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Understanding Colic – A Grandparents’ Guide

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posted September 6th 2019

We all know how distressing colic can be for both grandchild and us as nanna’s and pops. Here our friend Dr Lin Day, Founder of Baby Sensory (www.babysensory.com), shares with us some thoughts on colic.

Colic is often defined by inconsolable crying on and off for three or more hours a day, three or more days a week, and three weeks in a month. Your grandchild may cry or scream at the same time each day, usually in the late afternoon or evening. Colicky symptoms usually begin in the second week after birth, peak at about six weeks, and decline at three to four months. Colic rarely persists longer than six months.

Seeing your grandchild suffering with colic can be distressing for any grandparent and although parental tension and anxiety do not cause colic, it can increase your own levels of stress, which in turn can lead to increased bouts of fussiness and crying in babies.

Colic occurs in approximately 30% of breast and bottle-fed babies and equally in both sexes. Although first-born babies seem to be affected with colic more than later siblings, they are just as likely to suffer from the condition. Colicky babies still gain weight and are otherwise healthy.

Symptoms of Colic

One or more of the following may suggest that your grandchild has colic:

• Crying an hour or more after a feed
• High pitched, intense cry
• Incessant, inconsolable crying at a regular time each day or night
• Pulling the knees to the chest
• Abdominal bloating
• Excessive flatulence
• Frequent, explosive, watery stools

If your grandchild suffers from chronic constipation, diarrhoea with blood or mucus, a high temperature, vomiting, weak sucking or poor weight gain, your are advised to see a GP to rule out other illnesses.

Causes of Colic

One or more of the following may cause colic or exacerbate symptoms:

1. Milk sugar overload
2. Intestinal hormone imbalance
3. Lack of beneficial bacteria
4. Maternal diet
5. Formula milk protein allergy
6. Skull misalignment
7. Overstimulation
8. Lack of exercise or carrying
9. Tight clothing
10. Parental stress

Milk sugar overload can cause cells lining the small intestine to produce the enzyme lactase. Lactase breaks down milk sugars (lactose), which fuel metabolism and promote rapid brain growth. Insufficient lactase production can cause undigested milk sugars to ferment in the large intestine leading to excessive gas production, flatulence and abdominal bloating.

Foremilk (watery milk at the beginning of a feed) contains more milk sugars than hindmilk (high-fat milk at the end of a feed). The high-fat content of hindmilk increases the capacity of the intestine to digest milk sugars. If the baby is unable to nurse long enough during breast feeds, he or she may not receive the high-fat milk needed to aid digestion.

• Expressing some foremilk from both breasts before a feed will ensure that the baby receives hindmilk.
• Let the baby finish one breast before offering the other so that more high-fat milk (hindmilk) is consumed.
• Give the baby smaller, but more frequent feeds (bottle or breast feeding) to reduce lactose overload in a single feed.

When breastfeeding and milk production are fully established, a pacifier can help satisfy the need to suck when the baby is not hungry.

Although grandparents may be tempted to give their grandchild gripe water or natural remedies to relieve colic between feeds, they may contain potentially harmful chemicals, which can have adverse side effects.

In the case of a intestinal hormone imbalance, muscular contractions of the intestinal tract are stimulated by motilin, a hormone secreted by cells lining the small intestine.

Motilin in breast milk has a nocturnal peak, which may explain why breastfed babies become colicky in the evening or at night (motilin is also found in formula milk). High levels of motilin can lead to painful muscular contractions. However, close physical contact increases melatonin (a hormone that induces sleep), which suppresses painful intestinal contractions.

Motilin levels also increase when babies are exposed to environmental smoke and/or nicotine in breast milk. Exposure can be minimised by restricting smoking in the home or near the baby.

Lack of beneficial bacteria – beneficial or ‘friendly’ bacteria in the intestinal tract play a vital role in protecting the baby from harmful microorganisms that cause inflammation and bloating.

Babies born by Caesarean section may miss out on beneficial bacteria naturally passed on during vaginal birth. Bacterial colonisation may also be delayed if the baby has been exposed to antibiotics. This may explain in part, why some babies suffer from colic.

