COLIC AND FUSSINESS
This post was a collaboration between Dr. Ted Handler, Doula/parent educator/certified lactation counselor Julie Hartman, and Nurse Judy.
There is a LOT of information here, but we tried to create a comprehensive guide to dealing with fussy babies. We hope you find it helpful
Definitions and Causes
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What is colic?
The official definition is three hours of crying more than three days a week for more than three weeks.
Most people don’t bother to keep careful track. (They are too tired!)
Colic has become a catch-all term for babies who seem uncomfortable and are difficult to soothe. It is NOT a ‘medical condition’.
Show me the baby who is never fussy. I will wait………..
The fact is, it is the rare baby who doesn’t deal with at least a little fussy time. The typical “crying curve” starts around 2-3 weeks, peaks at 6-8 weeks, and then settles around 12 weeks. For some unfortunate kids it does last a bit longer, but at some point this does pass!
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The fussiness is typically associated with abdominal discomfort.
The biggest culprit is actually pretty straight forward. Nope, it probably isn’t the butter croissant, that cup of coffee that you had, or the baby’s microbiome.
Most Common Cause: drum roll please…swallowed air
A lot of the remedies such as baby gas drops will decrease the pain of the air, but if you can get to the source and decrease the amount of air that they swallow in the first place, you're actually treating the cause. This is true for both bottle and breast feeders.
There are several issues that might contribute to the excess air. Details and interventions discussed below:
The latch: if the latch isn’t providing a good seal they swallow a lot of air
In breastfeeding babies, the latch should be carefully examined. If there is a proper latch, after that initial “zing” of electric nerve sensation, there shouldn’t be discomfort with breastfeeding. There may be sensations of pressure, but any feelings that approach pain should be assessed. Simple adjustments by a lactation professional can make an enormous difference. Julie adds “ hearing your baby swallowing is an important indicator that your baby is drinking milk. However, if you hear a lot of slurping and noisy mouth sounds it is a strong indicator that the baby doesn’t have a good seal and thus will be taking in excess air. A quick fix for this can be to tuck the baby in closer to Mommy’s body and check that lips are flanged out ( think fish lips ). ”
Milk might be flowing too quickly
Parents with a heavy let-down can use the Haakaa or simple hand expression to soften the breast and pull off the initial gush of foremilk at the start of a feed. This can make for an easier latch for these babies. Give the Laid-back feeding position a try. This is not particularly intuitive so best results are usually when overseen by a lactation professional, if available.
For bottle feeders, a slow-flow nipple should be tried, and “paced” bottle feeding can often help. Note: not all baby mouths are built the same. This sampler box gives you the option to see which bottle and nipple shape fits your baby the best.
Restricted tongue movement
A strong tongue or lip tie might be restricting tongue or lip movement. Have your pediatrician take a look, If there is concern about a tie, they may refer you to an ENT or a pediatric dentist to assist with a release
Let’s talk about burping
For all of these gassy babies, early and frequent burping should be used to ensure that air is less likely to make it past the stomach.
A lot of parents will ask us about appropriate burping, and will sometimes be struggling because they tell us that they're trying to burp their baby and they can’t tell if they are doing it right. In truth, some babies give you a great big burp worthy of a beer guzzling trucker while others don’t give you the satisfaction.. Effective burping does not require an actual belch. Burping is just the act of tapping the baby in a position to let everything in the stomach settle, so that if there was any air that was swallowed, it has the opportunity to come out. If the baby's placed in a horizontal position too early while the stomach is full of too much air or too much milk, it will flow backwards and irritate the esophagus, causing fussiness.
Think about burping like you are tapping a very full bottle and giving it the opportunity for all of its contents to settle even if it doesn't necessarily have to produce air or milk.
Julie adds” breastfed babies with a good latch don’t necessarily need to be burped.”
Breastfeeding moms, how much do you need to focus on your diet?
If you have done your best to minimize swallowed air and you are still dealing with an unhappy baby, pay a bit of attention to what you are eating to see if you can find a link. This is especially worthwhile if your little one is fine on most days but clearly has some flares on others. See if you can trace this to specific things that you have eaten.
I know that not everyone agrees that there is a connection, but in my case I swear to you that if I even looked at cabbage my kids cried for hours.
You do NOT necessarily need to change your diet.
But it could be that tweaking it could make a difference.
Yes, I have some moms that know perfectly well that their baby is a bit fussier when they have coffee but drink it anyway because they can't face the day without it. As always, it is a balance. It is worth finding out if there is a connection between your diet and your baby's gassiness, but then make whatever choice works best for you. In my experience the biggest culprits are:
coffee
caffeine (in tea and chocolate among other things)
dairy
gassy foods (like cabbage, onions, broccoli, garlic)
spicy foods
If you are able to establish a clear link, you can decide what changes you are willing to make. (no judgment)
What’s the deal with foremilk and hindmilk?
