Colic in the Breastfed Baby

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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 three 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 healthy.

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 proven 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.

The breastfeeding baby with colic

Aside from the colic that any baby may have, there are three known situations in the breastfed baby that 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 drains more milk from 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, explosive, watery, green 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.

• 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.
• The mother should feed the baby on one breast, as long as the baby actually gets milk from the breast (see videos at www.thebirthden.com/Newman.html) until the baby comes off himself, or is asleep at the breast. If the baby feeds for a short time only, the mother can compress the breast (handout #15 Breast Compression) to keep the baby feeding, not just sucking. 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. Do not prevent the baby from taking the other side if he is still hungry.
• The next feeding, the mother should start the baby on the other breast in the same way.
• The mother's body will adjust quickly to the new method, and she will not become engorged or lop sided.
• 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 (use compression to keep him feeding longer) but if he wants more, then offer the other side.
• 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.
• 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.

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Please see next page for the remainder of this handout.

Handout #2. Colic in the Breastfed Baby. Revised January 2005

Written by Jack Newman, MD, FRCPC. © 2005

This handout may be copied and distributed without further permission,
on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated.

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