Colic and reflux are two words you will hear often when you have a baby and they can be quite foreboding for a new parent. If your baby is bringing up milk after a feed, is crying and grizzly, won't settle to sleep and appears to be in pain then the go to conclusion is often that your little one has colic and or reflux. Whilst they do often occur together there is a difference between the two conditions.
The difference between colic and reflux
Colic usually occurs between the ages of 6 weeks to 6 months and is defined by a baby crying for several hours a day when there is no obvious cause. This usually occurs at the same time of day, very often in the evening. Colic is caused by waves of pain caused by excessive air causing distention in the bowel and occurs in about 20% of babies.
Reflux on the other hand is the movement of fluid, food and sometimes acid from the stomach back up into the oesophagus known as acid reflux. This is very common in young infants and can be due to overfeeding, weak abdominal muscles, a slow digestive system or a weak or immature esophageal sphincter. This more often than not results in your baby bringing up milk regularly after a feed and 50% of all infants experience some sort of reflux at some point.
Can reflux cause colic in babies?
Reflux can not cause colic in babies. Reflux is often a symptom that shows itself in conjunction with colic, but the two conditions are very different. Colic is not a medically defined condition, but rather the name given to a group of symptoms a baby might be showing when in pain due to excessive wind or gas in their immature digestive system.
Reflux on the other hand is a medically diagnosed condition and the way in which it is treated will depend on the age of the child and the severity of the symptoms.
How can you tell if your baby has colic?
Colic will often appear out of the blue just as you have started to settle your baby into some sort of routine and you yourself are feeling as if you have finally got everything under control. Then suddenly your usually calm and happy little one starts wailing and screaming with a red face and clenched fists and you can't for the life of you work out what is wrong. If this is happening at roughly the same time of day and lasting for approximately 3 hours your baby could be experiencing colic.
Common symptoms of look out for are:
- Crying and prolonged periods of time at the same time of day. Often late afternoon and early evening.
- Your baby is difficult to calm and sooth in the normal way
- There are no obvious causes for the crying as in nappy is clean and baby has been fed
- Your baby may pull up their legs and clench their fists and go red in the face
- He may pass wind or bring up some milk
- Their tummy may gurgle and rumble
- Eating and sleeping are disrupted with your baby sucking then stopping and crying or falling asleep for short periods then waking up screaming.
Causes of Colic
There is no way to avoid colic in babies but there are a few reasons why it may occur.
- An immature digestive system
- Gastroesophageal reflux
- Overstimulated senses
- Food allergy or sensitivity
How to treat colic in babies
Colic is not a disease but a diagnosis and only the passage of time will see it end. However, there are as always, things you can do to help ease the symptoms and help you hold on to your sanity in the process. Some of these tips and remedies will require some trial and error, but doing something positive towards helping your baby at this point will help you deal with the situation far better.
Feeding and Winding
If you are breastfeeding and your baby shows signs and symptoms of colic then try and keep track of what you are eating, as that may be having an impact on your baby's digestive system. Avoid such stimulants as chocolate and caffeine, nuts and dairy products which your baby may be allergic to. Other foods such as cabbages, onions and spicy foods may also be restricted to avoid irritation to your baby's bowel.
When is comes to bottle fed babies you can try changing the brand or formula you have been using as some babies are sensitive to different proteins. You could also try feeding little and often. If your baby is a speedy eater try a teat with a smaller hole to slow them them down, however this can be counter productive as in some cases the slower flowing teat will cause them to swallow too much air, so a faster flowing teat will work better. It really is a case of trial an effort to see what helps your baby with regard to teats. You could also try one of the bottles on the market specifically designed to help with colic. Ideally a feed with winding should take around 20 minutes so this should give you an indication if your baby is feeding at the correct rate.
It is very important to wind your baby properly in the middle of a feed and at the end, as any trapped air will be a potential time bomb later on. Some babies wind more quickly than others and the simple movement of moving them from your lap to your shoulder will do the trick. However other babies are not so easy to wind and you will need to find a position that works for them which is usually over your shoulder, sitting on your lap or lying across your lap.
Sitting on your lap
Sit your baby on your lap facing away from you and place the palm of your hand flat against their back whilst you support their chin. Whilst leaning your baby forward slightly rub or pat your baby's back. You can also try rocking your baby gently backwards and forwards whilst in this position pivoting them at the hip. This is a trick I learnt from a Matron on the ward at Queen Charlotte's Hospital during my training and I often found it works in winding and generally calming young babies.
Over your shoulder
Rest your baby's head on your shoulder and support the head and shoulder area with one hand. With the other hand rub or pat baby's back. You may find walking around helps.
Lying across your lap
Some babies will find winding easier in this less conventional position. Lay your baby face down across your lap supporting their chin then gently rub or pat their back with your free hand.
