Is it reflux, colic or could there be something else behind the crying?
Infant colic is regular, excessive crying in an otherwise healthy baby. Colic is actually a process of elimination diagnosis, which means there’s no physiological cause to explain the excessive crying or discomfort and bub is otherwise healthy.
A diagnosis of reflux means that the stomach contents are coming up to the esophagus, and the acidity of the stomach acid is irritating the tissue in the throat. This causes discomfort and sometimes pain, which can lead to extended periods of unsettledness.
The term ‘colic’ can be used loosely though and is often used to describe tummy aches, likely from gas.
A newborn’s tummy is brand new, and hasn’t really needed to do any work before. Milk feeding is (or theoretically, should be) the easiest food for an infant to consume and digest. Unfortunately as we sometimes find out, this isn’t always the case and little tummies can be easily upset, leading to symptoms of colic and reflux.
What could be causing the crying?
- Tummy pain due to gas
- Immaturity of the gastrointestinal tract, leading to discomfort when digesting milk, passing gas or stool
- Tummy pain due to a reaction to something in milk
Trying to figure out the cause can be tricky. Babies with colic cry a lot, babies with gas can cry frequently and babies with reflux cry a lot as well. In some cases, there may be more than one underlying cause for their discomfort.
The lower esophageal sphincter is responsible for preventing the contents of the stomach from coming back up. Generally, infant reflux occurs because the esophageal sphincter is too immature to contract properly. In the same way that a baby’s muscle tone and strength is still developing, so is the esophageal sphincter. As babies grow and they get stronger, they spend more time upright and the symptoms of reflux begin to improve.
The exact causes of colic are still unknown. There are theories, but many colicky babies have no clear underlying causes. Diet during pregnancy and breastfeeding may contribute to symptoms of food sensitivities, leading to colic-like symptoms. Caffeine, nicotine and some medications found in breastmilk are also linked to infant irritability. Full bellies and gas are unfamiliar feelings to newborns, and some babies may actually interpret these sensations as painful or scary.
Symptoms of reflux
- Spitting up or vomiting that seems to cause pain
- Crying and irritability during milk feeds
- Arching the back, pulling legs up
- Poor sleep, due to pain when lying flat
- Refusing to feed, or feeding frequently
- Choking or gagging
- Frequent respiratory tract infections and wheezing
Symptoms of colic
- May settle with effective burping or after passing gas
- If breastfed, baby may be particularly sensitive to beans, brussels sprouts, broccoli, cabbage and cauliflower
- Episodes of inconsolable crying, vigorous kicking, pulling the legs up tightly to the body and making tight fists
- Swollen or distended tummy
- Frequent vomiting after feeding
Conventional treatment of infant reflux typically involves decreasing the acidity of the stomach acid. The reflux still occurs, but it no longer causes any pain because it’s less acidic. However, it’s important to consider the reasons why we have stomach acid in the first place. By the time babies begin eating solid food, their digestive systems rely on acidic stomach acid to help properly break down and digest food.
In regards to colic, it’s important to rule out all possible causes for pain or discomfort. If you’re unsure about a diagnosis of colic, it’s completely fine to seek a second opinion from a different health care practitioner or request a follow up assessment and additional testing. For most babies, making some adjustments to feeding techniques will help ease discomfort until they mature and the symptoms begin to subside.
Quick tips for reflux and colic
- Keep baby elevated where possible, for 20min after milk feeding and during feeding (consider baby wearing)
- Elevate for sleep
- Burp after every feed to decrease the amount of air building up in the stomach. Try tilting bub to their left to effectively move trapped wind
- Keep a symptom diary to discuss with your healthcare practitioner
- If bottle fed, bub may benefit from a slower flow nipple
- Carminative herbs (such as chamomile, fennel, dill). Only use after consultation with a qualified herbalist, as carminatives may worsen symptoms for reflux babies
Addressing the cause
Differentiating between colic and reflux can sometimes be very difficult. Some babies can have both reflux and gas, which can involve different treatment approaches. Carminative herbs are used to relieve gas pain and help it pass. Colic drops and gripe water are common over-the-counter options to treat wind pain, but these can actually make the symptoms of reflux worse for some babies. When considering herbal medicines, professional guidance is always your best option to find the right care and support.
Reflux in breastfed babies can sometimes be explained by a food that the baby is being exposed to through milk. Identifying and eliminating the offending food can help in the management of reflux. Very often, the culprit is coffee (even decaf), but could also be chocolate, dairy, spicy foods, or citrus. Other foods to consider include soy, eggs, nuts, wheat, cruciferous vegetables, or high histamine foods.
Once the culprit is removed, reflux symptoms can subside within a couple of days. Though keep in mind that dairy and soy elimination may take as long as 2 weeks to see a difference. When breastfeeding, it’s important to be very careful when considering eliminating food from your diet. The very last thing we want to do is risk calorie or nutrient deprivation. It is not advised for anyone, especially breastfeeding mums, to undertake an elimination diet without professional guidance.
For formula fed babies, we always review the current formula and if needed, begin trialing other brands of milk alongside digestive support. Different formulas can have varying protein ratios and ingredients. Just because one baby responds well to a particular brand, does not mean that another baby (even a sibling) will have the same positive experience. If changing formulas doesn’t provide any relief, we introduce herbal medicine and nutrient therapy.
A final thought
The use of evidence based naturopathic medicine can help to improve digestive function, soothe pain and finally bring some much needed relief. Herbal and nutritional therapy can be used safely and effectively alongside other healthcare modalities and pharmaceutical medicines, there’s no need to choose one approach over another.
I realise that naturopathic medicine is uncharted territory for many families, particularly in the area of children’s health, which is why I offer 15min discovery calls prior to an initial appointment. If this article has done nothing but raise more questions than answers, please feel free to get in touch!
Supporting children and their grownups.