I meet many mothers with unsettled babies, who often describe symptoms of “reflux,” “gas,” “colic” or an allergy. It is miserable for both the babies and their care-givers. Mothers are heart-broken at the distress of their precious babies, they are trying everything to resolve the problems and feel like they are doing something wrong. Their babies often fuss and arch back during feeds, they may be clingy and impossible to settle, they want to feed and then get agitated and upset when offered milk, their tummies seem to cause them pain, they are gassy and may bring back milk. What is going on?
After fifteen years working with new mothers and babies, I know you are not going to want to hear this. The truth is, we often don’t know. We really don’t. We can have some ideas that might or might not be useful in your particular situation. We can help to resolve breast and bottle feeding issues and we can certainly test for some of the less common medical conditions that might be causing the crying and fussing. However, for the vast majority of cases, there is no medical consensus about the causes of, or treatment for, these symptoms. Most babies grow out of it within about 16 weeks. Some take longer. In fact, the first 16 weeks is sometimes known as “The Crying Period.” It is really important that new families feel supported at this time, because it is horrible, makes everyone tired and anxious, and can have a huge impact on relationships.
As adults we are used to a world of cause and effect. We control the inputs and get the prescribed outcomes. Babies that cry and fuss do not conform to rules that we can explain. There is precious little reliable research evidence to draw on. There are just too many variables. The actions or treatments we try might or might not help for a while. It is hard to tell because many people use several interventions at once, the placebo effect is really significant, and most babies grow out of it anyway.
If you are in this situation, here are a few common sense things to think about.
Is my baby hungry?
Your baby will cry and fuss if there are unresolved breast or bottle feeding issues. These could be due to many things including baby’s position for feeding, the way they are able to use their mouth and tongue, your milk supply and speed of let down. I would definitely recommend seeking skilled advice and having a professional watch a breast or bottle feed before embarking on any other forms of treatment. It could be something really quite obvious e.g. undiagnosed tongue tie or super-fast let down that is causing the majority of the problem.
Is my baby in need of stimulation?
Does your baby have a high need for cuddles, physical comfort, rocking and other vestibular stimulation? Many babies benefit from being carried close to their carers in well-fitted slings. Well meaning advice about not “overstimulating” your baby is counterproductive for the majority of little ones. In cultures where babies are carried a lot, and fed abundantly (not to the clock), crying and fussing are minimal.
Is my baby allergic to cows’ milk?
Numerous new mothers, in their desperation, read that baby might be allergic to cows’ milk in their adult diet passing into breastmilk, or present in baby’s infant formula. While Cows’ Milk Protein Allergy (CMA) is possible, it is not the most likely cause of crying and fussing. Please talk to your GP about symptoms before drastic changes to your diet or buying specialist formula. True exclusion diets are difficult to achieve and might have quite an impact on the mother’s own health and wellbeing. Specialist infant formulas are definitely not recommended “just in case.”
The NHS website tells us that Cows’ Milk Protein Allergy occurs in anything up to 7% of children under one, but most grow out of it by age five. It is more likely to be experienced when starting a child on solid foods, and is uncommon for breastfed babies. CMA results in symptoms of an allergic reaction including:
- skin reactions – such as a red itchy rash or swelling of the lips, face and around the eyes
- digestive problems – such as stomach ache, vomiting, colic, diarrhoea or constipation
- hay fever-like symptoms – such as a runny or blocked nose
- eczema that does not improve with treatment
Sometimes these reactions occur at the time of exposure, and in other cases they take hours or even days to show.
Occasionally CMA can cause severe allergic symptoms that come on suddenly, such as swelling in the mouth or throat, wheezing, cough, shortness of breath, and difficult, noisy breathing. A severe allergic reaction, or anaphylaxis, is a medical emergency – call 999 or go immediately to your local hospital A&E department. There is more to read here: https://www.nhs.uk/common-health-questions/childrens-health/what-should-i-do-if-i-think-my-baby-is-allergic-or-intolerant-to-cows-milk/
What about lactose intolerance?
Again, this is theoretically possible, but really unlikely. Lactose is a normal sugar found in milk. A truly lactose intolerant baby will be really unwell and not thriving. Baby may struggle constantly with explosive, watery, foamy, frequent green poos and will definitely need to be properly assessed by medical professionals. This is a good place to start for more information https://kellymom.com/health/baby-health/lactose-intolerance/
A small number of people have a congenital issue that prevents them from properly digesting lactose, others develop lactose intolerance later in life. If you developed lactose intolerance as an adult, this is not the genetic form that you could pass to your baby.
