Colic in the Breastfed Baby

by Jack Newman, MD, FRCPC

Here's What You'll Find Below:Should I offer both or just one breast per feeding?
Help, baby's drowning in breastmilk -- overactive Letdown reflex
Are some proteins in my diet bothering my baby?
Should I limit time at the breast?

Colic is one of the mysteries of nature. Nobody knows what it really is, but everyone has an opinion. In the typical situation, the baby starts to have crying spells about two to three weeks after birth. These occur mainly in the evening, and finally stop when the baby is about three months old (occasionally older). When the baby cries, he is often inconsolable, though if he is walked, rocked or taken for a walk, he may settle temporarily. For a baby to be called colicky, it is necessary that he be gaining weight well and be otherwise healthy. However, even if the baby is gaining weight well, sometimes the baby is crying because he is still hungry. See below.

The notion of colic has been extended to include almost any fussiness or crying in the baby, and this is not surprising since we do not really know what colic is. There is no treatment for colic, though many medications and behaviour strategies have been tried, without any proven benefit. Of course, everyone knows someone whose baby was "cured" of colic by a particular treatment. Also, almost every treatment seems to work, at least for a short time, anyhow.

The Breastfeeding Baby with Colic

Aside from the colic that any baby may have, there are three known situations in the breastfed baby that may result in fussiness or colic. Once again, it is assumed that the baby is gaining adequately and that the baby is healthy.

Feeding both breasts at each feeding or feeding only one breast at each feeding

Human milk changes during a feeding. One of the ways in which it changes is that, in general, the amount of fat increases as the baby drains more milk from the breast. If the mother automatically switches the baby from one breast to the other during the feed, before the baby has "finished" the first side, the baby may get a relatively low amount of fat during the feeding. This may result in the baby getting fewer calories, and thus feeding more frequently. If the baby takes in a lot of milk (to make up for the reduced concentration of calories), he may spit up.

Because of the relatively low fat content of the milk, the stomach empties quickly, and a large amount of milk sugar (lactose) arrives in the intestine all at once. The enzyme which digests the sugar (lactase) may not be able to handle so much milk sugar at one time and the baby will have the symptoms of lactose intolerance -- crying, gas, explosive, watery, green bowel movements. This may occur even during the feeding. These babies are not lactose intolerant. They have problems with lactose because of the sort of information women get about breastfeeding. This is not a reason to switch to lactose-free formula.

It is also very important that you realize that a baby is not drinking milk from the breast just because the baby is making sucking movements on the breast. He may be "nibbling" not drinking and therefore the baby is not getting higher fat milk just because he is on the breast and sucking.

1. Do not time feedings. Mothers all over the world have successfully breastfed babies without being able to tell time. Breastfeeding problems are greatest in societies where everyone has a watch and least where no one has a watch.