7 Reasons Why Breastfed Babies Can Get Colic

by | BABY COLIC

When I was in charge of the Maternity Acupuncture Clinic at the Whittington Hospital in London, I learned that many expecting mothers believe that breastfeeding is a natural protection against baby colic. Not surprisingly, it was a shock to many of them to learn that their babies can still develop colic. Therefore, they asked me for reasons why breastfed babies can get colic.
So, can exclusively breastfed babies develop colic? Indeed, there are several reasons why breastfed babies can develop colic. First, the very act of breastfeeding itself. Second, a mother’s diet. Finally, exposure to nicotine, as well as antidepressants may promote baby colic. However, breastfeeding can also be a protection against colic!

Read on, if you want to know all 7 main reasons, why breastfed babies can develop colic! I will tell you exactly how to overcome them to reduce the likelihood of your baby to develop colic. And I will explain, under which circumstances breastfeeding can be a protection against colic.

Can Breastfeeding Cause Baby Colic?

It was long thought that breastmilk protects a baby from developing colic (1). However, recent studies have found that this might only be true if the “quality of the breastfeeding process” is high.

What does that mean?

In 2011, two scientists (2) found that if breastfeeding “is not going all too well”, it could increase the risk of a baby to “repeatedly and inconsolably cry without cause” (which is their definition of colic).

Learn more about this study
They investigated the “breastfeeding score” of breastfeeding mothers of two months old babies. The score is based on the “B-R-E-A-S-T Feeding Observation Form”. This form was developed by the World Health Organization (WHO) together with UNICEF.

The purpose of it is to assess, how well (high score) or badly (low score) breastfeeding is going. It involves factors like “how the baby is attached to the breast”, “how the mother holds the baby” etc.

Interestingly, the breastfeeding score was significantly lower in mothers of babies who suffered from colic. In other words, it seems that if breastfeeding is not going too well, it could trigger colic in babies.

A similar study (2018) investigated if there is a link between colic in babies and “breastfeeding success” (3). The babies in this study were all between 3 weeks and 6 months of age.
Side Note: What is "Breastfeeding Success"?
The scientists define “breastfeeding success” by four basic characteristics (4):

  • “How to hold the baby while breastfeeding”
  • “How to put the breast into the baby’s mouth”
  • “Sucking”
  • “Transmission of milk from the mother to the baby”
The scientists found that breastfeeding success is low in mothers of babies who suffer from colic. In other words, they too conclude that if breastfeeding is not going well, babies are more likely to develop colic.

So, let’s have a closer look at what exactly is meant if we say that “breastfeeding is not going well” and how this can promote baby colic:

1 Poor Attachment

Sally Inch is an infant feeding specialist and coordinator for the Women’s Centre, Oxford Radcliffe NHS Trust. She explains that “poor attachment of the baby during breastfeeding can result [among others] in colic” (5).

If the baby is having problems latching correctly onto the breast, she could be taking in a lot of air which can then cause colic-type symptoms (6).

What Are The Signs Of Poor Attachment?

So, how do you know if your baby is well attached to your breast? You would recognize it by looking at the signs of bad attachment, just like the following (7):

  • Pain and damage to nipples: sore nipples / fissures.
  • Breastmilk not removed effectively: engorgement.
  • Apparent poor milk supply: baby unsatisfied / wants to feed a lot / refuses to suckle.
  • Breasts produce less milk: baby frustrated / refuses to suckle / fails to gain weight

What Can You Do?

The following picture shows the correct attachment of the baby to the breast. I copied this picture from the “breastfeeding counselling” training course, which was developed by the WHO together with UNICEF. (These are the figures 13 and 19 in the training course. Note that the copyright is owned by the WHO and UNICEF!) (7).

As you can see on the picture, suckling on the nipple itself is considered a poor attachment of the baby. It is important for the baby to have a good mouthful of breast.

In order to accomplish that, according to Inch, the bottom lip and the tongue of the baby need to get to the breast first and make contact as far from the base of the nipple as possible (5).

If you can’t figure out how to properly attach your baby to your breast, don’t worry! Speak to a breastfeeding consultant at your local hospital! They will be happy to help you!

2 Offering Both Breasts During One Feed

Oftentimes, breastfeeding mothers offer the second breast before the first one has been adequately emptied. It is a common phenomenon observed in many breastfeeding mothers.

