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Colic – What, Why, and How to Make it Better!
A wise old doctor once told me that if you want to feel like an expert, just read one book. But if you want to realize that we are all NOT experts – read them all! Colic is one of those areas where the theories are many and the cures few. It is not a simple entity, and it’s not merely gases. Colic is a scary stage or phase that a significant amount of babies (and in turn families!) go through.
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Depending on how you define it, perhaps up to 20% of babies go through some degree of colic. Colic is perhaps a maturational phase of the intestines. Some babies are born without intestines fully ready to break down their nutrition into its constituents. Clearly it was easier when baby was inside you! She got her nutrition from your veins, and the gut was never asked to digest any nutrition – whether breastmilk or formula – into amino acids, carbohydrates and fats. Colicky babies look uncomfortable, and they twist, and turn and cry…loudly! Parents often come in to the pediatrician asking if something else is wrong, and indeed colic is a diagnosis of exclusion. We can’t miss other conditions, such as infection, milk allergy or more serious conditions when a baby is so irritable. But colicky babies are not irritable ALL the time – it just seems that way. They are often happy and can smile and eat well – only to have a colicky episode that can last for over and hour – and then return to normal.
Usually, the colicky phase starts between 2 and 6 weeks, and is over by 12 to 14 weeks. That doesn’t seem all that long, but it can seem forever when your baby is wailing for no apparent reason! We have tried many cures – from gripe water, to Humphries (very dangerous!), and nothing seems to work. Mylecon drops can help a little, and are safe, but I prefer to try non medical approaches. I find “The Happiest Baby on the Block” to have a very nice summary of why a baby might be colicky and how to alleviate their discomfort. The sushing and swaying is helpful for a colicky baby, as are dimming the lights and lowering your voices. Rubbing the intestines from right to left and bicycle kicks are also helpful. I don’t recommend changing a woman’s diet. This is a phase that many babies go through, and food allergy presents in different ways than colic. I have seen too many women eliminate milk, then beans, then citrus, spicy foods and gluten…only to get malnourished and cranky themselves! Then, when the colic passes naturally, we finally feel like we have found that magic offending food – but usually it would have passed anyway without depriving mom her favorite foods!
As if sleep deprivation is not enough, having a colicky baby can be very stressful. Try to hang in there as much as possible and do let your support (including your pediatrician) know if you are feeling overwhelmed. There are support groups specifically for colic here in Brooklyn as well. This is not an easy issue to suffer through, but as long as it’s really colic – every baby gets through it and the baby will not suffer any long term consequences.
Nutrition – What to Feed Your Newborn.
There have been numerous well done articles supporting the vast benefits of breastfeeding. We have strong evidence that mom’s milk lowers the risk of all types of infections, decreases allergies, improves maternal-infant bonding and clearly saves a lot of time and money! What new moms may not anticipate is just how much anxiety one can feel in those first days! Breastfeeding is a wonderful natural amazing endeavor – but let’s remember that for new moms going through so many other issues including lack of sleep, hormonal changes and the biggest life changing event ever – it can be a stressful undertaking as well.
Since all babies will lose some weight in those first few days, and mom’s milk is the lower volume (but very nutritious) colostrum those first few days, there is a feeling like you are not giving your baby enough. But unless there is severe jaundice and dehydration, you can indeed get through this first week with 100% breast milk and babies will usually regain their birth weight after 7 to 10 days. Nipple soreness, engorgement, and latching issues should all be fair game to discuss with your pediatrician, but we also have compassionate and amazingly skilled lactation consultants that can really make a difference.
When breastfeeding, it is best to feed on demand. Eventually you will find that baby feeds about every 2.5 to 3 hours, but these first few weeks, all bets are off and you should avoid looking at the clock! You may have a baby that falls asleep every time they start feeding, or another baby that stays on the breast grazing for an hour straight! Just hang in there! Soon enough your baby will feed more efficiently and you’ll get a little break, but in the first month always err on the side of offering the breast. Stay well hydrated, eat healthy, and talk to your doctor about any medicines that you are taking, as most do indeed pass to the baby. Alcohol, and even caffeine can affect the baby, so discuss these issues with your doctor.
Do I need supplements when breastfeeding?
Breast milk has a slightly lower level of iron than formula, but it is much better absorbed, and so you shouldn’t worry about anemia and don’t need supplemental iron. The one thing that breast milk can lack is sufficient Vitamin D. Although not common, enough breastfed babies have developed Rickets, or weak bowed bones. For this reason, we all recommend starting Vitamin D drops at around a month of age. You can get the right amount in a poly- or tri-visol supplement at any pharmacy. But if you only want to give Vitamin D, just drop by the local health food store and make sure it has 400 IU of Vitamin D. Yes – sun exposure helps, but we don’t recommend too much direct sun for a newborn, and I really don’t see any harm (except for the nasty taste!) in giving one milliliter of Vitamin D. I have seen Rickets, and it’s not a fun disease albeit not common either.
Many moms ask about water. There is just the right amount of water in breast milk and formula, so you never need “straight” water unless the baby gets constipated. We want every ounce of nutrition to help baby grow, and water has no calories. Indeed, there have been cases where the kidneys were overwhelmed and a baby got sick from too much water. And juices of course can wait until 6, or even better 9 months as they have a good deal of simple sugars, even when 100% natural.
I feel it’s necessary to point out that formula won’t harm your baby. Sometimes a new mom will confide in me that she feels too guilty here in Brooklyn to admit that she gives her baby formula! Indeed there is no way that a manufacturer will ever duplicate breast milk, but formula fed babies still grow up to be happy healthy people! There is indeed a possibility of nipple confusion if your baby gets too used to the flow of a bottle, as it takes less muscles and is faster. But once your baby has latched well, and is gaining weight, it is not harmful to introduce a pacifier at times, and a bottle (preferable of pumped breast milk, or if not, formula). Many Dads/partners are thrilled at the opportunity to feed the baby, and a flexible baby has its advantages! Indeed, there are many moms in my practice who had to change plans to return to work because their baby absolutely refused to take the bottle, despite all the tricks and twenty different bottles!
Dr. Gilgoff has been working with kids since 1986, and has been a pediatrician since 1996. He is available for same day sick visits, second opinions, well-child care and free prenatal consultations. More of his thoughts can be found at www.drgilgoff.com as well as the mountsinai.org website.
Look for other columns by Dr. Gilgoff:
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