According to most health professionals, about 20% of babies develop colic. There is a generally accepted rule of three – if your baby cries inconsolably for more than three hours a day, more than three days per week and is aged between three weeks and three months, he may be diagnosed with colic.
A classic case of colic is where the baby pulls his knees up, clenches his fists, closes his eyes tightly or opens them wide. They may even hold their breath for a short time. Bowel activity increases, and your baby may pass “wind”.
However, colic is a term that is used widely by people who do not have another reason for baby’s distress. In our experience, there is more likely to be a cause for little one’s distress rather than it being a case of true colic. Therefore, it’s always wise to look at other digestive issues that can affect baby before deciding it is colic.
Over the years we have noticed that when a baby presents with colic-type symptoms, and we have ruled out other digestive issues, the most likely cause is a gut immaturity or imbalance.
Many of the bacteria in a newborn baby’s gut come from Mum. The type of delivery is important in determining how populated the baby’s gut will be with good bacteria. A vaginal birth exposes the baby to the mother’s vaginal microflora and allows the baby’s gut to be well populated by good bacteria. A baby delivered by C-section is delivered into a sterile environment. This can therefore negatively affect the level of good bacteria in the gut. This small difference, different types of delivery, has been shown to have an influence on the development of a healthy immune system.
We must also factor in gut maturity. It’s worth remembering that anything from 38 weeks to 42 weeks of pregnancy is considered to be full-term. That’s a four week difference between two full-term babies and a four week difference in gut maturity.
The next thing that influences the gut health is how a baby is fed. In the first year of life, 30% of breastfed babies’ gut bacteria comes from breast milk and a further 10% from the Mum’s breast. This is another reason why support for breast feeding mothers is so valuable, particularly following a C-section. Many of the formula companies have now included prebiotics to their infant formulas to try to address this imbalance. If a baby has antibiotics at any stage this too will negatively influence the gut health.
We see babies who have issues with their gut health or their gut development at our clinic every week. They present with typical colic-type symptoms, grunting and straining with lower gas and can be generally unsettled. The main aim of our treatment is to give their gut a little help.
Firstly, we suggest an infant probiotic. This should be used daily for six weeks. The probiotic we generally recommend is Proven. It has both breastfed and bottle-fed products and its breastfed version is dairy free. However, any good pharmacy will have an infant probiotic. Speak to the pharmacist for advice regarding which one is best for your baby.
The second thing we suggest is lactase drops. These are an artificial form of the enzyme that is produced in the small intestine to break down milk sugar. This enzyme is produced at a slow and steady rate in the gut. Many babies can struggle towards the end of the day when the demand for this enzyme is high and this results in some milk sugar left undigested in the gut. Bacteria work on this free sugar and one of the byproducts is gas. This gas can cause pain and distress for your little one as they wriggle and strain to release it. Did you know that 95% of digestion occurs in the small intestine? That is why a healthy gut is so important in babies.
The combination of probiotics and lactase drops has been very successful in babies with colic over the years. This magic duo has helped many babies go from a distressed crying baby to a happy smiling one.
Some bottle-fed babies can take in too much air when feeding and this can cause distress. Every baby is different and what suits one baby will not necessarily suit another. However, if you feel your little one is taking in air with the feed, is gulping or does not have a good latch on the teat of the bottle, then a change of bottle and teat type would be recommended. We recommend MAM bottles for these babies. The surface area of the teat is much larger, and this increases the contact baby has with the teat. The better the contact, the lower the risk of taking in air.
There are specific formulas on the market for babies with colic. These comfort formulas contain partially broken-down milk proteins and a reduced amount of lactose milk sugar. This makes these formulas more digestible and takes the pressure off a busy overloaded gut.
Premature babies seem to be more likely to have immature gastrointestinal systems. We see these babies in our clinic after they are discharged from hospital and on regular formulas. In our experience, a change to an organic formula, in addition to some of the other treatment options, brings about a significant change.