Probiotics (live beneficial bacteria) occur naturally in breast milk. There is some evidence (http://pediatrics.aappublications.org/content/126/6/1217) that formula milk enriched with probiotics may reduce colicky symptoms in healthy bottle-fed babies, but more studies are needed to substantiate this.

Many breastfeeding mothers have also found that excluding cabbage, cauliflower, broccoli, onion, wheat, eggs, soy, caffeine-based foods and drinks, orange juice, and dairy products from their diet reduces colicky symptoms.

Foods not associated with colic include unsaturated vegetable oils, garlic, Brussels sprouts, beans, avocado, bananas, carrots, potatoes, beef, sardines, salmon, and low-fat yoghurt.

If the baby has been recently introduced to formula and presents the symptoms of colic, an allergic response to one or more proteins in cow’s milk could be responsible. Colic may also be accompanied by other allergic symptoms such as an itchy skin rash, vomiting and diarrhoea.

If an allergy is suspected, formula milk that has been specially treated to change the proteins, or contains no milk proteins, can be given as an alternative on the advice of a healthcare professional. Soy formula milk is just as potentially allergenic as cow’s milk, and there is no evidence to suggest that it reduces colicky symptoms.

Misalignment of the skull due to childbirth can put pressure on the vagus nerve, which passes through the neck and thorax to the abdomen. Compression of the vagus nerve can cause intestinal spasms and pain. Cranial osteopathy has been shown to be successful in treating colicky symptoms Treatment involves applying very light pressure to the affected area until tension is released (http://www.ncbi.nlm.nih.gov/pubmed/16648084).

Tight clothing may restrict movement – a snug-fitting nappy can push against the baby’s tummy, especially after a feed. If two fingers cannot be easily placed inside the nappy, it may be too tight. Tight clothing can restrict the movement of food through the intestines leading to bloating and discomfort.
Overstimulation can also irritate the nervous system and lead to uncontrollable, high-pitched crying at the end of the day. A daytime routine that includes frequent rest-breaks or naps, and short play episodes when the baby is alert and responsive will help avoid overstimulation.

By the end of the third month, the nervous system has adjusted to environmental stimuli, which is one reason why colic usually stops.

Lack of exercise or overuse of a baby bouncer, car seat or other restraining device may reduce intestinal contractions and lead to bloating. However, regular exercise and tummy time improves intestinal mobility and helps force out excess gas.

“The relative lack of carrying in our society may predispose to crying and colic in healthy babies.”

In many cultures babies are carried by their mothers, grandmothers or siblings in a sling or pouch, on their backs, fronts or hips, almost constantly. The baby experiences continual physical comfort and an intimate and secure environment. Colic is rare in babies who are constantly held or cuddled.

Research shows that carrying the baby in a carrier, for at least three hours during the day (in addition to feeding), reduces colic in the first three months of life by as much as 45% (http://pediatrics.aappublications.org/content/77/5/641.short).

Close physical contact, carrying and walking are undoubtedly the best ways to comfort a distressed baby. Skin-to-skin contact is especially effective in reducing stress.

Stress – continuous crying and maternal fatigue can have serious implications for the mother-baby relationship. It can also trigger postnatal depression, Shaken Baby Syndrome, and early termination of breastfeeding.

Parents and grandparents caring for a colicky baby need support, particularly in the early months when it is important to establish a strong bond with the baby.

If further help is needed, Cry-sis (www.cry-sis.org.uk) provides support to families with excessively crying, sleepless and demanding babies. The helpline (08451 228 669) is open 7 days a week from 9am to 10pm.

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About WOW World Group (www.wowworldgroup.com)

WOW World Group provides a diverse, exciting range of parent and child activity-based class experiences across the UK and overseas. Spanning seven different programmes, its adult classes are designed to equip parents with a variety of useful skills from first aid to preparing for life with a new baby. The fun-filled classes are designed to enhance early years learning and development while allowing parents to spend quality time with their child/children in a safe and established, nurturing environment led by qualified, knowledgeable class leaders.

WOW World Group is a founding member of the Children’s Activities Association having gained international recognition for its programmes, which include Baby Sensory, Toddler Sense, Mini Professors, Reading Fairy and Photo

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