05 Apr Does my baby have colic?
It’s 6.30pm. The evening is looming and so is the sense of foreboding that, contrary to what some of the (not so useful) books say should be happening, your baby will almost certainly not be going down for a peaceful long sleep any time soon. They have a cry that is so intense it seems that the windows might crack. But the glass is the last of your worries…. you feel helpless and heartbroken. Your beautiful baby is inconsolably writhing about, fists clenched and face puce. It has been happening on most days, if not every day, for weeks and possibly months. These babies are not just fussing or deliberately doing it for attention and the chances are that your intuition is rights and your baby is telling you that something is wrong.
Professionals, family, friends and the well-meaning-yet-potentially-irritating-random-on-the-street, may tell you that your baby has ‘colic’. The chances are that the bathroom cabinet is bursting with a whole host of remedies claiming to sort it out, you’ve tried all the soothing tricks of the trade and yet still it continues. You’re almost ready to accept the status quo that you just need to ride it out and do your best in the meantime to keep it together.
But here’s the good news – you CAN OFTEN DO MORE about it.
If a verbal older child can say that they are in pain then everyone would do their best to figure out the underlying cause of the issue and get it sorted. So it only makes sense that babies are approached with the same fortitude.
So, what actually is colic?
Firstly, let’s make it clear that we are not talking about ‘fussy’ babies. So-called ‘fussing’ can be differentiated from colic because although these babies may cry and often need to be rocked, carried, cuddled and feed-sleep-feed in short bursts (known as cluster feeding), they are ultimately and more often than not, able to be soothed, are not in pain and are in fact displaying common and expected patterns of infant behaviour.
Colic, on the other hand, is a descriptive term referring to intense and frequent bouts of inconsolable crying and originates from the Greek ‘kolikos’ which refers to pain or disturbance in the colon. To figure out whether your baby is colicky, try out the following “Rule of Threes”. Did/do the episodes of crying:
- Start within the first three weeks of life?
- Last at least three hours a day?
- Happen at least three times a week?
- Carry on for at least three weeks?
- May have resolved by three months of age?
If the answer is ‘Yes’ to most, if not all, of these questions then you can safely say that you are in or have been in the realm of colic.
What could be causing it?
Figuring out what is causing a baby to cry in this way takes a bit of detective work and sometimes the root cause may not ever become entirely clear. This is not an exhaustive list but here are some of the top things to consider, particularly if the crying is intensifying over time and not appearing to subside by 3 months, in an otherwise healthy and thriving baby.
Built up wind
Any baby can get trapped wind and don’t let anyone fool you into thinking that a breastfed baby doesn’t need winding. Even if feeding is going beautifully, a baby can still get air bubbles trapped in their system. However, anytime a baby fusses, cries and/or doesn’t have a great latch then there’s increased likelihood of that pesky air getting in. Wind, wind and wind some more throughout the day to always make sure that nothing is building up.
Unresolved Birth Trauma
Whether babies are born vaginally or via caesarean section, many (if not all, to some degree) have lasting physical effects which can seriously disrupt their temperament and ability to relax, feed and sleep. A visit to a cranial osteopath or chiropractor who specialises in babies can be a very worthy investment.
Temporary (or Secondary) Lactose Intolerance
This may be caused by prematurity, a period of diarrhoea and/or vomiting, certain medications or simply an immature digestive system. Lactase (the enzyme) is required to breakdown the Lactose (sugar) found in both breastmilk and formula. If a baby struggles to do this effectively the undigested lactose will ferment in the gut and cause pain. NOTE: this can be confused with congenital lactase deficiency (or primary Lactose Intolerance from birth) which is extremely rare in babies and can be a medical emergency and life threatening if not diagnosed promptly.
