The cause of colic still remains unknown, but a number of suggestions have been made. There are nine common theories related to the causes of colic. These range from birth trauma to imbalances within the gut.
It has been said that trauma to a baby during birth can cause colic. Newborns can experience birth trauma following birth complications, interventions such as forceps or a ventouse can cause this trauma, or even a rapid or premature delivery.
But how can birth trauma cause colic? One suggestion is that the baby’s body becomes compressed while making the journey through the birth canal towards the outside world.
The back of the infant’s head (the occiput) plays a significant role in opening up the birth canal, and the normal pressures of birthing cause the cranial bones to fold over one another. Infantile colic might be caused by excessive pressure to the baby’s occiput during labour and birth. The newborn’s occipital bone, located at the back of the head, is composed of four parts. Cranial nerves lie next to these parts, and the spinal cord passes between them through the foramen magnum (a “large hole”).
As the infant moves towards delivery, the head flexes, rotates and extends to pass through the bony pelvis. The unfused occiput is normally the presenting part and this means it is exposed to a variety of forces. The 4 parts of the occiput may become twisted and compressed, causing irritation of the cranial nerves, and sometimes even irritate the spinal cord. Impaired sucking, gastric irritability, and altered muscular tone may result. This can occur in babies that have been delivered by forceps or ventouse, but it can also happen when a baby is born very quickly.
One might think that of all delivery methods, a Caesarean section (C-section) would be the least traumatic for the newborn. However, a C-section brings specific challenges to both mother and baby. A C-section that isn’t pre-scheduled often takes place following complications that arise during vaginal delivery, for example, if there has been an unsuccessful forceps intervention. If the mother is admitted for an emergency C-section, it could be after her baby has remained compressed in the birth canal for some time and has experienced strong uterine contractions. As such, it is likely that babies born via Caesarian section will have suffered as much compression and pressure as babies born who are born vaginally, thus leading to the same symptoms. However, colic may still occur whether a baby is born by emergency or elective C-section. Babies born by elective C-section can go into a state of shock due to the suddenness of the birth. One moment they are in a warm, dark and secure place, and then suddenly they are lifted out into a brightly lit room with all sorts of strange things happening around them! It isn’t surprising that birth might cause a baby’s nervous system to overreact. Many osteopaths and doctors believe that the vagus nerve which exits from the base of the skull and supplies the stomach and the upper part of the intestines can be irritated or compressed and can be particularly vulnerable to distortion during the birth processes. If this nerve becomes distorted it is likely your baby will suffer from colic.
An immature digestive system
While gas pain is common and can afflict children of any age, it is particularly troublesome for newborns and young infants in the first few months of life because their digestive systems are immature. Although hydrochloric acid (used to facilitate digestion) is present in the baby’s stomach at birth, levels of this acid remain low during the first two months after birth, causing some babies to have trouble digesting their food. The human digestive system is so complex that it has its own nervous system, the enteric nervous system, which controls the transportation of gut contents in a wave-like motion called peristalsis. The newborn’s gut continues to develop in the months after birth as it begins to adapt to the processes of digesting food and dealing with waste effectively. Gas can be present due to factors including immature microflora found in the baby’s gut, carbohydrate metabolism and hormone regulation, and it can also be a symptom of constipation. Gas can cause colic symptoms but there are natural methods that can help with this.
Food allergens in breast milk
According to La Leche League, a breastfed baby can become sensitive to certain foods eaten by the mother. One study by researchers at the University of Minnesota found a link between maternal diet and colic symptoms. Maternal intake of cow’s milk, onions, cruciferous vegetables (e.g. cabbage, broccoli and cauliflower) and chocolate have become associated with symptoms of colic. In addition, nursing mothers are warned that carbonated drinks (fizzy drinks) can cause excessive gas in the baby’s intestinal tract. Although fizzy drinks like lemonade are not a proven cause of infant colic, nursing mums can boost their hydration levels and overall health by drinking plenty of water and restricting their intake of fizzy, sugary drinks.
Another suggestion relating to the diet of breastfeeding mums is that an excessive intake of drinks that contain caffeine, such as coffee, tea and energy drinks, might contribute to infant colic. Caffeine is easily transferred to breast milk and when consumed in large amounts by nursing mothers it may cause agitation and irritability in babies.
Although rare, it is possible for a breastfed baby to develop an allergic reaction to a food eaten by the mother. A reaction to a food allergen in breastmilk will initially cause increased fussiness and crying. Sometimes babies with a food allergy develop allergic symptoms like coughing, wheezing, sneezing, rashes or eczema. Common allergens include cow’s milk and peanuts. Other possible allergens include eggs, tree nuts, wheat, soy, and shellfish.
If you are concerned that your baby might have developed a food allergy, it’s important to consult your doctor or other health professional. It’s a good idea to keep a food journal to track your baby’s symptoms, such as gas, spit-up or fussiness, to see if possible links develop between your baby’s behaviours foods and any foods you have recently eaten. If you feel that your baby would benefit from dietary restriction, talk with your doctor before excluding any food groups from your diet, such as dairy foods, foods containing wheat etc. If you are breastfeeding, it’s particularly important to eat a well-balanced diet to ensure optimum nutrition for your infant’s growth and development. In a formula-fed infant, a trial of a hypo-allergenic formula may help if a baby is reacting to cow’s milk protein.
