Colic and Reflux and the Inconsolable Baby
BWS - 10
When a mother and father gaze upon the miracle of their newborn, it’s natural to feel a mix of awe and overwhelm. The early days of parenting come with so much to learn, and the weight of those first moments can feel heavy. Of course, a gentle, predictable routine can ease much of this anxiety because feeding routines bring a sense of order to your baby’s day, and in turn, it nurtures a quiet confidence in your heart as you begin this new chapter.
Yet, as we all know, life is rarely perfectly predictable. What do you do when your sweet baby doesn’t follow the routine and becomes fussy outside the usual times? Perhaps your little one cries for food, only to stop feeding after a few moments, refusing the bottle or breast. Maybe your baby arches their back, and discomfort clears on their face, but nothing seems to soothe them. Or perhaps, more concerning, your baby spits up what seems like the entirety of their meal every time and is waking from naps in visible discomfort. What should you do when your nurturing arms aren’t enough to ease their distress?
In Babywise Sleep Solutions’ Chapter Seven, we discussed the difference between normal and abnormal crying patterns. Some babies may fuss before feeding or while settling down for a nap. Many go through a fussy period at least once a day, often in the late afternoon, but otherwise, they spend their time in a relatively calm and peaceful state. These moments of fussiness are a normal part of infancy, something to be expected in those tender early months.
But for some parents, the challenges can run deeper. Imagine having a baby like little Asher or Ross, who showed all the signs of hunger, latched on to Mom, began to feed, and then abruptly stopped after just a few minutes. Crying soon followed, and they would refuse to nurse any longer. Exhausted, they would fall asleep, only to wake again 30 minutes later, hungry, and the cycle would begin anew. Or maybe your baby is like Caleb, who seemed inconsolable, fussing and crying before, during, and after every feeding, drawing up his tiny legs in pain. Some parents, like those of baby Micah, experienced the heartbreak of watching their little one vomit after every meal for six long months.
For these families, the cause of their baby’s distress wasn’t easy to uncover. It left them desperate and weary, their hearts aching with concern as they searched for answers. Yet, even in these challenging moments, you are not alone. We will explore these struggles together, offering understanding and guidance as you navigate this delicate time in your baby’s life.
Asher’s Story
According to Ashley, Asher’s mom, it happened at every feeding
“Asher showed all the normal hunger signals, began to nurse ferociously, and then would suddenly stop. He would pull away from me and just start screaming. I knew something was wrong, but what? I tried everything. I changed my diet, fed more often, fed less often, switched sides numerous times while nursing, and burped him often. Nothing helped. Sleep was not the best. Asher took very short naps, 30 minutes, if I could get him to sleep at all. At night he would wake four to five times. Nothing brought comfort to my son.”
Micah’s Story
Whitney provided a slightly different account of her son, Micah, but one just as stressful
“Forester, my firstborn, was a big spitter (soaked a burp cloth every feeding), but he was a happy spitter and a big baby (9 lbs. 11 oz./4.3 kgs at birth). He remained at the top of the growth charts, so I never thought twice about colic or reflux. After my second child, Micah, was born, I saw a similar pattern developing. By his second day of life, Micah was spitting up large amounts after each feed. At first, I just thought he was a big spitter like my firstborn, but by the end of Micah’s first week, my husband said, ‘This just cannot be normal.’ At two weeks Micah was spitting up 40-50 times a day. There were times when he spit up so much milk that I would wonder if I should feed him again because it looked like everything just came back up.
He remained on a 2-hour feeding routine for the first three months which wreaked havoc on his sleep cycles, and mine! I was discouraged and anxious. I remember being totally exhausted one night, crying at 2:00 a.m., thinking, ‘I’m never going to rest, and he is never going to sleep! By the time he stops spitting up, it is time to feed again, and we are going to start all over!’ I now realize that my first son, Forester, probably had a similar condition as a newborn.”
Ross’s Story
Sally, Ross’s mom, recalls “From the very beginning, we discovered that Ross had a pattern of spitting up during and after each meal. At three weeks, we noticed Ross had difficulty nursing and pulled off me and began crying during feedings. To say the least, feeding became a traumatic event for us both, as Ross would continually pull off, arch his back and cry, try to suck, and then pull off again. Although he slept fairly well, he was still waking at 3:00 a.m. or so at three months of age and had only moderate weight gain.”
