Colic is one of the mysteries of nature. Nobody knows what it really
is, but everyone has an opinion. In the typical 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 3 months of age (occasionally older). When the baby cries,
he is often inconsolable, though if he is walked, rocked or taken
for a drive, he may settle temporarily. For a baby to be called
colicky, it is necessary that he be gaining weight well and be otherwise
The notion of colic has been extended to include almost any fussiness
or crying in the baby, and this may be valid, since we do not really
know what colic is. There is no treatment for colic, though many
medications and behaviour strategies have been tried, without any
proved benefit. It is admitted that everyone knows someone whose
baby was cured of colic by a particular treatment. It is also admitted
that almost every treatment seems to work—for a short time, anyhow.
There are three known situations in the breastfed baby which may
result in fussiness or colic. Once again, it is assumed that the
baby is gaining 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 may result in the baby getting fewer calories,
and thus feeding 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 which digests
the sugar (lactase) may not be able to handle so much 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 greatest in societies where everyone has a watch and
least where no one has 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 is asleep
at the breast. If the baby feeds for only a short time only, the
mother can compress the breast (handout #15 Breast Compression)
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) 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 lop sided.
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 may 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 on
to the breast. A proper latch is the key to easy breastfeeding.
2. Overactive Letdown Reflex
A baby who gets too much milk too quickly, may become very fussy,
very irritable at the breast and may be considered "colicky". Typically,
the baby is gaining very well. Typically, also, the baby starts
nursing, and after a few seconds or minutes, starts to cough, choke
or struggle at the breast. He may come off, and often, the mother's
milk will spray. After this, the baby frequently returns to the
breast, but may be fussy and repeat the performance. He may be unhappy
with the rapid flow, and impatient when the flow slows. This can
be a very trying time for everyone. On rare occasions, a baby may
even start refusing to take the breast after several weeks, typically
around three months of age.
What can be done?
a) If you have not already done so, try feeding the baby one breast/feed.
In some situations, feeding even two or three feedings on one breast
before changing to the other breast may be helpful. If you experience
engorgement on the unused breast, express just enough to feel comfortable.
b) Feed the baby before he is ravenous. Do not hold off the feeding
by giving water (a breastfeeding baby does not need water even in
very hot weather) or a pacifier. A ravenous baby will "attack" the
breast and cause a very active letdown reflex. Feed the baby as
soon as he shows any sign of hunger. If he is still half asleep,
all the better.
c) Feed the baby in a calm, relaxed atmosphere, if possible. Loud
music, bright lights and lots of action are not conducive to a successful
d) Lying down to nurse sometimes works very well. If lying sideways
to feed does not help, try lying flat on your back with the baby
lying on top of you to nurse. Gravity helps decrease the flow rate.
e) If you have time, express some milk (an ounce or so) before
you feed the baby.
f) The baby may dislike the rapid flow, but also become fussy when
the flow slows too much. If you think the baby is fussy because
the flow is too slow, it will help to compress the breast to keep
up the flow (handout #15 Breast Compression).
h) This problem is made worse if the baby is not well latched on
to the breast. A good latch is the key to easy breastfeeding.
i) On occasion giving the baby commercial lactase (the enzyme that
metabolizes lactose), 2-4 drops before each feeding, relieves the
symptoms. It is available without prescription, but fairly expensive,
and works only occasionally.
j) A nipple shield may help, but use this only if nothing else
has helped and only if you have gotten good help without any relief.
k) As a last resort, rather than switching to formula, give the
baby your expressed milk by bottle.
3. Foreign Proteins in the mother's milk
It has been shown that some proteins present in the mother's diet
may be excreted into her milk and may affect the baby. It would
seem that the most common of these is cow's milk protein. Other
proteins have also been shown to be excreted into some mothers'
milk. The fact that these proteins and other substances appear in
the mother's milk is not necessarily a bad thing. Indeed, it should
be considered a good thing. Ask about this if you have any questions.
Thus, in the treatment of the colicky breastfed baby, one step
would be for the mother to stop taking dairy products. These includes
milk, cheese, yogurt, ice cream and anything else which may contain
milk. When the milk protein has been changed (denatured), as in
cooking for example, there should be no problem. Ask if you have
Please note: Intolerance to milk protein has nothing to do with
lactose intolerance. A mother who is herself lactose intolerant
should also still breastfeed her baby.
a) The mother should eliminate all milk products for 7-10 days.
b) If there has been no change, the mother can reintroduce milk
c) If there has been a change for the better, the mother should
then slowly reintroduce milk products into her diet, if these are
normally part of her diet. (There is no need to drink milk in order
to make milk). Some babies tolerate absolutely no milk products
in the mother's diet. Most tolerate some. The mother will learn
what amount of dairy products she can take without the baby reacting.
taking dairy products. Ask if you have any questions. One week off
milk products will not cause any problems. Actually, evidence suggests
that breastfeeding may protect the woman against the development
of osteoporosis even if she does not take extra calcium. And the
baby will get all he needs.
e) The mother should be careful about eliminating too many things
from her diet. Everyone will know someone whose baby got better
when the mother stopped broccoli, beef, bananas, bread etc. The
mother may find that she is eating white rice only. Our diets are
too complex to be sure exactly what, if anything, is affecting the
Be patient, the problem usually gets better no matter what. Formula
is not the answer, though, because of the more regular flow, some
babies do improve on it. But formula is not breastmilk. In fact,
the baby would also improve on breastmilk from the bottle because
of the regularity of the flow. Even if nothing works, time usually
helps. The days and nights may seem eternal, but the weeks will
Handout #2. Colic in the Breastfed Baby. Revised
Colic in the Breastfed Baby
Written by Jack Newman, MD, FRCPC
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