Updated: Jun 30, 2020
I'm sure as a new parent you have heard someone say to you that they think your baby has Colic due to periods of intense crying and you not being able to calm your baby. As a new parent you have most likely felt inadequate in being able to calm your baby and possibly even blame yourself for your baby's Colicky episodes but you couldn't be further from the truth. Your inexperience and your tension around baby at this time, is not causing your baby's pain and you are quite rightly allowed to feel distressed for you baby's discomfort. Take a breathe and read on to further understand from your baby's perspective what's going on here. What is Colic really, what does current evidence say & what practically can you do to support your baby?
Spoiler - "There is no magic treatment for all symptoms for all babies" - but lets better understand Colic first and then discuss some practical strategies that you can try with your baby, that are backed by current evidence. Not old opinions.
Stay with me....
Infantile colic was first described in 1954 by Dr Wessel, who defined colic as extreme crying for at least 3hrs per day, on at least 3 days a week, for 3 weeks. OK, well that's great that we know who discovered it and what the definition is but this discovery came with no understanding of the possible location of the pain or place of stress for the baby. In a more recent definition, ROME III criteria which is based of gastro-intestinal conditions, says that that infantile colic is the "spasmodic contraction of the smooth muscles of the intestine". We as parents have known this is the possible location for our baby's pain but what else impacts on the intestines and contributes to this crying/unsettled behaviour?
Colic or Colicky Behaviour is a symptom not a diagnosis of a condition. To manage Colic is to first understand the cause of the symptom. When I talk to parents about "colicky behaviour" they explain intense and unexplained crying, reddened faced baby, baby's knees pulled up, baby back arching and fists clinched. No amount of picking up, rocking, shushing, patting and/or feeding, feels like it does anything to reduce the crying and ultimately for baby to settle to sleep. Sound familiar? Research indicates that around 30% of all infants from 2wks up to 3-4mths of age have colicky behaviour episodes, more often in the later part of the day/evening and are more common in households where there is a smoke and/or the baby is formula fed but less common in exclusively breastfed babies (this leads me to think that for a BF baby the symptom is less likely to be directly intestinal - more on that later). So what are some of the causes of Colic that research has highlighted?
Causes - I will cover most of these as briefly as I can. But you can contact me at anytime for further support with Colic.
Overfeeding via Bottle
Heightened Stress Response Or/&
Lactose Overload - or combination of some or many of these.
Trapped Gas: As humans we all have trapped gas from time to time and it's the same for babies. The majority of babies can take care of bringing up their own wind in the form of burps without much input form us ie change of position to caregivers shoulder from feeding position. If the trapped gas appears to be further down in the baby's intestines or into the tummy area, than this can be harder to help release. Getting baby to be calm and more relaxed will be the first practical thing you can do to support baby with this. See practical tips below.
Please don't spend more than 5 mins burping your baby especially in the night as this will further disrupt sleep. Try it - feed and let your baby go back to sleep when they fall asleep after a feed and see if it makes any difference to how the baby settles/sleeps compared to you usual burping routine.
Practical Tip: Burping
There is a burp position that anatomically (how the stomach is structured) supports the release of air if any, with ease. If there is any air bubbles they will be at the top of the baby's stomach and with a slight tilt of baby to the left, the trapped bubbles will easily rise out of stomach with gravity. No need to back pat even.
1. Place baby up on your right shoulder, with the baby's bottom placed over the centre of your chest
2. Baby slightly tilted down to their left side and slightly forward.
3. You may or may not hear any burps. So don't linger here any longer than you need too.
Practical Tip: Tummy Massage
As an IAIM Certified Baby Massage Instructor, I teach families how to perform Colic Strokes on their babies with positive and calming researched outcomes in relation to reducing the effects of Colicky behaviours for babies.
1. Place a warm hand or hands on baby's tummy and sometimes this is all they need is a little firm pressure in this area like if they were lying on their tummy.
2. If you are going to rub their tummy I would always go in a clockwise direction as this follows the natural direction of the bowel. This motion can help move the trapped gas along as well as any poops that need to be passed.
3. You could try these massages after a warm bath as well.
4. Try the along the arm hold too. This places a little pressure on the tummy to provide relief to baby.
Practical Tip: Check your baby's latch at either the breast and/or the bottle
The first thing I would ask is where is the air getting into the stomach and at what times? As your baby grows, their latch can change, so check that there is not clicking, slurping and/or smacking noises when baby is feeding. Same for the bottle and check that you have the right flow teat for your baby's age.
Practical Tip: Colic Medicines
Avoid if you can. There is no backing from research that these actually work other than the plasebo effect it has on us, in that it makes us feel like we are practically doing something to help. Also many of the potions ie "Gripe Water" have Sodium Bicarb in them and when that hits the stomach acid, it actually creates more air bubbles. Also by adding something foreign into an already immature gut, will only add another thing your baby's system needs to process.
Overfeeding: Via bottle
You cannot overfeed a Breastfed baby. Anyone who tells you that you can or suggests spacing out your breastfeeds, doesn't have the specialist knowledge in the area of Lactation and is passing on incorrect information. Please seek out your local LeLache League Leaders and/or an IBCLC or Lactation Consultant in your area for specialist support.
