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Colic in the Breastfed Baby

Written by Jack Newman, MD, FRCPC   
Monday, 01 June 2009 00:00
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Colic is one of the mysteries of nature. Nobody knows what it really is, but everyone has an opinion. In a typical colic situation, the baby starts to have crying periods about two to three weeks after birth. These occur mainly in the evening, and finally stop when the baby is about three months of age (occasionally older). When crying, the baby is often inconsolable, though walking, rocking, or taking the baby for a drive might settle her temporarily. To be called colicky, it is necessary that the baby is gaining weight well and is otherwise healthy.

The notion of colic has been extended to include almost any fussiness or crying in the baby, and this might be valid, since we do not really know what colic is. There is no treatment for colic, although many medications and behavior strategies have been tried, without any proven benefit. Everyone knows someone whose baby was cured of colic by a particular treatment. Almost every treatment seems to work— for a short time.

In breastfed babies, there are three known situations that may result in fussiness or colic. (Again, it is assumed that the baby is gaining weight adequately and that the baby is healthy.)

1) Feeding Both Breasts at Each Feeding

Human milk changes during a feeding. One of the ways in which it changes is that the amount of fat increases as the baby nurses longer at the breast. If the mother automatically switches the baby from one breast to the other during the feed before the baby has “finished” the first side, the baby may get a relatively low amount of fat during the feeding. This can result in the baby getting fewer calories, and thus needing to feed more frequently. If the baby takes in a lot of milk (to make up for the reduced concentration of calories), he may spit up. Because of the relatively low fat content of the milk, the stomach empties quickly, and a large load of milk sugar (lactose) arrives in the intestine all at once. The protein that digests the sugar (lactase) may not be able to handle such a large amount of milk sugar at one time and the baby will have the symptoms of lactose intolerance— crying, gas, and explosive, watery, greenish bowel movements. This may occur even during the feeding. These babies are not lactose intolerant. They have problems with lactose because of the sort of information women get about breastfeeding. This is not a reason to switch to lactose-free formula.

What can be done?

a) Do not time feedings. Mothers all over the world have breastfed babies successfully without being able to tell time. Breastfeeding problems are most prevalent in societies where everyone wears a watch.

b) The mother should feed the baby on one breast, as long as the baby breastfeeds, until the baby comes off himself, or the baby is asleep at the breast. If the baby feeds for only a short time only, the mother can compress the breast to keep the baby nursing. Please note that a baby may be on the breast for two hours, but may actually feed for only a few minutes. In that case, the milk taken by the baby may still be relatively low in fat. (This is the rationale for compressing the breast.) If, after “finishing” on the first side, the baby still wants to feed, offer the other side.

c) At the next feeding, the mother should start the baby on the other breast in the same way.

d) The mother’s body will adjust quickly to the new method, and she will not become engorged or lopsided.

e) Just as there should be no “rule” for feeding both breasts at each feeding, there should be no rule for one breast per feeding. Let the baby finish on one breast (compress milk into his mouth if necessary to keep him swallowing longer), but if he wants more, then offer the other side.

f ) In some cases, it might be helpful to feed the baby two or more feedings on one side before switching over to the other side for two or more feedings.

g) This problem is made worse if the baby is not well latched onto the breast. A proper latch is the key to easy breastfeeding.