Babies enjoy receiving loving attention from their parents, other family members, friends and caregivers. However, it’s also true that over-stimulation can adversely affect a baby’s wellbeing, and in some instances, lead to increased gassiness. For example, a baby who is exposed to constant noise and bright lights might try to ‘shut down’ in an attempt to reduce stimulation. However, a shut-down response does not completely protect babies who are particularly sensitive to over-stimulation. Babies that are easily overloaded often experience more severe gas, fussiness, and difficulty sleeping later in the day or night. In general, the more activity (siblings home from school, T.V, phones, etc) in baby’s day, the higher the chances of fussiness in the evening and night.
A certain amount of crying is normal for all infants, as it’s their only way to communicate. Babies’ cries can indicate that they are hungry, lonely, warm, cold, and uncomfortable or have a dirty nappy. Many babies go through periods of crying for no apparent reason as they begin to adjust to their new world. Crying in general causes babies to swollow air into their digestive systems. These air bubbles can get trapped in their stomach and/or passed on to the intestine. Gas pain can be a direct result of air that is swallowed during crying. Resulting in colic-like symptoms.
Gut imbalance and antibiotic use
At the time of birth, the baby’s digestive tract is sterile. Within hours of delivery, bacteria from the surrounding environment begin to colonise the tract. The importance of probiotics – bacteria that are beneficial to the digestive process – has been well known for over a century. Probiotics are known for their ability to deactivate toxic bacteria, supplement natural digestive enzymes and help process the nutrients in food. Since babies are born with a clear and pristine gut, it takes them several months to accumulate adequate levels of gut flora to aid in the digestion of milk and formula.
It is unclear if it is the absence of benevolent bacteria, or moreover the presence of harmful bacteria that causes baby’s digestive discomfort. However, several studies show that probiotics in the form of dietary supplementation can reduce the severity and duration of infant colic symptoms (A study by The University of Texas also linked the Klebsiella bacteria to about half of the colicky babies in their sample). Supplementing an infant’s diet with probiotic drops can help reduce colic symptoms if performed consistently over a period of several weeks. It’s advisable to consult your doctor to obtain the best probiotics for your baby.
Another possible reason for infant gassiness is hyperlactation syndrome. When a mother has an abundant milk supply, she may produce a larger amount of foremilk. Foremilk is higher in water content, higher in lactose and usually delivered with greater force during letdown. The good news is that hyperlactation means your body is doing a great job and producing plenty of food that your baby needs to thrive. However, babies whose mums are producing too much milk sometimes receive more foremilk than hindmilk, this may result in them gulping their milk down too quickly. A baby that gulps down the fast-flowing milk often takes in more air causing colicky symptoms. They also become hungry more often, due to the fact they are not receiving the right dose of the richer hindmilk which adds to the problem. A treatment for overproduction commonly mentioned by breast feeding advisors is to pump some milk directly prior to breastfeeding. Rationale for this option is to stimulate the surge of the milk ejection reflex and allow the peak of the overwhelming milk flow to pass, remove some of the lower-fat foremilk and to enable the child to receive the fat-rich hindmilk sooner.
In his book “Colic Solved”, paediatrician Bryan Vartabedian suggests that undiagnosed infant reflux is the most common cause of colic. Infant reflux (or gastroesophageal reflux disease) means that your child has an underdeveloped oesophageal sphincter Infant reflux occurs when the valve that opens to allow food to pass from the mouth to the stomach doesn’t close as it should once the food is swallowed. This means that milk can come back up the windpipe, and when it does, it brings stomach acid with it. Symptoms of infant reflux can sometimes be mistaken for the less serious (although still painful and uncomfortable) condition of colic.
Symptoms of Reflux
- A disinclination to gain, or reduction in, weight
- Inconsolability, as a result of severe stomach pain
- Grumpiness during or after a feed
- Inability to settle for long periods of time
- Arching away when feeding, or refusing to feed.
A variation on this condition is known as silent reflux (laryngopharyngeal reflux), which has no outward symptoms, making it difficult to identify. However, if your infant shows discomfort, irritability or pain when lying down, or is troubled by a persistent, chronic cough, then he or she may be experiencing this common complaint. Silent reflux is characterized by a sore throat, hoarse cry and persistent cough, with the throat and nasal passage exhibiting tenderness due to the stomach acid.
Serve ConstipationReflux is a common infant complaint, particularly during the first three months of life, but if symptoms persist or you have a cause for concern check with your doctor, especially if any of the following symptoms are present:
- Bloody or Completely black stools
- Choking or blue colouring in the face
- Continuous refusal of food
- Renewed bouts of vomiting after six months
- Stomach distension
- Bile (Green Vomit)
- Projectile vomiting
Constipation is often cited as an underlying cause of infant distress. However, constipation is not a reason for infant colic (as colic notably occurs at predictable times in the evening and for weeks on end). Even so, constipation does affect the digestive system in a way that’s similar to colic and can be just as painful for the infant.
All these suggested causes of colic can have an impact on your baby’s behaviour and wellbeing. Fortunately, there are many natural methods to calm a restless baby. Research has shown that regular baby massage and natural remedies can greatly reduce colic and colic-like symptoms. When babies feel physically comfortable, they become more settled; and a comfortable, contented baby is something that the entire household will benefit from!
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