Caleb’s Story
Caleb’s struggles were even more distressing. His mom, Stephanie, writes
“Although I had a c-section when Caleb was born, he was very healthy and weighed in at 6 1/2 pounds/3 kgs. Initially, he was cast as an “easy” baby. He nursed well, had a ravenous appetite and those first few naps were wonderful. But my peaceful assessment and my easy-going baby lasted only a few days.
“By the end of the first week, everything started going downhill and fast! Caleb was very fussy and always seemed to be in pain and distress. If I was lucky, he would sleep for an hour and a half at a stretch, but then he would wake up screaming, covered in vomit. At his two-week checkup, Caleb was weighed and measured, and I was told he was growing beautifully. He had grown from six and one-half pounds at birth to 9lbs/4 kgs. I relayed all of the problems Caleb was having to the doctor, but I was assured it was ‘just colic and a little bit of reflux.’ When I tried to insist it was more, I was told there was nothing to worry about because he was gaining weight beautifully.
Of course, everything was not fine. Caleb’s condition grew worse. During feedings he would arch his back and be as stiff as a board. Caleb kept his legs drawn up to his stomach and his arms clenched tightly to his sides. Changing, dressing, and bathing him were a chore due to his stiffness. His condition necessitated a visit to a gastroenterologist. After taking Caleb’s history, the gastroenterologist examined him and did an ultrasound of his abdomen. Based on the findings, he said that Caleb had a severe case of gastroesophageal reflux disease (GERD).”
Understanding The Conditions
This Post addresses three medical conditions. While each condition has its own diagnosis, they are related symptomatically through crying and spitting up. The three conditions are:
1. Colic
2. Gastroesophageal reflux (GER)
3. Gastroesophageal reflux disease (GERD)
We trust that by sharing these four examples, you will become proactive in seeking medical attention should your baby demonstrate any of the distress signs. With Asher, Micah, Ross, and Caleb, all four were gaining weight, but that did not mean everything was medically okay with them. No one knows a baby like his parents, and if you sense something is not right, for your peace of mind and your baby’s health, pursue medical advice until you are satisfied your baby’s condition is understood.
Crying and Colic
There is a big difference between a fussy baby and a colicky baby. Fussy babies have fussy times followed by relative peace and calm the rest of the day or night. The colicky baby seems irritable nearly all the time, day and night. Symptoms of colic include piercing cries combined with these signs of acute stomach distress: folding of the legs, flailing arms, inconsolable crying and passing gas. Although this list of symptoms makes colic sound like a digestive disorder, it is not.
Most theorists suggest that colic is the immaturity of a baby’s nervous system in processing the full range of stimuli common among newborns at birth. This condition affects about 20 percent of the infant population. It shows up usually between weeks two to four and generally ends by the third month. While there are no significant medical concerns associated with “true colic,” a term that indicates how easily the condition can be misdiagnosed, the main problem is the stress and anxiety it creates within the home. It is emotionally difficult to cope with the constant crying of an inconsolable baby. Close friends and extended family can really help by giving the frazzled parents short breaks during this temporary crisis.
What Can a Mother Do?
It would be wonderful if there were a medical cure for colic or some homespun remedy that could bring babies relief from their physical distress. However, to date, no such cure exists. But there is some encouraging news. Colic, while distressing to parents, is not hopeless, and babies do outgrow it. If your baby is showing signs of colic, here are some practical suggestions from some of our experienced mothers of colic babies.
One: Always consult your pediatrician to rule out any medical reasons for your baby’s excessive crying or spitting up. Ask your practitioner what might be helpful for your infant. Get a second opinion, if you sense your concerns are not being taken seriously.
Two: Remember that all babies are different and respond to different measures. Find out what works for your baby and stay with it. Some moms have found it helpful to wrap their newborns in swaddling cloths, while others find giving a warm bath helpful or placing the infant in a swing or near a vibrating dryer (not on the dryer). If you are bottle feeding your baby, try changing formula. Your pediatrician can advise you.
