Colic in the Breastfed Baby

Overactive Letdown Reflex

A baby who gets too much milk very quickly, may become very fussy and irritable at the breast and may be considered "colicky." Typically, the baby is gaining very well. Typically, also, the baby starts breastfeeding, and after a few seconds or minutes, starts to cough, choke or struggle at the breast. He may come off, and often, the mother's milk will spray.

After this, the baby frequently returns to the breast, but may be fussy and repeat the performance. He may be unhappy with the rapid flow and impatient when the flow slows. This can be a very trying time for everyone. On rare occasions, a baby may even start refusing to take the breast after several weeks, typically around three months of age. What can you do?

1. Get the best latch possible. This problem is made worse if the baby is not well latched on to the breast. A good latch is the key to easy breastfeeding. No matter what you are told about how good the latch looks, try to improve on it. Think of it this way: if your chin is tucked into your chest while you are trying to drink you would become overwhelmed by the fast flow very easily. If you want to drink quickly you will throw your head back, chin in the air, and be able to handle the fast flow.

This is the kind of position baby's head should be in while breastfeeding -- his chin deep into your breast, his head in a slightly tipped-back position, his nose away from your breast, and his chin far from his own chest. This position will help him to handle the faster flow of the let down. See the information sheet When Latching and the video clips.

2. If you have not already done so, try feeding the baby one breast per feed. In some situations, feeding even two or three feedings on one breast before changing to the other breast may be helpful. If you experience engorgement on the unused breast, express just enough to feel comfortable. Remember, if the baby wants the second breast, the mother should offer it

3. Feed the baby before he is ravenous. Do not hold off the feeding by giving water (a breastfed baby does not need water even in very hot weather) or a pacifier. A ravenous baby will "attack" the breast and may cause a very active letdown reflex. Feed the baby as soon as he shows any sign of hunger. If he is still half asleep when you put him to the breast, all the better.

4. Feed the baby in a calm, relaxed atmosphere, if possible. Loud music, bright lights are not conducive to a good feeding. Older babies tend to become very distracted as the flow slows down. Using compressions gently at first, and then more firmly as necessary to keep the speed of flow consistent, will often keep baby interested in staying on the breast longer, because he is drinking better.

5. Lying down to breastfeed sometimes works very well. If lying sideways to feed does not help, try lying flat, or almost flat, on your back with the baby lying on top of you to breastfeed, or try leaning back in a chair. Gravity helps decrease the flow rate. Remember, the baby may be frustrated at the inconsistent flow, so it may be necessary to lie down at the beginning when the flow is fast, and sit back up as the milk slows. Babies like the lying down position; they tend not to fuss with slower flow but tend to sleep.

6. The baby may dislike the rapid flow, but also become fussy when the flow slows too much. If you think the baby is fussy because the flow is too slow, it will help to compress the breast to keep up the flow (see the information sheet Breast Compression).

If all else has not made things better:

7. On occasion giving the baby commercial lactase (the enzyme that metabolizes lactose), 2-4 drops after each feeding or between breasts if you give both, relieves the symptoms. It is available without prescription, but fairly expensive, and works only occasionally. It is difficult to understand why it would work, since the enzyme is broken down in the baby's stomach but sometimes it does seem to work.