And there is a simple reason why mothers do this! They are afraid that they can’t satisfy the baby’s hunger! So, who can really blame them?

However, Jack Newman, chairman of the “Infant Feeding Action Coalition Canada”, says that the result of offering both breasts is the exact opposite!

In an interview with “Pathways to Family Wellness” (8), the Toronto-based pediatrician explains that breastmilk changes during a feed! The amount of fat increases the longer the feed lasts and so does the number of calories.

Because of that, switching from one breast to the other too early can result in the baby getting too few calories, according to Newman. As a result, the baby may feed more often.

Moreover, the baby may also drink considerably more milk per feed to make up for the fewer calories. And this can cause her to spit up.

Finally, the stomach empties quickly because of the low-fat content of the milk according to Newman. Subsequently, a large amount of lactose (milk sugar) arrives in the stomach at one time.

However, the baby’s body is not able to metabolize the high amounts of sugar. This is because there is not enough of the protein available that digests milk sugar: lactase.

Unfortunately, undigested lactose can cause symptoms similar to lactose intolerance, such as gas, flatulence, explosive, water diarrhea and: colic.

That very problem that Newman describes, has also been investigated in a scientific study (9).

The scientists found that babies of women who prolongedly emptied one breast during each feed had a lower incidence of colic over the first 6 months of their lives.

Learn more about this study
Evans and his colleagues (9) assigned 302 breastfeeding mothers to two groups. In group one, they investigated mothers who prolongedly emptied one breast during each feed. The other group involved mothers who had both breasts equally drained during each feed.

The result was that the first group had a lower incidence of colic over the first 6 months of the babies’ lives compared to the group of mothers who offered both breasts during one feed (12% vs. 23.4%).

What Can You Do?

It is advisable to always empty one breast first if you want to decrease the probability of baby colic. Newman recommends doing this until the baby comes off herself or falls asleep (8). A mother can also compress the breast to keep the baby nursing, if she feeds for only a short time (8).

Looking for ways to help your baby with colic?

Check out my Shonishin Baby Colic Massage Course and learn how to help your little one!

3 The “infant hyperlactation syndrome”

The term “infant hyperlactation syndrome” describes a situation in which babies demand to be fed. Yet, they choke and sputter because of a strong milk ejection (10).

A medical doctor from the Breastfeeding Centre in Vancouver, called Livingstone, was the first one to describe the problem (10). It is yet another scenario in which a too large amount of lactose can enter the baby’s stomach at one time.

In this scenario, babies often come off the breast, just in order to return to the breast shortly thereafter. Yet, because of the strong flow of milk, they let off the breast again.

Some experts (including Newman mentioned above) call this strong milk ejection “overactive let-down” (8). Maybe, you are already familiar with that term.

Such babies drink a large quantity of milk within a short period of time. According to Livingstone, it can be as much as 120 to 140ml (4oz – 4.7oz) within 5-10 minutes.

This can ultimately cause the exact same symptoms of a lactose overload as described above.

What Can You Do?

If you think that this describes the behavior of your baby, here is what you can do according to Newman (8):

  • Express some milk before you feed your baby!
  • Try to lay down flat on your back with your baby on top of your breast! Gravity will often do the job to avoid fast milk ejection.
  • Feed your baby in a calm atmosphere! No unnecessary distractions, no TV, no sound, no nothing!

4 Low “Breastfeeding Self-Efficacy”

Another scenario in which breastfeeding could cause colic is when the mother’s “breastfeeding self-efficacy” is low.

In simple terms, breastfeeding self-efficacy is “a mother’s perceived ability to carry out breastfeeding” (11).

Side Note: How do scientists assess "breastfeeding self-efficacy"?
While there are many different tools to assess breastfeeding self-efficacy, the most famous one comes from Dennis and Faux (11). The two scientists have developed 43 questions about breastfeeding. All of them need to be answered on a scale ranging from 1 to 5. “1” means “not confident at all”; “5” means “always confident” etc.

Here are 3 example questions so that you understand what their tool is all about:

  1. I can always hold my baby comfortably during breastfeeding.
  2. I can always take my baby off the breast without pain to myself
  3. I can always manage to keep up with my baby’s breastfeeding demands.