Three: A breastfeeding mom may find that certain foods in her diet trigger Baby’s discomfort. You can start by eliminating gas-producing foods (e.g., beans, broccoli, cauliflower, cabbage, onions and garlic) or any spicy foods, then dairy products, caffeine and alcohol. Be systematic so you can identify a particular food or type of food that may be causing problems for your baby. If food sensitivity is the issue, there will be a noticeable decrease in your baby’s colic-like symptoms within a couple of days. After a few weeks, gradually reintroduce individual items back into your diet and watch for a reaction.
Four: Avoid having your baby around secondhand smoke, especially when you have colic symptoms to deal with.
Five: It may help to give your baby a pacifier, especially after a feeding. Pacifiers bring comfort and help babies relax, although some babies show no interest in them. (Some research suggests that SIDS rates among infants who use a pacifier is significantly lower than those who do not.)
Six: Colicky babies need to be burped frequently. If you are bottle feeding, try a different bottle or nipple designed to help reduce the amount of air your baby swallows during a feeding. Some of the bottles made for this purpose are curved, vented, or have a collapsible bag inside. After each feeding, lay your baby across your knees, stomach down, and gently massage his back. The pressure of your knees against his abdomen may help relieve his discomfort.
Seven: Most newborns, especially those struggling with colic, have a low threshold for rapid movements, such as the flickering of a computer or telivion screens. A baby’s developing neurological system has difficulty processing those types of rapid light and sound changes. Such stimulation may further heighten an already stressful situation, for both baby and parent. Try offering your feedings in a soothing, calming environment. Keep the lights low and televison off.
Eight: At the other end of the spectrum are babies who are comforted by rhythmic motion, steady sound (commonly called white noise) or both. Some parents find securely placing their infant in the baby swing close to the white noise provides some temporary relief.
Taking Care of You
First-time moms and dads may find the early months of parenthood challenging beyond belief, especially if they have a colicky baby. One of the best things you can do for your baby is to take care of yourself. As much as reasonable, keep your baby’s routine going, but if you are feeling overwhelmed, take a break. Ask a family member or friend to take over for a while, even if it is only for an hour or two. While time seems to move slowly during stressful situations, keep in mind this hope-giving truth: your baby will outgrow his colic and life will return to normal.
Reflux and GERD
One of the biggest medical risks associated with colic is not the condition itself, but its symptoms because they mimic and often mask serious conditions such as milk-protein allergies, lactose intolerance, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD).
GERD is a serious digestive problem in newborns that is often missed because it is too quickly labeled as colic. It is not the same as GER (gastroesophageal reflux) or just plain reflux. GER causes asymptomatic spitting up and does not require medical treatment because the baby is growing well and is not fussy. GERD, however, causes intense pain and will lead to a feeding aversion if not treated. Caleb’s case manifested pain, inconsolable crying and excessive spitting up, although his weight gain was excellent; so, it took a while to diagnose the true condition. GERD requires medical attention, usually in the form of medication to decrease gastric-acid production; but it sometimes calls for surgical repair. The encouraging news is this condition is highly manageable.
Reflux/Gerd: What do we know?
Note: For purposes of this discussion, the term, “Reflux,” applies to both GER and GERD. Approximately 2½ million babies are born every day around the world, and many will experience a minor degree of reflux. This reflux decreases as the newborn’s digestive system matures. It is estimated that in the United States, three to five percent of all newborns have mild to severe reflux symptoms for the first few months of life. Reflux is usually due to an immature sphincter valve between the stomach and the esophagus. When working properly, the valve opens to allow us to swallow, burp or vomit and closes immediately afterward. Reflux occurs when the sphincter either stays relaxed or relaxes periodically, allowing food mixed with stomach acid to back up into the esophagus and throat, causing a burning sensation.
Reflux usually presents itself in the first few weeks of life. It often corrects itself, but in extreme cases, the infant may develop a feeding aversion because he associates feeding with pain. The condition can advance to the point where it causes significant weight loss or esophagitis, creating a condition known as “failure to thrive.” When reflux requires advanced medical attention beyond observation, the baby is said to have GERD.
Many babies with reflux are happy and thriving, despite their excessive spitting up. These little ones are sometimes called “happy spitters” or “happy chuckers,” and require little medical intervention. They are growing well, are not abnormally fussy and not in significant pain. They usually outgrow their reflux without complications. A smaller percentage of babies, however, like Asher, Micah, Ross, and Caleb, suffer with a type of severe infantile heartburn that requires medical attention. These are the GERD babies.