This is very different to an intolerance to lactose (which is often over-diagnosed) but will produce similar symptoms. With lactose overload there is a normal level of lactase in the system but due to factors regarding the management of either breast and/or bottle feeding, a baby can end up with too much lactose in the system for the baby to be able to digest comfortably. For example, a breastfed baby who has a poor latch may struggle to take a full feed from one breast – the subsequent lower intake of fat, will then both speed up the passage of milk through the gut (not allowing time for the lactose to be digested) and also result in the baby being hungrier sooner and thus taking in more lactose, perpetuating the cycle of pain in the gut and green, frothy and explosive stools. For formula-fed babies it is possible to give them too much milk owing to the sucking reflex of the newborn and a fast flow of milk from the teat, leading to the same problems.
Hypersensitivity to Stimuli
One theory for colic is that some babies are hypersensitive to normal stimuli. In other words, these babies react more acutely (i.e. crying, arching back etc) to changes in their body such as hunger and wind, or in their external environment, such as loud noises, lots of movement and so on. Most babies will experience this to a degree whilst they are adapting to life outside the womb, but for some babies their reactions are more pronounced and require understanding and careful management. This can also be linked to my point re birth trauma.
There is little evidence to support the belief that gassy or spicy foods, when eaten in moderation by the mother, cause problems to most breastfed babies. However, there can always be exceptions to the rule! If a food is suspected of causing a problem, it can be eliminated from the mother’s diet for a minimum of 2 weeks and then if symptoms have subsided and reappear when the food is re-introduced, it is probably best to avoid it for the time being. A major food group for which there is clear evidence in causing problems (particularly if there is a strong family history) is dairy. These babies may be intolerant (or possibly allergic) to the cow’s milk protein (see below) consumed in the maternal diet.
NOTE: a food sensitivity/intolerance does not mean babies are allergic to the breast milk! They are simply reacting to components of the maternal diet that have found their way into her milk. It is always best to seek professional advice before considering eliminating a major food group from your diet such as dairy.
Gastro-oesophageal Reflux (GOR)
About one third of babies have some degree of reflux, where stomach acids can be regurgitated into the oesophagus causing pain. The baby may or may not vomit (known as ‘silent reflux’) and cry particularly intensely after feeds. For many babies this can be conservatively managed through a variety of strategies without medication, however, where reflux is a possibility it is important to seek professional advice. One possible cause of reflux of which health professionals are increasingly becoming more aware, is cow’s milk protein intolerance, as discussed below.
Cow’s milk protein Intolerance (CMPI) and Cow’s milk protein Allergy (CMPA)
Not to be confused with lactose intolerance, CMPI and, less often, CMPA cause bloated tummies, gas and subsequent pain and crying in affected babies. Both CMPI and CMPA can also result in diarrhoea, vomiting and possible eczema. The difference between the two is that the cow’s milk protein triggers an immunological response in CMPA producing immediate allergic symptoms, after exposure to cow’s-milk-based formula (and breast milk where the mother has ingested dairy produce). These may include wheezing, itchy rash, runny noses and coughs and possible anaphylaxis. These allergic signs are not seen in CMPI, where the body is simply having a tough time digesting the protein.
So, the most important bit of all…….what can you do!?
ONE…… always remember that this is NOT your fault and if you can, get help at home and hugs whenever possible
TWO….. be persistent with your health professional to help you get to the root of the issue. Taking in a diary of all the crying episodes over a period of at least one week will help them see how big a deal this is for you and your baby. Better still take in a video…..it is always typical that when you are trying to convey the pain your child is in, they are on your lap smiling and cooing!
THREE….. try one thing at a time. It is very difficult to isolate the cause of the issue if you go in all guns blazing with every trick. There is no point trying lactase drops , elimination diets and/or changing their milk (if they receive any formula and CMPI or CMPA is suspected) all at once.
FOUR…. keep going with all your calming techniques. One of these days one or two of them may just fall into place and start to help.
Vanessa Christie (MSc, MN, IBCLC, RHV, RNC, CIMI) is one of the UK’s leading Lactation Consultants and Early Parenting Experts. She is a speaker for The Baby Show and regularly writes for parenting magazines and blogs. To book an online consultation with Vanessa please visit her website.