Another theory is that colic may be as a result of nervous system over-stimulation. We hear from parents so often about how colic seems to start in the early evening. They tell us that the more they try to soothe their baby, the more distressed baby can become. We have often advised these parents about cutting down on external stimuli and have suggested a little siesta for baby just before the early evening upset. The feedback has been very positive with parents reporting that baby was better able to cope with the evening period by giving baby a little time to rest their brain and nervous system. Again, all babies are different and they respond to different things, but this may be worth a try.
Breastfeeding mothers should avoid spicy or heavy foods. Dairy products, broccoli, cabbage, beans and coffee may also need to be avoided.
Colicky babies, for some reason, like their tummies supported. When sitting down, place your infant along your forearm, face down, cradling the head in one hand. This tiger in the tree technique takes practice to perfect.
Slings are invaluable when your baby is crying inconsolably. Just being nestled against your warm chest is comforting, as is your heartbeat.
Place your baby in a mechanical baby swing as the continual and steady back-and-forth motion has calmed many distressed babies.
Get a white or a pink noise app or toy. The sound is like a lullaby to the ears of some colicky infants. Sometimes, colicky babies respond to the sound of a tumble drier, one of ours loved it. Any white or pink noise may work!
Cut down external stimuli. Sometimes, the more you try to calm a colicky baby, the more he seems to cry. This might be because the baby’s nervous system is too immature to handle any noise. Just hold her in your arms and avoid making any noises or eye contact, which is a form of stimulation.
Do not pat your baby’s back when burping her as this can irritate an already-inflamed area. Gently rub in circular motions on the left side of the back or rub upwards with baby’s arm straight over your shoulder.
My view with colic and gut immaturity is that it affects the lower intestinal tract more than any other area of the digestive system. This creates bloating in the large intestine and slows down its peristalsis (wave like muscle contractions that move digested food through the gut). The subsequent explosive poos are the result of large volumes of gas being pushed out. Bloating increases abdominal pressure which gives the baby the typical colic type pain.
Treatment involves releasing tension in the fascial tissue that supports the abdominal organs in order to improve their natural motility (movement). Gentle techniques are applied to synchronise the pump handle and bucket handle action of the ribcage to allow a lengthening of the breathing diaphragm and a deepening of the breath. Pump handle action occurs in the upper ribcage and is an upward movement of the ribs. Bucket handle motion occurs in the lower ribcage and is rib movements to the sides. These are the movements that happen when a child breaths in. This gives the abdominal organs more space to function and enhances digestive clearance.
Mum brought Olivia to see me at four weeks old. Her birth was eventful, and she was born at 36 weeks by C-section. For the first two weeks Olivia was very good, sleeping well and feeding well on formula. Then Mum noticed a change in Olivia. She was getting trapped wind after drinking her bottles more frequently. Olivia was also grunting and groaning in her sleep especially at night. She was also pushing and straining when trying to do a poo. Bowels were opening with two to four loose motions each day, but Olivia was in pain doing a poo or passing wind. Mum said that Olivia looked bloated.
At night Olivia was restless and grunting throughout the night in her crib. Baby also had a period most nights from 7-9pm where she was crying a lot, going red-faced, looking to feed but refusing, pulling her knees up to her chest and very irritable.
On speaking to Mum about Olivia, my conclusion was that she had colic. My opinion on colic is that it presents as a lower digestive tract problem. Often this is due to wind ingested from a bottle that doesn’t suit the baby’s sucking action, a formula that is tough on the lower digestive system to digest all day, or a gut flora that isn’t fully established in young infants.
I treated Olivia’s digestive system, focusing on the lower digestive tract. I recommended a change of bottle type, drops to aid lactose digestion and a probiotic for improved gut flora. I gave Mum a Symptom Management Chart to monitor Olivia for the next ten days. Mum returned with baby and reported that her symptoms were significantly better. She had less wind, was pooing easier, had no grunting at night and the evening crying was down to 20–30 minutes, and not every night. Olivia was discharged and check-up booked for one month