Supporting families whose babies experience symptoms of colic, reflux and infant allergies
Whether your baby has colic or reflux seems to be the deciding factor on whether or not you are able to enjoy the first couple of months of their lives – and whether you manage to get any real sleep. I hear so many stories of people at their wits end, unsure of what to do, what to try and where to turn next, desperate to avoid medicating their new baby, concerned about the side effects of the drug but also desperate to ease their child’s suffering. There is so much conflicting advice out there and a fundamental lack of knowledge and research into some of these issues.
I attended a masterclass with BabyEm recently on supporting families whose babies experience symptoms of colic, reflux and infant allergies. The class was led by internationally renowned infant feeding specialist and LBCLC Shel Banks – who has co-authored three Cochrane Systemic Reviews on various aspects of Infantile Colic. I learnt about ways to assess whether medical intervention might be required, and some simple strategies to solve the root cause – rather than just the symptoms.
More than a third of babies regurgitate feeds at least once per day with around 10% experiencing reflux symptoms that lead parents to seek medical intervention. But where is the line between normal physiological baby behaviour and Gastro-Oesophageal Reflux Disease (GORD)? When is medical intervention (whether that is medication or surgery) required? And what is the impact of medicating incorrectly or unnecessarily?
A crying baby is a stressful sound, and if you are trying to soothe that baby it can very quickly escalate as the carer gets stressed and baby feeds off that stress to become even more worked up. So, the first thing is to be able to identify why that baby might be crying or in distress, as if you know why, you will be able to help more quickly.
The number one cause for crying is trapped wind in the stomach or intestines causing discomfort – there are two solutions, you can either stop the wind getting there in the first place by optimising feeding or addressing any allergies (see the third and fourth reasons for crying), or help baby to get rid of it before they are laid down. There are medicines that can help babies deal with wind, which are discussed below, or you can apply simple non-medical strategies such as wonky winding - having baby upright, with their tummy pressed against you and at a 45 degree angle so with their bottom in the middle of your body, and their head on your right shoulder - this position places any bubbles of air in the stomach directly under the gastro-oesophageal valve, so it can easily get up and out; or the ‘tiger in the tree hold’ - baby laying face down on an arm with legs and arms dangling - which allows baby to be in a ‘prone’ position which feels natural, and with the warmth and pressure of mum/ dad’s hand on their tummy.
The second most common cause of crying is overstimulation, babies are stimulated just by looking around the room, and it can very easily and very quickly all become a bit too much and they get overwhelmed. Solution: they need sleep so that their brain can process everything. An overtired baby is very difficult to get to sleep so it’s important to learn how to recognise what their sleep cues are and act on them quickly. If you do have an overtired baby on your hands then wonky winding whilst bouncing from one leg to another can help calm a fractious baby so they are then able to sleep.
Number three is suboptimal feeding, this may include taking in gas as they feed (leading to the number one cause of crying) which could be due to tongue-tie, poor positioning and attachment (both in breast and bottle feeding), not using paced and responsive bottle feeding, incorporating air into the milk when it is made up (for example if shaken) - babies are often less colicky on liquid ready-to-feed formulas although these are of course considerably more expensive, not transferring milk effectively, hunger, being overfed via bottle, ineffective breastfeeding leading to baby getting too much ‘foremilk’ which contains more lactose, feed (expressed or formula) not being made up properly causing gastroenteritis (a bacterial infection via the bottle or milk). Solution: adequate infant feeding support – for example from a lactation consultant or tongue-tie practitioner - can ‘fix’ most of these issues.
Number four is allergy or gut dysbiosis (a disruption to the microbiome) – dairy/ cows milk protein is the most common allergy and this allergy can be ‘triggered’ if a baby is ever exposed to formula, which is now very common in the early days if milk is slow coming in and/ or there is slow weight gain. So even if a baby returns to being exclusively breastfed, they are then more susceptible to an allergy to cows milk protein and babies can have an allergic reaction to something via mother’s milk. Of course, there are also many other allergens to consider such as tomatoes or onions and other causes of dysbiosis include exposure to antibiotics in birth or postnatally, being born via caesarean, exposure to smoke in the home (if a mother smokes it doubles the chance of colic), or mothers cortisol levels.
