him tummy-down over a large beach ball and gently roll in a circular motion. Another use for a large beach ball (you can purchase “physio balls” from infant-product catalogs) is the baby bounce. Hold baby securely in your arms and slowly bounce up and down while sitting on the ball.”

  • The gas pump/pedal!

“Lay baby face-up on your lap with her legs toward you and her head resting on your knees. Pump her legs up and down in a bicycling motion while making a few attention-getting facial expressions.” A similar alternative: “Place baby’s head and back against your chest and encircle your arms under his bottom, then curl your arms up. Or, try reversing this position by placing baby’s feet against your chest as you hold him. This way you can maintain eye contact with your baby and entertain him with funny facial expressions.”

Tricks That May (or May Not) Work For You

  • Research gripe water, Colic Calm, or Hyland’s Baby Colic Tablets (over-the-counter) to see if these remedies would be suitable for your child.
  • Mirror trick! Dr. Sears says to try this: “Hold a colicky baby in front of a mirror and let him witness his own drama. Place his hand or bare foot against his image on the mirror surface and watch the intrigued baby grow silent.”

“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 and breastfeeding is much more than 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.”

  • Are probiotics a cure for colic? Dr. Laura at Aha! Parenting describes a study reported in the January 2007 issue of Pediatrics:

    “[The study] cured 95% of the colicky babies by giving them probiotics AND eliminating cow’s milk.  They gave colicky babies who were breastfeeding 5 drops daily of beneficial gut bacteria (the probiotic L. reuteri).  All the moms were asked to eliminate cows milk from their diet.  95% of the probiotic babies improved, as opposed to only 7 percent of the control babies, with crying improving somewhat in the first week and dramatically within a month.  If this study is repeated with the same results by other researchers, probiotics will soon be prescribed as the cure for colic.”

  • Try the “colic carry” hold: Position your baby along your arm, face-down with her cheek at your elbow. Her spine should lay against you with her knees pulled in toward her belly. You can also try laying your baby across your knees for a similar effect (some babies tolerate this position better than arm-carry with dads). Now, this won’t work well she is hungry. Face-down on an arm with a view of the carpet doesn’t sound too delicious, does it? Alternatively, if a restless, colicky baby is not hungry, the traditional cradle hold may be too stressful as it symbolizes a “Let’s settle down and eat” scenario.

Resources

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