This is the eighth and final part in our series, a guide for new parents and how to take care of your baby. This section focuses on wind, colic, reflux and silent reflux in babies.
Regardless of how old your baby is, how babies cope with their environment and respond to the new experiences of their new life is dependent on their temperament. While some babies are extremely sensitive to external change, others are less so.
Many parents are all too familiar with this scenario: a peaceful baby will suddenly erupt into inconsolable crying in the early weeks, either woken out of sleep, unable to get to sleep or unable to settle.
From here, parents need to figure out: why is my baby crying? What are they telling us and how do we respond?
As you get to know your baby, you will begin to learn what each cry means and what your baby’s common ‘trigger points’ are. If your baby begins bawling, go through this process of elimination:
- Hunger. Parents too often make the mistake of rushing in to offer a feed as an immediate panacea to the crying. Instead, consider the time of your baby’s last feed and how well they fed before concluding that your baby is hungry.
- Overtired. Babies, when simply overtired, can do nothing else to tell us except cry inconsolably.
- Too hot. Babies can become quickly overheated. If you suspect this may be the case, consider room temperature and the amount of clothing that your baby is wearing.
- They are overwhelmed. The number of external stimuli from daily life, and to which a baby has to adjust in the early weeks, can often overwhelm babies. Try taking your baby into a quieter, less brightly lit room and offer a cuddle and some gentle soothing reassurance. If they seem inconsolable, consider some ‘skin to skin’ time to help quieten them down.
- Uncomfortable nappy. Your baby’s nappy may have quickly become quite full or may have been fastened a little too tightly.
- Unused to the crib. A baby may simply not be able to settle in a crib to sleep.
Wind, colic and reflux in a baby
Wind, colic and reflux in babies can be the cause of crying bouts, making them a cause for concern in parents.
The first step to fixing the problem is to first know the cause; whether or not your baby is crying due to wind, colic or reflux. However, what is the difference between them? And how can you best manage the symptoms?
Wind in babies
Wind is an accumulation of trapped air inside the upper digestive tract. Air gets trapped here when babies feed too rapidly, gulping down lots of air along with the milk they consume. There are three main ways this can happen:
- Some babies are inclined to feed very rapidly, gulping down as much as they can in one mouthful;
- Sometimes the breast milk flow is very fast;
- The bottle teat size is too large or too small, which can cause gulping during feeds, increasing the potential for wind.
How can we help?
- Try different feeding positions to assist your baby to remain in an aligned position when feeding, holding them semi recumbent or in a fairly upright position (top tip: look up the ‘koala position’ for slightly older infants). Seek guidance from your midwife, health visitor, lactation consultant or breastfeeding support group on the variety of feeding positions and try a few out.
- Allow your baby time to rest and ‘draw breath’ a few times mid-feed, especially if they are fast feeders.
- Get familiar with various mid and post feed winding positions. Either hold your baby upright, or do a gentle circular rotation of your baby as you hold them securely on the end of your lap to help pass wind. Here, seek guidance and use manuals with explicit diagrams. There are a number of options and babies vary in which one works best for them. Time and your developing experience will help.
- Don’t lay your baby straight down after a feed. Allow some upright or ‘semi-reclining’ time.
- Use a proprietary product such as ‘infacol’ or ‘dentinox colic drops’ to help the wind bubbles ‘accumulate’, making it easier for the baby to ‘burp and release’. If used, this should be given at the start of each main feed.
- Use gripe water from four weeks of age.
- Keep a food diary to see which foods your baby may be sensitive to. If breastfeeding, some foods that you eat can increase wind symptoms in your baby, such as pulses, acidic fruits, onions, garlic, wheat, grains or dark, leafy green vegetables.
- Lactose intolerance. Although this is much less common, lactose intolerance is attributable to the baby being unable to process the lactose present in breastmilk or in formula milk. In some cases, there are insufficient amounts of an enzyme called lactase in a baby’s body, the enzyme responsible for helping your baby break down the lactose. If you suspect your baby is lactose intolerant, consider giving your baby ‘colief’, a product which replicates the lactase in the milk, which can be given either in formula milk or breastmilk. However, it is always best to consult with your health visitor or pharmacist before taking action.
