What can be done?
If you have not already done so, try feeding the baby one breast/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.
Feed the baby before he is ravenous. Do not hold off the feeding by giving water (a
breastfeeding baby does not need water even in very hot weather) or a
pacifier. A ravenous baby will “attack” the breast and cause a very active
letdown reflex. Feed the baby as soon as he shows any sign of hunger. If he is still half
asleep, all the better.
Feed the baby in a calm, relaxed atmosphere, if possible. Loud music, bright lights and
lots of action are not conducive to a successful feeding.
Lying down to nurse sometimes works very well. If lying sideways to feed does not help,
try lying flat on your back with the baby lying on top of you to nurse. Gravity helps
decrease the flow rate.
If you have time, express some milk (an ounce or so) before you feed the baby.
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.
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.
On occasion giving the baby commercial lactase (the enzyme that metabolizes lactose),
2-4 drops before each feeding, relieves the symptoms. It is available without
prescription, but fairly expensive, and works only occasionally.
A nipple shield may help, but use this only if nothing else has helped and only if you
have gotten good help without any relief.
As a last resort, rather than switching to formula, give the baby your expressed milk by
bottle.
Foreign Proteins in the mother's milk
It has been shown that some proteins present in the mother's diet may be
excreted into her milk and may affect the baby. It would seem that the most common
of these is cow's milk protein. Other proteins have also been shown to be excreted into
some mothers' milk. The fact that these proteins and other substances appear in the
mother's milk is not necessarily a bad thing. Indeed, it should be considered a good
thing. Ask about this if you have any questions.
Thus, in the treatment of the colicky breastfed baby, one step would be for the mother
to stop taking dairy products. These includes milk, cheese, yogurt, ice cream and anything
else which may contain milk. When the milk protein has been changed (denatured), as in
cooking for example, there should be no problem. Ask if you have any questions.
Please note: Intolerance to milk protein has nothing to do with lactose
intolerance. A mother who is herself lactose intolerant should also still breastfeed her
baby.
Suggested Method:
The mother should eliminate all milk products for 7-10 days.
If there has been no change, the mother can reintroduce milk products.
If there has been a change for the better, the mother should then slowly reintroduce
milk products into her diet, if these are normally part of her diet. (There is no
need to drink milk in order to make milk). Some babies tolerate absolutely no milk
products in the mother's diet. Most tolerate some. The mother will learn what amount of
dairy products she can take without the baby reacting.
If there is concern about your calcium intake, calcium can be had without taking dairy
products. Ask if you have any questions. One week off milk products will not cause any
problems. Actually, evidence suggests that breastfeeding may protect the woman against the
development of osteoporosis even if she does not take extra calcium. And the baby will get
all he needs.
The mother should be careful about eliminating too many things from her diet. Everyone
will know someone whose baby got better when the mother stopped broccoli, beef, bananas,
bread etc. The mother may find that she is eating white rice only. Our diets are too
complex to be sure exactly what, if anything, is affecting the baby.
Be patient, the problem usually gets better no matter what. Formula is not the
answer, though, because of the more regular flow, some babies do improve on it. But
formula is not breastmilk. In fact, the baby would also improve on breastmilk
from the bottle because of the regularity of the flow. Even if nothing works, time
usually helps. The days and nights may seem eternal, but the weeks will fly by.
by Jack Newman, MD, FRCPC