You might have read about the difference between foremilk and hindmilk. The implication here is that thin foremilk is at the front of the breast, fatty hindmilk is in the back of the breast. There is no actual “different kind of milk” that's produced by milk-producing glands in the breast tissue. All breast milk is created equally. However, as milk sits in the breast, the thinner, waterier breast milk will naturally fall towards the front of the breast, just due to gravity and time, and the larger, fattier molecules will sit in the back of the breast. This creates different consistency and nutritional contents with more carbohydrate and watery milk in the front and fattier milk in the back.
Sometimes the increased gas issues are because you are switching breasts too soon and never getting to that slower-moving hindmilk. Watery greenish stools (not necessarily something that I worry about) might be a clue.
One approach for this is to feed from only one side per feeding to ensure that you are really emptying the breast. This is referred to as block feeding.
Basic soothing interventions:
The baby is still fussy/Now what?
Baby wearing can help
Sometimes holding them right up to your heartbeat can settle them right down. There are some lovely baby wearing options. See which ones are the most comfortable for you. Skin to skin contact is a bonus.
Sucking
Offer your baby something to suck on. A finger or a pacifier can help calm them. This is an especially reasonable option when you know perfectly well that they are likely NOT hungry, but still want to suck. Note: just as not all babies want the same bottle, not all babies want the same pacifier. This sampler box gives you the opportunity to try different shapes.
Swaddle
Putting them in a nice swaddle can feel like magic. Sometimes you need to semi force them into it, but this is a worthwhile skill to master. For the record, I was terrible at it, this was my husband’s job and he could wrangle them into a nice tight burrito lickity split. These days there are special swaddle blankets with velcro that make it a bit easier.
Get up and dance.
Hold your baby over your shoulder with their knees tucked up in the fetal position. Give firm pats on the back. Sway, bounce and sing. Do some nice SHOOSHING sounds or turn on a white noise machine.
Don't forget about massage!
Go online and check out baby massage techniques on YouTube or take an infant massage class. Julie adds “ when doing tummy massage with your baby, make sure you are moving your hands in a clockwise motion so as not to push air back into your baby’s system”.
Also, there are some acupressure points that can help. Make gentle circles on the baby’s palm with your thumb (also clockwise)
Hip circles/figure eights
While they are on their back, hold the butt cheeks, while you lift their little legs.. Push both legs up at the same time and make a little circle or figure eight motions. There is something very satisfying about getting little farts out this way!
Giving a bath
Many kids will calm down in a warm (not too hot) tub. If you have two parents, I suggest having one parent in the bath with the baby securely on their lap, and the other parent on duty to help get the baby in and out of the tub.
Heated tummy wraps
There are tons of these products available. Make sure you don’t put anything that is too warm (i.e. is much warmer than your baby’s tummy feels) directly on the baby, but when used properly these can be very soothing.
As a bonus you can put the warm packs in the crib before putting the baby down for a nap. You might be surprised what a difference that makes!
Still fussy? Hang in there, we have more things left to try
Colic remedies/Let's throw some spaghetti at the wall!
Gas drops
Simethicone is the ingredient found in most of the OTC gas drops that you can get at a drugstore. Some of the name brands are Mylicon or Little Tummies. Simethicone drops are very safe because the medication is not actually absorbed into the body: it works by breaking up the surface tension of air in the intestine so that large painful gas bubbles become small and manageable. The gas drops are helpful to most of my patients and are certainly worth a try. These are on my list of things that are worth having on hand ‘just in case’.
Homeopathic colic remedies:
There are several products on the market.
The Boiron brand that I was a fan of, is no longer available except in France.
An alternative brand, ColicCalm has a lot of 5 star reviews.
In general, I consider homeopathic remedies harmless if used properly and I’ve seen plenty of kids who seem to get relief.
Gripe Water
This is an herbal remedy that can be found in many health food stores or Whole Foods. Stools might get a bit green with this (not to worry). It’s very safe, but we don’t know how or why it works.
Brew some tea
The most common for this are chamomile and fennel, you can add a few grains of sugar and give a dropperful or two to your baby. (NOT HOT) Remember not to add honey or give your baby any products that contain honey.
Colief
https://colief.com/products/
is a product specifically for babies who may have a lactose intolerance. Think Lactaid for babies. If you are going to give this a try, you need to make sure you give it with each feeding for a few days to see if it is helping.
What about PROBIOTICS
Evivo
An imbalance of healthy bacteria in a baby’s gut, along with a digestive system that is not fully developed, can be linked, and certainly contribute to colic symptoms and severity.
There are many strains of probiotics, but Evivo contains something called B.Infantis. In perfect circumstances a baby would have proper levels of this strain naturally. Research has found that the transfer of good bacteria from mom to baby during birth doesn’t always happen. Babies born via C-section are even more likely to be missing the B. Infantis that babies born vaginally are exposed to.
