Does my baby have Colic, Reflux or Allergies?
There is nothing more distressing than having your inconsolable baby in your arms, that just doesn't stop crying. You would do anything to help them - and have some peace and quiet!
It is often incredibly difficult (even for specialists) to determine whether your baby has colic, reflux or cows milk allergy as often the symptoms are very similar and overlap- crying, irritability, tummy pain, regurgitation, back arching and wind.
Colic in babies
Colic is a very common condition affecting approximately one in five babies, however it is still quite poorly understood. The medical definition for colic is a baby who is otherwise healthy and well fed, but cries excessively for more than three hours per day on at least three days each week. Often the most intense crying occurs in the late afternoon/evening and this pattern tends to last for more than three weeks.
We need to remember that it is normal for babies to cry - it is their one and only way of communicating distress or dislike for something. At six to eight weeks, it is normal for babies to cry for up to 2-3 hours per day.
Colic usually begins within the first few weeks of life and peaks at around six to eight weeks. It often settles by the time the baby is six months old.
Whilst a colicky baby may appear to be in distress, the crying outbursts are generally not harmful and babies usually continue to feed and gain weight normally. There is no clear evidence that colic has any long-term effects on a baby’s health.
Reflux in babies
Reflux is the passive flow of stomach contents that travel from the stomach up into the oesophagus. It is common occurrence in healthy infants younger than 1 year. The major cause is the unwanted relaxation of the oesophageal sphincter (that sits at the bottom of the oesophagus just before the stomach). When this happens, acidic stomach contents come back up into the oesophagus.
Are vomits normal in a baby?
Yes it is common/normal for babies to vomit/spit up. This often improves by 4-6 months of age, however in some babies this will take longer. The vast majority improve within a few months of walking age. It is also often reassuring to hear that in most situations, happy thriving babies that spill or vomit will not come to harm as a result of reflux.
Should I see my doctor?
You should see your doctor if:
- Your baby’s irritability/crying/fussing is longer than three hours total (per 24 hours) on more than three days of the week
- If you feel your baby is at risk of dehydration – symptoms including: dry skin, reduced urine output, yellow smelly urine, hard poo
- If you feel your baby’s growth and weight gain is being affected by the amount of milk that is lost in vomits
Is my baby losing nutrition?
Often the volume that your baby regurgitates seems bigger than it actually is. If your baby is still growing well, then it is likely that they are still receiving everything that they need. If however your baby’s weight gain is not adequate, there is the possibility that they are losing too much milk and are not getting what they need. In this situation, seek medical advice.
How do you diagnose Reflux?
Often reflux is diagnosed without clinical investigation (such as a 24 hour pH monitoring which tests how much acid is coming back up into the oesophagous). If your baby’s symptoms improve after treatment, (such as reflux medication) they may be diagnosed with reflux.
Is reflux an allergy?
Clinically diagnosed reflux is not an allergy, however gut mediated cow’s milk protein allergy in infants can cause very similar symptoms of vomiting, regurgitation and irritability. For this reason it can be confusing and difficult to determine whether it is actual reflux or a cows milk allergy reaction.
Dietary Elimination of cows milk and soy
A dietary trial of removing cows milk and soy products may well improve symptoms of colic, cows milk protein allergy and reflux. This involves a 2-4 week trial of the mother strictly removing all cows milk protein and soy protein from her diet if breastfeeding. If the baby is formula fed, they should be changed to an appropriate cows milk and soy free formula - advised by your health professional (note: goat and sheep milk are not suitable).
Will thickening breastmilk help?
Research suggests that this can help to reduce the amount of milk that is lost in vomits. To thicken breast milk, you will need to express some or all of your breast feeds and then thicken it in a bottle. Some good thickening options include regular breast milk fortifier or baby rice cereal. These can be purchased from the supermarket or pharmacy. You may choose to alternate breast feeds and expressing. In this situation, you may choose to express/thicken for the times of day when your baby’s symptoms are most problematic. Expressing does not influence the quality or benefit of breast milk to your baby.
I’m using infant formula – how can I thicken it?
Infant formulae known as “AR” or “Anti Reflux” can be purchased in a pre thickened consistency that is usually appropriate for most babies. These can be purchased from the supermarket or pharmacy. If your baby requires a slightly more specialised formula such as lactose free (LF) or hypoallergenic (HA) then you will need to purchase a thickener to add to the formula. Some good thickening options include regular baby rice cereal or corn based thickeners. These can be purchased from the supermarket or pharmacy.
How else can I help my baby?
Some find that smaller, more frequent feeds and being kept upright following feeds can help. In situations where more support is needed, medication generally involves trying to reduce the acidity of the stomach contents so that if/when stomach contents do come back up into the oesophagus, it is not as painful or damaging. There are different types of medication -antacids act to neutralise or buffer the amount of acid present in the stomach whereas acid suppression therapy (eg. Losec/Nexium) works to reduce the amount of acid actually produced in the stomach.
Will my baby grow out of this problem?
As with Colic, babies with reflux will often improve after the first 6 months and continue to improve over the next few years of life. This improvement often relates to changes in feeding habits – more solid foods, growth and improved function of the lower oesophageal sphincter. Some babies with diagnosed reflux will need ongoing medical supervision and treatment to manage symptoms.