One of the most important indicators of GERD is an infant’s inability to be consoled. He is crying because he is in pain. Suppose GERD is the issue, when a physician prescribes a medication that blocks acid production in the stomach. In that case, you will see some improvement within two days and substantial improvement within 14 days. If no improvement takes place, the parents need to contact their healthcare provider immediately to find what will help their baby.
Several diagnostic tests are available to confirm the diagnosis of GERD. Your baby’s symptoms will direct the doctor in determining the most appropriate test. If you are uncomfortable with or do not understand the pros and cons of the prescribed treatment or tests, request a second opinion. Dealing with any form of reflux is emotionally stressful for parents. You must have confidence and understanding, so that you can wisely cooperate with your baby’s healthcare provider and bring relief and soothing comfort to your baby.
In addition to medication, there are aggravating foods for breastfeeding moms to review. Proper feeding positioning for the baby is essential. Holding a baby at a 30-degree angle (the most natural angle for breast or bottle-fed infants) will result in fewer reflux episodes than when a baby is held horizontally.
Colic, Reflux, and the PDF routine
Parents who have an infant with either colic or reflux (GER or GERD) may assume the PDF routine will not work for them, but the opposite is true. Preparation For Parenting will help you recognize progress and bring order to an otherwise chaotic situation. Although you may need to make adaptations to the PDF routine for your unique situation, you are still providing what is best for your baby and managing his particular needs. Let’s now consider how colic and reflux issues affect feedings, waketimes, and sleeping.
Challenges with the Routine
One: In general, try to keep your baby on a regular routine. With a reflux baby, consider feeding more often than the 2½ to 3 hours generally recommended (possibly every 2 hours). This may be easier on your baby since he will not try to get as much food each time. The pressure of a full stomach could worsen his reflux. Use routinely whatever time increment you find helpful to your baby.
Two: The basic principles of PDF remain the same, including the establishment of healthy feed, wake, and sleep cycles. A well-established sleep pattern can take longer to accomplish with reflux, but it will come. In Asher’s case, consistent, uninterrupted nighttime sleep was not achieved until he was six months old. It should be noted that some reflux babies begin sleeping through the night between 13-18 weeks.
Three: Keep Baby’s environment calm and quiet. Try wrapping him snuggly to minimize extra stimulation and stress. Hold him gently and avoid bouncing, jiggling or excessive back patting.
Four: Do not worry that your baby is not following the plan exactly like the book describes. Instead, learn to enjoy his uniqueness, in spite of your baby’s digestive condition.
Feeding Times/Waketimes
One: As a parent, avoid the two feeding extremes: letting your baby get too hungry and over-feeding him.
Two: Keep the feeding environment calm and relaxing. Turn off the television and any loud music (carries vibrations that some newborns find irritating).
Three: Try propping your baby in an upright position after each feeding for at least 30 minutes or elevating his crib mattress slightly (maximum of 30 degrees). This will help with digestion. Also remember, be sure to burp him frequently.
Four: If a particular feeding is dragging out longer than 45 minutes, either because he no longer seems interested, or is struggling due to discomfort, discontinue the feeding, burp well and then use recommendation of #3 above. It is better to let him wake earlier (but hungry) at his next feeding than to go at it for an hour just to get a full feeding. This will only exhaust parent and child.
Five: Some breastfeeding mothers have an overflowing supply of milk. Their babies will attempt to compensate by swallowing faster and gulping, taking in excessive air, which produces gas. That exacerbates the reflux condition. If this is your situation, allow gravity to help solve the problem. Either recline in a lounge chair or lie down propped on a pillow (so you are not completely reclining), and gravity will slow down the force of your letdown. Another technique is to use your index and middle fingers for a gentle scissors hold to control the initial flow of milk during your letdown. When your letdown begins, direct the initial spray into a towel and then bring your baby back to your breast.
Six: For babies diagnosed with reflux and spit up, the American Academy of Pediatrics (AAP) suggests holding off offering an additional feed and instead wait until the next feeding.