These causes of crying are often linked and overlapping, so if you attempt to treat a symptom without understanding the cause it could create further problems. For example, if a baby is allergic to an element of their milk, then thickening that milk to ensure it stays down will only add to the baby’s discomfort. It could also lead to further problems and medicalisation if baby then becomes constipated and needs medication to resolve this, or an allergy causes fermentation in the gut which in turn causes trapped wind. Similarly a ‘comfort’ formula which has a lower level of lactose is still based on cows milk protein so will continue to cause issues for a baby that has an allergy, the symptom may be milder but the allergy is still there – and if the cause of the symptom wasn’t an allergy and the baby was previously breastfed then they have now been exposed to the cows milk protein and are now more at risk for developing an allergy.
It is also important to remember that it might not be as simple as trapped gas or overstimulation etc, there might be an underlying health issue such as GORD (Gastro-Oesophageal Reflux Disease), Pyloric Stenosis (when the opening into the bowel is too small so the baby can’t process stomach contents quick enough, so sends it back up) which requires surgery; tongue tie or other oral restriction. We risk missing a more serious health condition if we do not first understand the underlying cause, if we understand the cause of the symptom we can address the underlying condition, which will have a more long-term effect.
Clearly, medication isn’t always the fix, and there are always side effects to medication, but that is not to say that in certain circumstances medication is not required. Gastro-Oesophageal Reflux Disease (GORD) for example - characterised by faltering weight, blood in the regurgitate (which indicates damage to the oesophagus), pneumonia (because the stomach contents are being aspirated) and feeding difficulties – is serious with potential for long-term problems and needs to be addressed quickly. There is a stepped care plan to treat GORD which starts with feed management and works down towards medication (omeprazole). Omeprazole works by reducing the stomach acid which means that less stomach acid is coming up so less damage is caused to the oesophagus or aspirated, but the baby is still regurgitating, there’s just less of it. The NICE (National Institute for Health and Care Excellence) guidelines state that it is only under these circumstances that omeprazole should be prescribed.
Colic has many causes, some of them complex and not all of them fully understood. There are many over-the-counter medications available and each address a different single potential cause, so it is impossible that one medication can help all babies, some will work for some babies, and others for others. This again shows us why it is important to understand the cause of the discomfort before jumping to medication.
Simeticone (Infacol) helps group together the bubbles of gas to make it easier to burp, Dimethicone (Dentinox) does the same thing as does wonky winding
Probiotics may be effective if the baby is in gut dysbiosis, but if we don’t know how they are in dysbiosis then introducing additional bacteria (even if they are the friendly ones) is unlikely to fix the problem, and could make things worse – the only exception to this rule is when a baby is in special care and there is evidence to support probiotics being given to babies in these circumstances
Colief (or Lactaid) lactase enzyme drops breaks down the lactose into glucose and galactose, this can work in the short term if baby has been unwell with upset bowels, has a lactaste shortage or the milk has too much lactose for the body to handle but it will not work in other circumstances and is not necessary beyond the short term
Gripe waters (basically bicarbonate of soda) helps to produce carbon dioxide by causing a chemical reaction with the babies stomach acid, so baby will burp but that’s because you’ve created a burp – it’s also worth knowing that ‘back in the day’ gripe water had sugar and alcohol in it, so it probably won’t have the same effect as it did for your granny (and that’s probably a good thing!)
Colic, reflux and allergies can cause huge distress in new families, and I want to help ease that burden. You are probably being bombarded by conflicting advice - from your granny who swears by gripe water, the fellow new Mum who hit the jackpot and her baby responded to lactase drops, the suggestions of tongue tie or the GP who is readily prescribing medication but clearly it is really important to seek professional advice from somebody that has in-depth knowledge on these issues. I know a bit more now than I did, but there is new research all the time, and there is still so much to learn.
Doula Bea x
