Colic is a poorly understood phenomenon that causes significant distress for both infants and parents. Breastfed, formula-fed, and combination-fed infants can all experience this condition, which typically begins a few weeks after birth. Colic is defined as excessive, unexplained crying in an otherwise healthy and thriving infant. While not a disease, it is a common, temporary issue that generally resolves as the baby matures. Understanding the diagnostic criteria and unique factors related to breastfeeding can help parents identify and manage their baby’s discomfort.
How to Identify True Colic
Colic is distinguished from normal newborn fussiness by its intensity and duration, following Wessel’s Rule of Threes. This rule characterizes colic as crying that lasts for more than three hours a day, occurs for more than three days a week, and persists for at least three weeks. The crying episodes are inconsolable and appear to occur without any discernible cause.
These crying spells commonly happen in the late afternoon or evening, peaking around six weeks of age. During an episode, the infant often shows signs of distress, including a flushed face, clenched fists, and drawing the knees toward the abdomen. Although symptoms often suggest gastrointestinal pain, colic is a diagnosis of exclusion—meaning other medical issues like acid reflux or infection must first be ruled out.
Factors Unique to Breastfeeding
While the exact cause of colic remains elusive, several factors related to the mechanics and composition of breast milk may contribute to symptoms in nursing infants. One potential mechanism involves a foremilk/hindmilk imbalance, often occurring with an overabundant milk supply. Foremilk is the thinner, lactose-rich milk available at the start of a feeding. If a baby fills up primarily on this milk, they may experience lactose overload, leading to gas and digestive discomfort.
Another issue is an overactive let-down reflex, where milk flows rapidly and forcefully. This can cause the baby to gulp, cough, or swallow excessive air during the feed, contributing to intestinal gas and abdominal pain. Furthermore, sensitivities or allergies to certain dietary proteins consumed by the mother can be transferred through breast milk. Cow’s milk protein is the most common potential allergen, but others include soy, eggs, and wheat.
Relief and Management Strategies
Managing colic involves a combination of soothing techniques and, in some cases, temporary dietary adjustments. Soothing methods often focus on recreating the rhythmic sensations of the womb:
- Gentle rocking.
- Swaddling.
- The use of white noise.
- Holding the baby upright during and after feedings to minimize air swallowing.
- Applying gentle pressure to the baby’s abdomen, such as by laying them tummy-down across a parent’s lap.
For a suspected food sensitivity, a short, guided maternal elimination diet can be attempted, starting with the removal of common culprits like dairy. It is advisable to consult a healthcare provider before making any significant dietary changes to ensure proper maternal nutrition. If a food is eliminated, the mother should monitor the baby’s symptoms for up to two weeks before reintroducing the food. Parents should seek immediate professional guidance if the baby exhibits concerning symptoms beyond crying, such as fever, lethargy, blood in the stool, or failure to gain weight, as these may indicate a more serious underlying medical condition.