The Colic Hold and Massage
Another way to wind your baby that sometimes has good results is the colic hold or aeroplane hold. Lie your baby face down along the length of your outstretched forearm and gently rub or pat their back.
If your baby won't burp with any of the above methods you could try lying them on their back and massaging their tummy in a circular movement and or moving your baby's legs back and forth in a bicycle riding movement.
The position in which you feed your baby can also be helpful in dealing with a colicky baby. Aim to keep your baby as upright as possible.
Rocking, swinging and shushing
Colicky babies often respond to being rocked or swung. A swinging or rocking motion reminds them of the type of movement they were used to in the womb. You can rock your baby yourself or put them in a baby swing. Colicky babies will often respond well to the motion and find it calming. Making a shushing noise while you are rocking your baby can also help to calm the crying.
Swaddling your baby can also help. The pressure of a swaddle and its cocoon like feeling can calm a baby suffering from colic as it makes them feel safe and avoids them becoming over stimulated.
White noise has been proven to calm babies in distress from colic. If you don't have white noise machine the hum of a hair dryer or a fan can do the trick. However, a white noise machine is a great investment not just for helping to calm a colicky baby but as a great aid to helping your baby to settle to sleep in general.
Sometimes a warm bath will help your baby if they are in discomfort caused by colic.
Offer a dummy
Some colicky babies want to suck all the time and as feeding them continually would only make the situation worse offering a dummy may be the solution to calming them.
Get out of the house
A change of scenery is sometimes helpful if your baby will not stop crying. Some babies are soothed by a walk in their pram or a ride in the car but more often than not may start crying again once the movement stops.
Spinal manipulation or cranial osteopathy
Cranial osteopathy for baby's suffering from colic has been proven to be helpful as it is believed that some babies have reduced neck movement from a difficult birth or their position in the womb. The treatment involves age appropriate soft tissue release around the head to help with swallowing and winding.
It is possible that massage can help with your infant's colic. It can also help your baby's digestion by helping to move trapped wind and poo. There are some excellent books and online courses endorsed by paediatric physiotherapists that can guide you through the massage process.
Both of the above remedies are worth trying if all else fails, but they do require some expert instruction or need to be carried out by a qualified professional. Always consult with your doctor before proceeding with these treatments.
Avoiding Overstimulation and over tiredness
If you suspect your baby is suffering from colic due to bouts of inconsolable crying in the late afternoon or early evening, you may want to check that they are not becoming overstimulated and over tired.
In some cases infant colic may not be the culprit for your baby's crying, but if it is ensuring that they do not become overtired will definitely help.
An overtired and overstimulated infant will exhibit a lot of the symptoms of having colic such as the high pitched wailing, clenched fists, redness in the face and acting as if they are in pain. They will be difficult to settle and if they do drop off will often wake again quite soon after.
I always advocate a healthy sleep routine for young babies to include plenty of age appropriate sleep during the day (remember sleep breeds sleep) and a regular bedtime routine that is a definite calming down process at the end of the day with no over stimulated activities. Calm and quiet is the key at this time of day with time to wind down and be ready for sleep.
Learning to spot sleep cues will help you make sure your baby has enough sleep at appropriate times in the day and ensure they do not become over tired.
In some cases sticking to a healthy sleep schedule as described may fix the bouts of early evening crying and you may discover that your baby did not have colic after all.
How can you tell if your baby has reflux?
Reflux can often occur in tandem with colic or on its own. Reflux however usually starts around 8 weeks old and can go on until a baby is 1 year old and is more common in premature babies. Most babies will bring up a little milk after a feed especially when they are very young but in some cases it can be more of a problem.
Common symptoms of when reflux might be an issue are:
- Bringing significant amounts of milk up or being sick after a feed
- Coughing or hiccuping when feeding
- Unsettled and fidgety during feeding
- Swallowing or gulping after being winded or fed
- Not gaining weight as they should
- Crying and not settling
- Abnormal arching of the body
It is not usually necessary to seek medical advice if your baby has reflux unless it is so severe that they are not gaining weight. It is also rare for reflux to continue in children past their 2nd birthday but if it does it may be a sign of infant gastroesophageal reflux disease which will require medical attention.
How to treat reflux in babies
Reflux can be very distressing for parents as our desire to feed our children and see them flourish is a basic instinct that drives us all. Seeing your little one being sick continually after a feed and in distress is not easy. Apart from riding this period out and waiting patiently for it to pass there are some things you can try to ease symptoms.
Feed Little And Often
If your baby is experiencing reflux then it may help to try feeding them less milk more often . With a small stomach and immature esophageal sphincter over filling the tummy will lead to milk being brought up.
