Colic in the Breastfed Baby

I always thought that breastfed babies were the happiest babies on the block. What is there to be upset about? The books say it’s the “perfect food” at the “perfect temperature”, always ready and loaded. Why then is my breastfed baby so darn miserable???

Colic in the Breastfed Baby

Ah, colic one of the great mysteries of babies. Ask 10 people and get 10 answers on what it is and how to fix it. Medically speaking it is defined by the rule of “threes”, it starts about 3 weeks after birth, occurs more than 3 times a week and the baby cries for 3 or more hours a day. In order to apply the label of “colic” to a baby, he must be gaining weight well and otherwise be healthy.

There is no treatment for colic, although there are many “remedies” out there. Some work - at least for a short time - but ultimately time seems to heal most babies with colic.

How can colic be different in a breastfeeding baby? Well, it might actually have a cause and thus a solution!

There are three known situations that might result in an overly fussy or colicky baby:

TOO MUCH LACTOSE (MILK SUGAR)

Human breast milk changes in many ways over the course of a full feeding. One of the ways is the amount of fat increases as the baby drinks more from the breast. IF MOM SWITCHES FREQUENTLY FROM BREAST TO BREAST, the baby might get a lot of the “foremilk” that is high in lactose or milk sugars and not a whole lot of the “hindmilk” that is more full of fat. Remember that fat has more calories and is more filling. A baby getting a lot of the high lactose milk will need to eat more volume of milk to get the same calories. This can cause a tummy ache, spitting up, being hungry faster and worst of all a large load of milk sugar arrives in the intestines all at once. The baby’s protein that digests the sugars (lactase) might not be able to handle all the sugars at once and the baby will have symptoms resembling “lactose intolerance” - crying, gas, explosive, watery, green bowel movements. BABY IS NOT LACTOSE INTOLERANT - its just there isn’t enough protein to digest all that high lactose milk. This is not a reason to switch to lactose free formula. But the solution is less lactose...

WHAT CAN YOU DO ABOUT IT?

1. Do not time feedings. Breastfeeding problems are greatest in societies where everyone has a watch and least where no one has a watch! Let baby “finish” - the clock doesn’t help you.
2. Feed on one breast. Baby should feed on one breast for as long as it takes to finish as long as baby is actually getting milk from the breast. Baby should come off himself or fall asleep at the breast. Sometimes babies slow down when the flow slows, use compressions to keep baby going. (see Video part 1 and part 2) The compressions help the baby get to the higher fat milk. If you think the baby is “finished” on one side and still hungry then offer the other side. This is not an absolute, do not prevent two sided feeding, just encourage an emptying of side one before offering side two. The next feeding should start on the other breast and continue in the same way. 

OVERACTIVE LETDOWN REFLEX

If a baby gets milk too quickly she may become very fussy, very irritable at the breast and sometimes moms think they don’t “like the breast” or are colicky. These babies usually are gaining weight very quickly. These babies often start to nurse and after a few seconds to minutes start to cough, choke or struggle at the breast. The can come on and off and you might even see mom’s milk spray. The baby keeps trying to return to the breast to eat only to repeat the whole process. Even worse when the flow slows done they get inpatient with the now slow flow. This isn’t a fun time for anyone. Some babies might even start to refuse the breast after taking it this way for several weeks.

WHAT CAN YOU DO ABOUT IT?

1. Feed on one breast. If you have not already done so, try feeding the baby on one breast per feed. Sometimes, you even have to feed two or three feedings on one breast before changing to the other at the next feed. In order to slow down production and increase the fat in the breast milk, allow the other breast to remain as full as you can. If you feel uncomfortable or engorged, express enough to feel comfortable again. Do not drain the breast!
2. Feed baby when calm, in calm atmosphere. Don’t wait for baby to be ravenous. A overly hungry baby will attack the breast and cause a very active letdown reflex in some moms. If baby is half asleep it might go easier. Try to feed baby in a calm and relaxed atmosphere that is conducive to a good feeding.
3. Lie down to nurse. Lying sideways to feed sometimes works very well to slow the flow down. If it doesn’t 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.
4. Express some milk. Express about an ounce or so before you feed the baby to slow things down. Do not try this before the above suggestions as it might compound the problem by increasing your supply even more.
5. Use Compressions. If baby fusses again when the flow slows, use compressions to increase the flow again. See Dr. Newman’s videos: part 1 and part 2
6. Use a nipple shield - but not without seeing a lactation consultant first. A nipple shield can be a godsend or can destroy a fragile milk supply.
7. Get Help! A good latch is the key to easy breastfeeding. If your baby isn’t well latched, get help.
8. Give Expressed Breast Milk in a Bottle. Sometimes pumping out the milk and giving in a bottle will slow your production enough to allow for better feeds after a few days. Do this as a last resort rather than switching to formula and only after speaking with a lactation consultant!

FOREIGN PROTEINS IN THE MOTHER’S MILK

Everything you eat appears at least in parts in your milk. This is actually a great thing. By the time your baby is ready to eat her first “table foods” she has been exposed to all kinds of flavors and tastes. Also, these small exposures might actually act as a way of desensitizing your baby to food proteins and thus decreasing the incidence of food allergies in breast fed babies. Sometimes however the proteins present in the mother’s diet may affect the baby in adverse ways. The most common culprit is the cow’s milk protein, although there are other documented intolerances. NOTE: Milk protein intolerance is not lactose intolerance (lactose is a sugar, not a protein). A mother who is lactose intolerant herself can and should still breast feed her baby.

WHAT CAN YOU DO ABOUT IT?

1. Change you diet, one food at a time. The first dietary change is to take dairy out of the mother’s diet. Dairy products include milk, cheese, yogurt, ice cream and butter and anything with whey or casein. Check here for a list of foods that are ok and the different foods that contain cow’s milk proteins. This is a great diet for losing those extra pounds as well as a very healthy way to eat.
2. Elimination Diets. If dairy doesn’t do it, there are complete elimination diets to be found on the web that can be tried. 
3. Take Pancreatic Enzymes. Some have found that if mom takes a pancreatic enzyme, 1 capsule at each meal this will break down proteins in her intestines and they will not appear in the milk. You will need to see Dr. Moore or your internist/obstetrician if you want to go this route.

Thanks to Dr. Jack Newman and his Handout #2: Colic in the Breastfed Baby on which this entry is based on.