- Breastfeeding mums could consider removing all dairy products from their own diet, although this can take up to 3 weeks to show any results. For formula fed babies, lactose-free milks are available as an alternative. For best advice, consult your health visitor, pharmacist or GP to find the best course of action for you and your baby.
- Cow’s milk protein intolerance. As mentioned above, this would also require eliminating dairy products if breastfeeding, as outlined earlier. There are infant milks available which have the milk protein structures that trigger this intolerance either modified or eliminated. Again, consulting a healthcare professional is always advised.
- Infant probiotics are recommended by some practitioners. Discuss this with your health visitor, GP or pharmacist before taking action.
Always be alert for any additional symptoms which may suggest that medical assessment is required, such as:
- Bowel changes, for instance, a change in colour or consistency
- Weight loss
- Reluctance to take full feed
Soya milks are rarely indicated for infants, and only ever suggested under the direction of a paediatrician.
Colic in babies
There are some things to establish before diagnosing your baby with colic:
- Sometimes a baby is diagnosed with colic because they become extremely fractious each evening. It should be acknowledged that many babies that appear irritable during the early evening may simply be overtired, overstimulated from the day and in need of a ‘wind down’, which is why establishing a bedtime routine is so important.
- It is debatable as to whether colic is actually a diagnosis or rather more a ‘blanket term’ for a collection of symptoms. One theory is that ‘colic symptoms’ are an accumulation of gas in the large intestine (bowel) rather than the upper digestive tract.
- More recently, it is being considered that these ‘colic symptoms’ may be due to ‘the 4th trimester’ theory. This theory states that some physiological systems of a baby, the digestive system being one of them, are still under-developed at full term birth and require a further 3 months (or the ‘4th trimester’) to fully mature.
So, does ‘colic’ actually exist? Clinical opinions are divided. One thing is for sure: a baby in digestive discomfort is deeply unhappy. With wind, once you have established what resolutions work with your baby, things are usually resolved quickly. However, colic symptoms can be indicated by the following:
- A more persistent and sharp cry, often involving the drawing up of legs into the tummy in a series of ‘spasmodic’ episodes
- The baby goes red in the face during these spasms
- The cry is unrelieved by simple winding methods or Infacol
Reflux in babies
Reflux in babies is generally recognised as ‘regurgitating milk’, also known as ‘spit up’, ‘possetting’, or just a ‘sicky baby’. In general, if a baby is gaining weight in line with their centile pathway, is thriving and and otherwise happy, treatment may not be needed unless they become symptomatic, for instance if the baby shows signs of discomfort from the repeated reflux of stomach contents containing gastric acids, or faltering weight gain. The majority of babies experience some reflux without developing any associated symptoms.
‘Silent reflux’ in babies
Silent reflux is an associated condition which has only become recognised and acknowledged in more recent years.
How does silent reflux manifest in a baby?
To return to the 4th trimester theory, an ‘immature infant gut’ allows some ‘backflow’ of feeds which result in partial regurgitation of milk. While no vomiting is usually seen, gastric contents are still able to flow back some way and enter the oesophagus. Although some babies remain asymptomatic, reflux, silent or otherwise, can cause irritation to the esophageal lining.
The most common symptoms of silent reflux are:
- Feeding disturbance, where the baby is keen to feed but quickly pulls off breast or teat. This is due to the initial sucking relieving symptoms, but the pain that follows forces the baby to pull away;
- Chronic irritability;
- Frequent hiccups;
- Chronic cough or congestion (noisy breathing) not associated with any other cold symptoms, which can seem worse at night;
- The baby appearing fretful when laid down in their back;
- Sleep disturbance;
- The baby may gulp or sound as though they are about to vomit but nothing comes up;
- Often, these symptoms have begun to manifest by around 3 weeks
Sometimes only one or two of these symptoms may be present, but it is useful to keep a symptom diary for a few days before liaising with your healthcare team to discuss management options.
This blog is the final in our ‘A New Parents' Guide to Baby Sleep and Routine’ series.
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