My grandson took Evivo for several months. It was NOT a magic wand for his colic, It is quite possible that he would haven been worse without it. It certainly seemed to be very helpful for diaper rash.
Soothe probiotics drops: This is yet another strain of probiotics being studied called L. Reuteri. These claim to cut crying time by 50% after a week of use. They should be given daily. This is the probiotic strain that has the backing of the American Academy of Pediatrics.
There is no potential harm in full term babies in using both kinds of probiotics if you are already on one and still dealing with some gassiness.
Dr Loo’s Chinese medicine patch.
Several years ago, I was fortunate enough to meet the inventor Dr. Loo and do some beta testing on some of my patients. Many of them reported back that these seemed to give relief
These little patches are simply applied over the belly button area. If you don’t want to deal with giving something orally, these might be worth a try.
Windi
https://www.fridababy.com/
When these first came onto the market, I used to have some samples of these in my office that I couldn’t even give away. Most parents didn’t seem too eager to stick something up their kids' butts. But now that these have been around awhile, lots of parents swear by them.
Obviously you need to be very gentle when you insert it. If it feels like you need to force it, stop right away. When you do it properly it should slide in easily and not cause any more discomfort than taking a rectal temp.
This frees up a pocket of gas and many kids seem like they get quite a bit of relief.
Specialists
Craniosacral therapy and chiropractic treatment
Here in San Francisco, my favorite is Sandra Roddy Adams 415-566-1900. As Sandra says, it is the rare baby who manages the birthing process without some alignment issues. Here is a nice link that talks about the safety and usefulness of a chiropractic treatment.
Acupuncture is another option.
Den Bloome Bremond sees patients as young as newborns. She uses various modalities. She offers a very safe herbal tincture and also teaches the parents some massage techniques that they can try at home
Parents put your oxygen masks on
There is NOTHING easy about this. Adding extra crying to the lack of sleep can feel overwhelming to say the least.
The first 3 months are the worst. Plan your family visits and parental leave accordingly. The crying curve starts around 2-3 weeks, peaks at 6-8 weeks, and then settles around 12 weeks. If your parents are coming in the first week or so to meet the baby and want to know when to come back, you’ll likely value the second set of hands around that 6 to 8 week mark.
Allow yourself emotional space: Cry, vent to friends/family/partner or professionals. It is okay to communicate what you are feeling. This $%%#s
Avoid anything that makes you feel ineffective as a parent, including advice from people, books and the web that do not apply to you or your baby. People on social media are probably faking it anyway!
Find the helpful help: Who can relieve you for a bit to give you time to sleep, eat, take a bath or do anything else you like-no strings attached?
Your crying baby will survive perfectly well, being placed in a safe crib while you take a ten minute shower.
The migraine connection
Interestingly, recent evidence suggests there may be a relationship between infant colic and migraines. Mothers with migraine are more likely to have a colicky infant, and colicky infants are more likely to grow up to have migraines as adolescents.
If there is a family history of migraine, it is possible that migraines could be playing a role in your baby’s colic. If there is a family history of colic, think about things like how to limit light and sound stimuli etc during the evening "witching hours".
Make sure there is nothing poking
If you have a baby who is taking it up a notch and actually seems to be way fussier than usual, check to see if there is something obvious that is bothering them. Do a quick head to toe exam. Make sure there is nothing poking them, like a diaper that is too tight or a hair wrapped around a finger or toe.
When to worry
If you have a baby crying steadily for longer than an hour without reprieve (gas pains can be sharp and sudden, but usually there will be some calm moments in between waves
If the belly seems rigid or markedly distended
If they are not gaining weight
If they’re projectile vomiting all their feeds. Projectile is usually 3 feet away or more (think exorcist)
If they have any bright green or bloody vomit at any time (check mom’s nipples for any bleeding before you freak out, that is the more common cause)
If they aren’t making 5 wet diapers per day (after the newborn period)
If they have a fever and they’re under 3 months of age
If they are breathing fast (over 60 breaths per minute) and seem distressed
If their skin seems to be changing color
If they are refusing all feeds
If you have given everything on the list a try, there are no worrying signs as above, and your baby is still very uncomfortable, I would suggest that it is still worth an office visit with your primary pediatrician.
Let them know what you have tried so far
Take note of the time of day at which the fussiness is the worst, and the relationship to feeding time (before? after?).
Count the number of poops per day and be able to describe what they look like.
Counting pees isn’t always relevant after the first week or two, but that might become important again when getting checked out for colic.
If you’re feeding by breast, observe your diet to see if there is a correlation with different dishes (see above for common culprits).
As with everything, this stage will pass. Enjoy the calm moments.
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