Tuesday, August 19, 2008

Your Baby Does Not Have Colic!

A colicky baby is a parent's nightmare. It hits right at your core to not be able to soothe your baby, and to watch helplessly while they cry inconsolably for several hours a day. We went through this with AB starting when he was around 4 weeks old. It was incredibly stressful and tiring. At my wits end, I finally consulted my pediatrician for some help. Fortunately, our pediatrician was able to diagnose and treat the underlying cause. It turns out that a lot is now known about colic, and a large percentage of "colicky" babies can now be treated.

"Colic" is not really a diagnosis. *Something* is wrong with the baby. Otherwise they would not be screaming and crying in pain. This pain is not in their imaginations! It's just that until recently, it was unknown what was wrong with them, so they diagnosed them as "colicky". The best they could do was to advise the parents on soothing techniques, warn them against shaking the babies, and tell them to get "extra" help so that they could cope better.

Fortunately, doctors are learning more and more about the underlying causes of colic and fewer and fewer babies now fall into the "unknown" category which is colic. Hopefully, there will come a day when all the causes are understood and no baby will ever again be diagnosed with "colic".

Here's what my doctor told me about "colic" i.e. babies that cry a lot. There are 4 basic categories:
1) milk protein allergy
2) reflux
3) gas
4) unknown = colic

1) There is a protein in cow's milk that the baby is unable to break down. Eventually, this causes in micro-tears in the intestine and results in blood in the stool. This is not the same as lactose intolerance. *Any* dairy product that the mom eats will result in these proteins being passed onto the baby. There are two remedies: a) mother cuts *all* dairy from her diet, b) put infant on a milk-free formula. The test for this is to test for blood in the stool. Your doctor can do this test by taking a stool sample. If there is *not* blood in the stool, this does not mean that the baby does not have the allergy, it just means that the problem might not be bad enough yet to detect. If there is blood in the stool, then this is a positive diagnosis and you have to proceed with remedy (a) or (b). Other symptoms of this are constipation and increased gas (but these don't always occur). If there isn't blood in the stool, then you can try (a) or (b) to see if it helps the "colic". Remedy (a) takes several weeks (3 weeks or so) to see results, and remedy (b) takes 3-7 days. The problem with remedy (a) is that it takes so long to see results, and in the mean time, the baby suffers. Also, in my experience, it is very difficult (or nearly impossible) to achieve (a). My best friend was able to do it by going completely vegan + meat, but she was emaciated in the process. Even the slightest bit of added butter in a loaf of bread would cause the baby's symptoms to return. The problem with remedy (b) is that the formula is *super* expensive (nearly 2x the cost of regular formula). Also, if you want to try (b) out, then you have to keep pumping for the trial period so that if this isn't the problem, you can go back to breast feeding. Both of these are difficult, so I recommend saving diagnosis (1) until after you've ruled out diagnosis (2) and (3).

2) Reflux: some babies have more acid in their spit-up than others. This causes burning in the esophagus and thus discomfort. This has nothing to do with the volume of the spit-up, just the acidity. AB rarely even spits up; the reflux goes up and back down the esophagus but never out his mouth. It does, however back up into his sinuses, and this causes him to have a snotty nose. We heard him gulping at night, and this was basically him swallowing the spit-up back down. So, that was a good clue. Also, reflux babies arch their backs when they are experiencing reflux, like they are trying to elongate their mid-section. AB did this too. We put him on an incline pillow, and this helped a lot. (there are several models of incline pillows at Babies-R-Us. We got the simple wedge.) There are two medicines for reflux. We have him on Prilosec. Zantac is also used. Zantac is faster acting, but you have to give it twice per day. Prilosec is slower acting, but can be given only once per day, and is more expensive. My doctor started us on Zantac for the first two weeks, and then switched over to Prilosec because we were having a really hard time getting him to take the Zantac twice per day. Within 3 days of going on the Zantac, he was totally symptom-free. As he grows, he outgrows his dose. So about every three or four weeks, there is a 1-2 day period where his symptoms return. We have to go in for a weight check to have his dose readjusted, and by the next day, he is totally symptom-free. If the baby has gas bubbles in the belly, this exacerbates the reflux problem, so fixing the gas problem will help reflux. There is no test for reflux, you just have to try the medicines to see if they work. Fortunately, the trial period is short (less than one week) and there are virtually no side-effects.

3) Gas: AB also had gas problems. The classic symptom of gas is that they pump their knees to their bellies and back down (alternating like they are bicycling, or both at the same time), they also are comfortable while upright, but not comfortable being horizontal. We use simethicone drops with every feed (giving them right before a feed). There are several brands of simethicone drops (usually called "baby gas drops") . They are all virtually identical. We buy the Target brand. The simethicone works by reducing the surface tension of the gas bubbles in the belly, thus making them collect into one large gas bubble which is easier to burp up. This helps for babies that have a hard time burping. (Some babies are just better burpers than others.) The simethicone drops do *nothing* for gas that has already reached the intestine, or gas that is generated *inside* the intestines. For gas bubbles generated in the course of feeding, use the simehticone drops and make sure to give the baby a good burping at every meal. This reduces the volume of gas bubbles that reach the intestines. Also, you should avoid gas-producing foods, like cabbage and broccoli.

4) If you have ruled out (1), (2), and (3), then your baby has "colic" which means that your baby has unexplained symptoms. There is nothing that you can do besides getting more help so that you don't go insane dealing with a constantly crying baby.

In my experience, gripe water is not a consistent remedy for any of these things. It seems to help sometimes, but not always, and never seems to help completely. So, I don't think it's even worth trying unless you are in category (4). The wikipedia recommends probiotics which I think are also worth a try if you are in category (4).

If you think your baby is colicky, you should talk to your doctor, explain the symptoms and develop a course of action. There is a lot they can do nowadays and your baby does not have to suffer.

AB is now completely symptom-free. But, it was several weeks of hell until we figured it out. Hopefully, this information can save you and your baby from the same.

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  1. Anonymous11:55 AM

    good job! thx for d info

  2. Anonymous4:16 PM

    Thank you for this information I'm gonna try this and hopefully it works!!!


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