Infant Colic

Is it normal for your baby to cry? Well probably, and there is usually a good reason for it, like when your baby is hungry, has a dirty diaper, or is over tired. But, when you have tried fixing all of those things and the crying continues, then you might be dealing with something else.

What is colic?

Colic is a very common condition that happens in about 1 in 10 babies, starting in the first 3-4 months of life. Colic crying usually happens for more than 3 hours per day, more than 3 days per week, for more than 3 weeks, and it can be characterized as high-pitched, seemingly painful, and inconsolable. It can feel pretty scary –  your baby is screaming, red-faced, arching their back and you are trying to hold them, rock them, bounce them, burp them and nothing helps! This pattern usually happens at the same time of the day, usually in the evenings, starting suddenly and stopping just like that. 

Seriously, this can be super stressful and frustrating as a parent who is probably already over-tired from lack of sleep and a long day of caring for a little human being. It is important that if you find yourself in this situation, take turns with your partner, a friend or a family member and take a break. If you are by yourself, and feeling upset, start by setting your baby down, on their back and in their crib, without pillows, blankets or stuffed animals. You can then take a break, go to the bathroom, get a snack, and/or call someone. You can continue to check on your baby every 10 minutes until the crying stops. Never shake a baby. 

If your child has a fever, is not sucking or feeding well, not gaining weight, not as alert as usual, is vomiting, has diarrhea or blood in their stool, you should seek the help of your health provider as there is probably something more than colic going on.

Causes

So, what causes infant colic? Most will say that the cause is unknown, and that it will pass as the baby grows, and that is mostly true. But here are some naturopathic things that I investigate and do to support the parent and baby, to prevent and resolve infant colic. And it all starts in the gut…

A healthy infant microbiome is the key. It can be influenced by many things starting from when baby is in utero, the way they are brought into the world, or their feeding early in life. Antibiotic use is one of the most common influencers and they are sometimes used during this period for things like UTIs, GBS or mastitis. It is important to always weigh the risks and benefits of using antibiotics, as they can have a significant disruption to the microbiome. An altered microbiome can contain more gas or endotoxin-producing bacteria that can result in low grade inflammation or pain.

Prevention: Supporting the pregnant parent’s microbiome

So, let’s start with prevention when possible. Here are my top 4  ways to support a pregnant parent’s healthy microbiome, because this can have a significant impact on baby’s digestive health.

• Avoid antibiotics and heartburn medications when possible. Antibiotics used during pregnancy can alter the vaginal flora that helps to establish baby’s microbiome at birth. They can also alter the microbes in the breast milk,  including a decrease in bifidobacteria.
• Eat probiotic foods and take probiotic supplements throughout your pregnancy and breastfeeding. This can include foods like yogurt and miso or a supplement that includes both Lactobacillus and Bifidobacteria.
• Eat foods that are good sources of prebiotics (FOS and GOS) like beans, nuts, bananas, chicory, onions, garlic and jicama. 
• Avoid microbiome-restricting diets like low carb or keto diets. These diets can reduce the prebiotic sources that are necessary to feed and optimize your  microbiome. 

Prevention: Supporting baby’s microbiome

And for baby, here are my top 6 recommendations to support their gut health:

• Avoid unnecessary Cesarean birth. Babies born by Cesarean tend to have more Clostridia and Firmicutes bacteria vs Bacteroides, Bifidum and Lactobacillus in babies born vaginally. But, it is interesting that babies born by Cesarean who had a period of labour before surgery showed to have a microbiome more similar to those of vaginally-delivered babies, than babies who had scheduled births.
• Practice skin-to-skin care after birth. In addition to many other benefits of skin-to-skin care for both parent and baby, those pairs who practice skin-to-skin have shown to be more likely to exclusively breastfeed and breastfeed longer.
• Breastfeed exclusively for 6 months, if you can. Formula-fed and even mixed-fed infants had microbiomes with less Bifidobacteria than exclusively-breastfed infants. This is important especially after a disturbance due to antibiotics or Cesarean birth. 
• Avoid antibiotics if possible. 
• Take an infant probiotic supplement.  L. reuteri, and L. rhamnosus GG have been the best studied for colic and reflux. B infantis has also shown to be helpful for colic. 
• Prebiotics – FOS and GOS are abundant in breastmilk and can be found in formulas or infant probiotics. These might be the most important piece that helps to alter the microbiome back to health.