If your baby has an occasional green poo, or a few days of green poos after a tummy bug, that is not usually something to worry about. Possetting is normal, babies have runny poos, and most babies have wind!
What about lactose overload?
Lactose overload can occur when a baby’s digestive tract becomes overwhelmed with large quantities of milk. This can happen when mothers have an oversupply of milk, or when bottle feeding parents overfeed their baby. Lactose overload happens when the baby cannot produce enough of the enzyme lactase to break down all the milk in their gut. This means that some lactose passes undigested through the intestine and causes discomfort, leading to fussy, windy and colicky behaviour in the baby.
Lactose overload is not a syndrome and can be rectified with correct feeding advice. Newborn babies are likely to show feeding cues when they want the comfort of sucking, as well as when they actually want to eat. There may be cases where other means of soothing the baby may be more appropriate. Please consider asking a baby feeding specialist to look at the big picture and assist you with this.
So perhaps my baby has colic then?
You might be told that your baby “has” colic. As Dr Jack Newman says, “Colic is one of the mysteries of nature. Nobody knows what it really is, but everyone has an opinion”. Very often a baby starts to have crying periods about two to three weeks after birth. This mainly happens in the evening. Baby may be inconsolable, although walking, rocking or driving with baby might help for a while. Otherwise baby is well and putting on weight. Colic stops around three months old, sometimes a little later.
There is no proven treatment for colic. Many medications and behavioural strategies have been tried, and none proven to work. That includes over the counter medications such as “Infacol” and “Colief”. We will all know someone whose baby was “cured” and most treatments work sometimes or for a short time. To be honest, the baby was likely to grow out of it anyhow.
OK, so colic isn’t a thing, it must be reflux
I imagine that you are probably really exasperated with me by now. Reflux, if defined as “bringing up milk” is totally normal in the vast majority of newborn babies. Almost all babies vomit or posset up milk at some point in the day, and some do it many times a day. It is to do with the immaturity of their digestive system. It will probably happen more if your baby takes a lot of milk or milk quickly from a rapidly squirting breast or fast bottle feed. It may happen if you move your baby round vigorously after a feed, such as during a nappy change. Sometimes it happens between feeds when your baby is lying down in a cot or pram. Provided that baby is putting on weight, thriving and doing an appropriate number of wet and dirty nappies, this is really just a laundry issue. What can you do about it? See a lactation professional if fast flow is an issue, perhaps feeding baby against gravity in a laid back position might help. This is good place to start https://kellymom.com/bf/got-milk/supply-worries/fast-letdown/. Feed your baby on one side until baby really is not sucking, then switch sides. Pace your bottle feeds using responsive feeding techniques. Use a slower flow teat perhaps. Baby will grow out of this, as in most things.
“Ah, but my baby isn’t thriving. Feeding is a nightmare and my baby is dropping centiles on the growth charts”. Now this is a different thing. If your baby is really not doing well with feeding we need to know why, and I would recommend seeing your GP and also some feeding professionals to rule out medical and mechanical issues. These babies often seem to be writhing in pain and many parents are offered antacids or even medications that reduce stomach acid. However, this is also controversial and there is limited evidence that they work. As babies are regularly fed milk, their vomit is not particularly acidic. Investigations into most reflux babies rarely shows inflammation or damage to the oesophagus. True Gastro-oesophageal Reflux Disease (GORD), that we experience as adults, is really unlikely. The medications prescribed for reflux can have quite significant side effects, not least uncomfortable spikes in stomach acid production as we take our babies off the drugs. They should be used with caution. The “Discontented Baby Book” by Dr Pamela Douglas offers a useful perspective on this, and how we look after parents’ mental health while it is going on.
If a newborn baby has started projectile vomiting every feed, not just the occasional one, baby needs to be urgently reviewed by a medical professional in case something is wrong such as pyloric stenosis (very rare).
Argh, this article hasn’t helped at all!
Sorry. I suppose it has done one thing. It has shown that as health professionals we really care about you and your baby and we really want to help you. It is just that very often we don’t know how because each case is complicated and the evidence for effective treatment methods just isn’t there. Please rule out feeding and medical issues, and then experiment and find what works for you. The vast majority of babies just grow out of these things. We need to keep you and your family as calm as possible while it happens.