Bottles and teats
The flow at which your baby takes in milk may aggravate reflux so make sure the teat is not too fast flowing as taking in too much milk too quickly will cause your baby to bring up some of his feed.
Making sure that you wind your baby during and after feeds to get rid of any excess air. Keeping your little one upright for 30 minutes after a feed especially before bedtime will allow the milk to settle in his system before laying down.
Some babies have an allergy to cow's milk that can cause them to be sick after a feed and you should contact your doctor if your baby is also suffering from any of the following symptoms in addition to bringing up milk.
- proper vomiting or projectile vomiting
- coughing or wheezing
- a rash
If CMA is diagnosed then your doctor will advise what formulas to try in order to manage the condition.
Sleep as I am always saying is important for both you and your baby, so despite your concerns you should stick to the bedtime routine as your baby will find it calming and therefore easier to settle. Remember to allow enough time after a feed before putting your baby down. Rocking your infant in a upright position until they are drowsy and almost asleep can help sooth them and lesson the symptoms of reflux.
You may be tempted to not put your baby on their back to sleep if they have reflux but you should not do so unless recommended by a medical professional. You could try raising the head of the crib slightly but again I would advise getting medical advice first.
There is no scientific evidence that thickening feeds can help with reflux however I do know that it appears to have worked for some parents in easing symptoms. The principle is quite simple in as much that thicker feed is taken in more slowly and stays in the stomach more easily. There are special thickeners on the market that can be used, however you should not give thickened feeds without consulting a doctor first and you should not thicken feeds if your baby is gaining weight and thriving, despite bringing up milk regularly.
There are some herbal remedies on the market for both colic and reflux and some may work. However, lifestyle changes and the tips I have suggested should be tried first and I would not recommend taking any form of medication herbal or otherwise to treat colic or reflux without the consent of your medical practitioner.
Does 'Colic Calm' help with reflux?
The exception to the above may be Colic Calm. This is a homeopathic gripe water that is aimed at relieving the symptoms of infant colic, wind and reflux. Many parents and midwives swear by its efficacy, so if you have checked with your doctor and they feel it is fine for you to try it then I would see no harm in giving it a try. Whereas most other gripe waters are made from herbal oils or extracts, Colic Calm is made with natural active ingredients. The homeopathics in Colic Calm are administered in small doses which stimulate the body's own self healing properties which is very helpful in babies with immature digestive systems.
When to seek medical advice
If your baby starts to have reflux after the age of 6 months or carries on having symptoms beyond 1 year old then you should seek medical advice. Under six months you should get advice if your baby is experiencing any of the following symptoms.
- Often has projectile vomiting
- Brings up a lot of milk after every feed
- Coughs or gags while feeding
- Has green or yellow vomit
- Has blood in vomit
- There is blood in his stool
- Has a swollen tummy
- Starts to refuse feeds
- Has a fever over 38C
- Is not gaining weight
- Is arching his back during feeds and in general discomfort
Looking after yourself
Dealing with an infant with colic and or reflux can be extremely trying and exhausting. You can often feel helpless in easing your baby's discomfort and just riding it out can seem endless. Getting an infant to sleep and into a healthy sleep routine is a challenge at the best of times and colic and reflux can just make this more difficult. Therefore, it is very important that you take care of yourself during this time.
If your baby is being sick often you will need to change them more often too so make sure you dress them in easy to change clothing. In other words not too many buttons and fiddly fastening. Easy to put on and easy to take off clothes are the best for this stage, as well as ones that are easy to wash. It is advisable to have plenty of changes of this type of clothing in order for you to not worry about running out.
Have plenty of muslin cloths on hand and always protect your shoulder and to wipe up any brought up milk. You can not have enough muslin cloths in my opinion.
When you are out and about make sure you have a change of clothing for your little one and a couple of clean tops for yourself packed in your baby day bag. Pale tops show milk stains far less than dark ones and can be added to the baby whites wash easily so make sure your baby bag is packed with all the necessary things you need to deal with reflux mishaps.
Enlist extra help in looking after your colicky baby as it can be very draining if you are the only one soothing your little one. Taking turns with your partner or a relative to try and calm your baby is a good idea as trying to calm a crying baby and failing can be very stressful. If you feel that you are not coping and you are on your own it is OK to put your baby down for 10 minutes even though they are crying and take time out to re group. Don't feel like you are failing if you do this as you will be in a better position to help your baby if you have had a break and return calmer. A baby will pick up on your stress and it will make it more difficult for you to settle or calm them, therefore it is important that you break that cycle.
Talking to other parents who are in the same situation will also help and chatting to medical and childcare professionals can ease your anxiety and help you realise that colic and reflux is not your fault and that you and your baby will come out of it the other side.