General naturopathic treatments

Here are a few of my most common suggestions in addition to those things mentioned above:

• Remove dairy products from the breastfeeding parent’s diet. This can have a significant impact in some cases and the changes can be seen quickly if dairy is a factor. If the infant is formula-fed, changing to a partially or fully hydrolyzed formula can have similar effects. 
• Try an elimination diet. Other foods can have an impact too, but doing an elimination diet during the postpartum period can be very tricky for a lot of reasons. Gas producing brassicas, allium, eggs, dairy, gluten and soy can have an effect, but you should only eliminate and reintroduce under the supervision of your health care provider, and after a thorough discussion of the risks and benefits. 
• Investigate and treat for yeast. Some signs that yeast might be the culprit include antibiotic use by parent or baby, history of vaginal yeast infection, yeast at the breast, other signs of thrush, or a red painful diaper rash.
• Physical treatments like infant massage or acupressure/acupuncture. The points LI4 and ST36 may be effective for treating colic, including changes in  crying, feeding and bowel movemetns by reducing GI excitability and pain. Acupuncture for infants involves tiny sticky tacks that are placed on the skin or acupressure can be done daily at home by the parent.
• Try homeopathic remedies that correspond with your baby’s emotional and physical symptoms. Chamomilla, Pulsatilla or Colocynthis individually or in a combination product are some of the ones that best fit colic symptoms.

Colic can be one of the most frustrating and puzzling conditions of infancy. It is important to work with your healthcare provider to learn how to best prevent this condition and support your baby and yourself.  Keep in mind that as babies grow and their immune and digestive symptoms mature and develop, they will fully grow out of this condition.

References

MitreE, Susi A, Kropp LE, Schwartz DJ, Gorman GH, NylundCM. Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood. JAMA Pediatr. 2018 Jun 4;172(6):e180315. doi: 10.1001/jamapediatrics.2018.0315. Epub2018 Jun 4. PMID: 29610864; PMCID: PMC6137535.

Navigating the Pediatric Gut Integrative Strategies for Digestive Disorders in Children . Dr. Megan Taylor ND and Dr. Whitney Hayes, ND. 

Nicholas A. Bokulich, Jennifer Chung, Thomas Battaglia, Nora Henderson, Melanie Jay, HuilinLi, ArnonD. Lieber, Fen Wu, Guillermo I. Perez-Perez, Yu Chen, William Schweizer, Xuhui Zheng, Monica Contreras, Maria Gloria Dominguez-Bello and Martin J. Blaser Antibiotics, birth mode, and diet shape microbiome maturation during early life Sci TranslMed 8, 343ra82343ra82. DOI: 10.1126/scitranslmed.aad7121

Dugoua, Jean-Jacques et al., “Probiotic Safety in Pregnancy: A Systematic Review and Meta-analysis of Randomized Controlled Trials of Lactobacillus, Bifidobacterium, and Saccharomyces spp, Journal of Obstetrics and Gynecology Canada, 2009; 31(6).

Shao Y, Forster SC, TsalikiE, et al. Stunted microbiota and opportunistic pathogen colonization in caesarean-section birth.Nature. 2019;574(7776):117-121. doi:10.1038/s41586-019-1560-1

Tanaka, M. and J. Nakayama (2017). “Development of the gut microbiota in infancy and its impact on health in later life.” Allergology International 66(4): 515-522.

IndrioF, Di Mauro A, RiezzoG, et al. Prophylactic use of a probiotic in the prevention of colic, regurgitation, and functional constipation: a randomized clinical trial.JAMA Pediatr. 2014;168(3):228-233. doi:10.1001/jamapediatrics.2013.4367

Dabin Lee, Hojung Lee, Jiwon Kim, Taehun Kim, Siyun Sung, Jungtae Leem, Tae-Hun Kim, “Acupuncture for Infantile Colic: A Systematic Review of Randomised Controlled Trials”, Evidence-Based Complementary and Alternative Medicine, vol. 2018, Article ID 7526234, 11 pages, 2018. https://doi.org/10.1155/2018/7526234