Seven: It is sometimes suggested that bottle-fed babies who suffer from reflux may benefit from having their formula thickened with rice cereal (usually one tablespoon per one ounce/ 30 mls of formula. Here again, check with your pediatrician first.)
Eight: If your pediatrician recommends any medicine for your baby, ask about the possible side effects. Some medications can give babies stomach cramps, which may appear as colic.
Nine: When changing your baby, take care not to pull the diaper too tight. That can place additional pressure on his stomach.
Sleeping
Sleep can seem impossible when a baby is waking up screaming 35 to 45 minutes into his sleep cycle. Here are some practical suggestions to consider.
One: You might try swaddling your baby when putting him down for a nap. If there is excessive crying, a pacifier will sometimes help him settle, or simply changing his sleep position.
Two: If your baby is habitually waking up 45 minutes into his nap, screaming in pain and inconsolable, consider going in after 40 minutes and gently rocking him through the cycle so he does not become over-stimulated by his crying.
Three: For the baby over three months, try using a pacifier immediately upon waking; or if he is fully awake, pick him up and comfort him as best you can. Sit, walk or rock him until he displays signs of tiredness, and then try putting him back down.
Crying
One: Typical signs of reflux are crying through feedings, not latching on, very small feedings and crying until exhausted. Feed a very young baby immediately upon waking. Avoid letting your reflux baby get into a full cry.
Two: Whenever a baby is showing signs of stress during a feeding, stop, soothe and relax your baby, and then continue feeding.
Three: Since reflux infants tend to be more comfortable in an upright position, they generally object to being laid down, especially on their backs. While the AAP recognizes that the back position may increase crying with a reflux baby, the organization generally recommends the back sleeping position because of SIDS statistics. You will need to discuss this matter with your pediatrician for what is best for your baby’s situation.
Four: Remember to take one day at a time, focusing on the long-term goal of establishing healthy feed/wake/sleep cycles. Some days will go well, and other days you will have to regard as stepping stones toward the big picture. All of parenting is a process, but especially with a reflux baby; so be patient with yourself and baby. It will probably take a few extra weeks before he stabilizes his routine, but he will get there.
Whatever Happened To The Babies?
From Ashley’s Journal:
“Once Asher was diagnosed with reflux, we knew what we were up against and that made caring for the little guy that much easier. Asher improved greatly with the help of medication, and by six months his acid reflux problem was gone. It was then he began to sleep through the night. (He was night trained in three days.) Once he started sleeping through the night, he simultaneously developed a much better napping routine. He eventually moved to two naps a day, about 1½ hours each (morning and afternoon). Today, at two years of age, we constantly have people amazed at how well Asher goes to sleep at night. He still sleeps 12 hours and naps 2 to 3 hours.”
From Stephanie’s Journal:
“Because of his healthy weight gain, Caleb’s pediatrician chose medication over any invasive procedures. The meds worked wonderfully. His reflux improved beautifully, and most significant of all, his little body began to relax. After a week of this, Caleb went to bed and slept 12 hours through the night, and he has continued to do so ever since.”
From Whitney’s Journal:
“At his three-month checkup, Micah was placed on Prevacid® and that fixed the problem. He transitioned to his crib and began sleeping through the night. At 15 months of age, we dropped the medication completely. His 18-month checkup was encouraging. For the first time, Micah was above the 50 percent range. In hindsight, I was discouraged by how many people told me, ‘All you really have is a laundry problem.’ Not true! The information I wished I had beforehand was the best way to continue working on a routine with a reflux infant without thinking he should be sleeping through the night at eight weeks. I learned reflux babies are delayed in this category, and that is not a reflection on either the baby, the parent or Preparation For Parenting; it is just a normal outcome for a reflux baby.”
From Sally’s Journal:
“We took a list of symptoms to our pediatrician, who immediately suspected reflux. She prescribed Zantac®. We saw a significant difference in Ross in two days. As he began feeding better, his day and night sleep also improved. Ross continued nursing for 13 months. Once he started drinking from a cup, we stopped the medicine. The reflux was gone.”
Summary
Caring for a baby with colic, reflux or GERD, is a major task that can be very stressful for the entire family. For that reason, parents should get medical help for their baby as soon as possible. This is a time to bring in family and friends, who can provide assistance with home care and meals.