Breastfeeding – the Best Diet for you and Your New Baby (part 5) - Colic and cows’ milk

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It can be very distressing if your baby has colic, and you are probably willing to give anything a go. However, before you start avoiding dairy foods, wheat, soya, eggs or any other food, it is important to learn as much as you can about colic and to talk to your midwife, doctor or health visitor. Sometimes improving your baby’s position when feeding can make a real difference. If not, try not to worry unduly. Although feeding is unlikely to be enjoyable and relaxed for either of you, babies with colic generally take just as much milk as others and gain weight normally.

What is colic?

Colic is thought to affect about one in five babies. It is characterised by periods of frantic crying at roughly the same time every day, typically in the early evening. A baby with colic is also likely to draw their knees up to their chest, pass wind and become red in the face. Colic generally appears in the first few weeks and disappears by the time a baby is 3 or 4 months old. If you are unsure whether your baby has colic, it is best to talk to your doctor to rule out other possible causes of distress.

Colic and cows’ milk

In some babies, colic may be the result of lactose intolerance or an allergy to cows’ milk. These may sound very similar, but they have quite different causes and should be treated differently.

Lactose intolerance

This is a sensitivity to the sugar (lactose) found in milk, including formula and breast milk. If a baby doesn’t produce enough of the enzyme lactase, he or she is unable to break down the lactose sugar in the small intestine. The lactose therefore passes into the large intestine, where it is fermented, producing hydrogen and methane gases and discomfort. If your baby is receiving formula, your health visitor may suggest switching to a lactose-free or low-lactose formula. Breast milk contains lactose irrespective of what you eat, so cutting out milk and dairy foods from your diet won’t help: your body will still produce lactose for your milk. What you can do, however, is give your baby lactase, for example Colief®. This shouldn’t be given to your baby directly but should be added to a small amount of expressed milk. Your baby can then be given the milk from a spoon or cup, before being put to the breast as normal for a feed. The problem is often called ‘transient lactose intolerance’, because babies generally grow out of it. Once your baby is 3 to 4 months old, he or she should be producing sufficient lactase to digest the lactose so you won’t need to supply additional lactase.

Allergy to cows’ milk

This is an immunological response to the proteins that the milk contains. These are found in most formula milks, as these are based on cows’ milk. The proteins are also present in breast milk if the mother consumes cows’ milk or any dairy products such as yogurt and cheese. If your baby is receiving any formula, then switch to a hypo-allergenic variety. The only way to ensure that your baby does not receive cows’ milk proteins from your breast milk is to remove all cows’ milk products from your diet. Your doctor or health visitor will be able to advise you on how to do this, and how and when to try reintroduction, possibly in a clinic.

Other causes and cures

In reality, there is usually no cure for colic. However, several strategies may help to ease the symptoms of colic. No one really knows the cause of most cases of colic, but some research suggests that the baby’s immature digestive tract could have difficulty coping with milk; as a result, the baby suffers from cramps. Colic may also be due to the baby swallowing air bubbles when he or she feeds or cries. To help minimise this, try to sit your baby as upright as possible during feeding rather than lying him or her flat on their back, and burp your baby well. The drug simeticone may also help; this is an anti-flatulent, which changes small bubbles of air in your baby’s intestine into larger bubbles that are easier to burp up. Simeticone has been used for years and is readily available from pharmacists, for example as Infacol®. It may also help if you breastfeed your baby on the same side until he or she has definitely had enough milk; switching from one breast to the other before your baby’s got enough of the high-fat hind milk may mean that he or she feeds more to compensate, meaning that your baby has a larger volume of milk to cope with and more lactose than he or she can handle comfortably.

Sometimes women find breastfeeding so stressful with a colicky baby that they are tempted to stop. You may even wonder whether your baby would do better with a bottle of formula. However, research has shown that formula-fed babies are much more likely to get colic than those who are breastfed.

Adapting your diet may help to relieve your baby’s colic symptoms. Different things seem to affect different babies, but it may be worth cutting out certain foods to see whether the colic is reduced. It is best to try just one dietary change at a time, otherwise you could end up eating a very limited diet and missing out on some nutrients. If, after a week, there is no improvement, go back to your normal diet. If your baby’s symptoms get better, then it might be worth skipping the food for a while, if it is something you can live without, such as tea or onions. However, if it is a key food, such as fish or dairy products, then you should try gradual reintroduction or look for alternative sources of the nutrients that you will be missing. It may be that you just need to eat less of the trigger food, or to eat it in a different form. For example, if milk is the problem, you may find that if you have a smaller amount of milk, or consume milk as part of another cooked dish, then it is OK.

Here are the foods most commonly suspected of causing or aggravating colic:

  • tea and coffee;
  • alcohol;
  • cruciferous vegetables such as broccoli, cauliflower and cabbage: these may encourage the production of wind;
  • cows’ milk and milk products, such as cheese and yogurt;
  • wheat and corn;
  • fish;
  • eggs;
  • onions;
  • chocolate;
  • citrus fruit.

The whole area of diet causing adverse effects in breastfed babies is quite complicated, and guidelines are still evolving. Whether it is colic or some other unwanted symptoms, it really is best to get professional help from your GP, health visitor or state-registered dietician.

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