When we feed a baby a bottle (and sometimes even if we offer expressed breast milk) we tend to follow the guidelines of volume on the formula tin ie 100ml for a baby who is 6wks 2-4th hrly but at the breast a baby of this age may only need and take 60-80ml in a feed maybe every 1-3hrly. So the bottle fed baby's stomach over time will slightly stretch to take more of the volume offered. And lets face it if there is only 20ml left in the bottle we find a way to offer that last 20ml. But that there can be the cause of tummy pain and colic behaviours.
Practical Tip: Paced Bottle Feeding
Please watch this demonstration from Possums Education on Paced Bottle Feeding
Microbial Dysbiosis: This is purely put as your baby's gut bacteria is in disarray, together with an immature gut system in the first place. Our baby's gut is very immature and digestion will always/most likely cause issues for baby in the first 12wks of life. Breastfeeding is the best practical tip in this incidence and no or reducing any formula intake. Breastmilk is designed to feed the bacteria in the baby's stomach, support the strength of the gut lining and aid in gentle digestion.
Practical Tip: Probiotics
The research is just not there yet in regards to the use of probiotics for babies. The mother can take a probiotic by all means. Only time there could be a place for probiotics given to babies is when that baby has spent time in the NICU special care nursery. Please seek further advice from your healthcare professional.
My thoughts are, why would you add further bacteria to your baby's gut when:
1. You don't know what the number or types of "good bacteria" that there are already colonising your baby's gut and by you adding more of the same or different bacteria in to the mix, is this going to upset the natural state if things.
2. You can't be sure even if your baby's gut bacteria is the issue here with the colic episodes, so this is too big of a gamble to take. You could make things worse and/or create a new problem.
3. Not enough research yet to make a safe clinical decision.
Allergy: Gas is caused by allergy by fermentation in the gut from the bacteria and irritation of gut wall from damage caused by proteins in the milk breast or formula. Cows milk protein tends to be the main culprit here either in the formula or in the mothers diet. In the breastfed baby, its important to look further into both parents, grandparents and siblings food history as well, as it maybe a genetic throwback to something else in the mothers diet that is triggering the allergy response in the baby ie the father doesn't like berries and it makes his mouth feel funny when he eats them. Remove berries from mums diet and this could solve the issue. Potential triggers for allergies are soy, eggs, dairy proteins, wheat, fish and peanuts.
Lactose Overload: This occurs when the baby's gut ferments the lactose in the milk either breastmilk or formula and the result is a green looking poo, gas build up and colicky behaviours. The green poo usually clears in a few hours and returns to the mustard colour, if your breastfeeding, fairly quickly. This intolerance tends to be short lived for most babies.
Practical Tip: Breast Emptying
Sometimes if you have a really good supply, we can switch to the other boob too soon without the full feed being drained. As the feed goes on the fat content in the breastmilk increases and this settles the fermentation in the gut. So during times of possible lactose overload remember to return the baby to the same breast to complete that full feed but also be mindful of your supply in the other breast ie we don't want any blocked ducts from reduction in a feed from that breast.
There is some research that suggests that one of the causes can be from overstimulation of the babies immature nervous system or a "pain in their brain". It seems that these babies have difficulty tuning out stimulation and/or find it difficult to move between states ie being alert to sleeping and get stuck in crying loops. This reduces as the immature nervous system matures at around 3-6mths. So in the meantime its our job to "dial our babies nervous system down" to allow for transition out of the crying loop. How do I do that you ask??
Practical Tip: Respond & Retreat
1. Always respond to your crying baby as this builds up emotional confidence that someone will come and protect them. Leaving babies to cry induces uncertainty and lowers the baby's confidence about their overall safety with their caregiver. By responding appropriately to our signalling/crying baby, this builds independence quicker and emotionally safer over the coming months, than leaving baby to cry to "self settle" which many people believe teaches a baby to be more independent of their caregiver.
2. Retreat to a darkened quiet space with your baby to reset the nervous system or the brain pain. Snuggle your baby close on a bare chest ie skin to skin so they can feel and hear your heartbeat.
3. Offer the breast if your are breastfeeding or a clean finger or dummy (only if you know they have fed well previously) to suckle on to induce the calming reflex.
4. Over the next 24hrs reduce stimulation for your baby ie darkened room, no TV or phone, snuggling your baby as much as possible. Contact napping is ideal here after you have completed a Safe Co-sleeping assessment. Also take turns with the other caregiver in the home too.
5. In the days following hold your baby as much as possible or baby wear is a great option as well as swaddling baby. Reduce others outside your immediate family holding baby and keep the house calm.
6. Prepare ahead those "witching hours or colicky times" in your day by planning dinner earlier in the day, get a routine ready for calming strategies for baby ie warm bath, baby massage or get your retreat quiet room ready to escape to.
7. Be kind to yourself when you and your baby are having a particularly "bad" night or episode. Use your breathe to calm yourself and your baby and remember baby is looking to you to learn calm.
I hope that you can find something within this blog or many techniques you can try and I do hope that you now have a better understanding what Colic actually is. It's really important to try to see this from the baby's perspective and know that Colic behaviours is nothing to do with the way you are caring for your baby.