Eventually, the scores of all answers are added up. Higher scores indicate higher levels of breastfeeding self-efficacy and lower scores mean the opposite.

A recent study (2018) investigated if there is a link between colic in babies and “breastfeeding self-efficacy” (3). The babies in this study were all between 3 weeks and 6 months of age. Interestingly, the scientists found that breastfeeding self-efficacy is low in mothers of babies who suffer from colic.

How Is Low Self-Efficacy Related To Baby Colic?

If a mother’s perceived ability to carry out breastfeeding is low, she is probably unsure how to do things correctly.

For example, a mother with low self-efficacy might not know how to properly attach a baby to her breast. This in turn might cause colic, or at least colic-like symptoms, as the baby could take in lots of air with each feed.

Of course, a low self-efficacy does by no means mean that this mother is less capable of breastfeeding her baby!

It just means that she has not received proper training, for whatever reason. And let’s be honest here! Even if you would have received the best training ever: hearing the theory and then actually holding your baby in your arms are just two completely different things.

What Can You Do?

If you believe that your ability to carry out breastfeeding is low, get in touch with a breastfeeding consultant at your local hospital! The midwives will be more than happy to help you!

Now that you have your baby, it will be much easier for them to show you how to correctly breastfeed. They are now able to observe you while you breastfeed your baby! And because of that, they can give you immediate feedback on what you might be doing wrong.

 

So far, we have been looking at colic-causing factors, which are related to the act of breastfeeding. However, what if your breastfeeding skills are perfect and your baby still develops colic?

Could it be that there are substances in your milk which can promote baby colic? So let’s have a look at reasons, why breastfed babies can get colic, which are not related to the act of breastfeeding itself:

5 The Breastfeeding Mother’s Diet

It has been suggested by many scientists that a breastfeeding mother’s diet could be the reason for her baby to develop colic.

A particular focus here are allergenic foods, like cow’s milk, eggs, peanuts, tree nuts, wheat, soy and fish, as well as cruciferous vegetables and foods which contain high levels of FODMAP (these are short-chain carbohydrates like fructose, lactose). Some studies have shown that eliminating such foods reduces colic in breastfed babies (12, 13, 14, 15, 16).

However, other scientists have criticized that the quality of those studies is low (17). Some of them even put the reliability of their results into question (17).

On top of that, it is worth noting that there are also scientists who come to different conclusions. In other words, they do not find that eliminating foods from a mother’s diet has any effect on colic symptoms in babies (18, 19).

Therefore, as of today, scientists are still unsure if restricting a mother’s diet can help prevent colic in babies. That is why it is up to each mother herself, to make a decision to restrict her diet or not.

If that’s something you are interested in, read my blog post: “Anti-colic diets for breastfeeding mothers: do they work?

In this blog post, I will tell you everything about what we currently know about the effect of a mother’s diet on baby colic. Moreover, I will show you, which foods you should eliminate from your diet according to scientists. 

6 Exposure To Nicotine While Breastfeeding

It has been suggested by numerous scientific studies to date, that smoking during pregnancy can cause multiple problems in a baby. One of those negative effects could be developing baby colic according to many scientists (20, 21)! In fact, the risk of developing baby colic seems to be twice as high when the mother is smoking during pregnancy.

But what about smoking after pregnancy when a mother is breastfeeding? Is it likely for a breastfed baby to develop colic when her mother is smoking?

Indeed, maternal smoking has been identified as potential risk factor for colic after the baby is born too. For example, a study from 2000 found that colic is more frequent in infants of smoking mothers (22).

The finding that smoking could promote baby colic was also confirmed by another study one year later (23). Interestingly, that study did not even focus on maternal smoking, but on environmental tobacco smoke in general.

What does that mean?

Imagine that a baby is exposed to nicotine from a smoking nanny and not from her breastfeeding smoking mother. Is the baby likely to develop colic in such a scenario too?

According to the study, the answer is “yes” (23). The scientists have found a positive link between a baby being exposed to environmental tobacco smoke and her colic symptoms (23).

Therefore, keep in mind that being exposed to tobacco smoke is always bad for the baby!

What Can You Do?

I know that most mothers would have quit smoking already if it was that easy, right?

However, there is a reason why they call it “addiction”.

“How to quit smoking” is a question that I hear very often as a practitioner. Since I am a TCM practitioner, I naturally offer acupuncture treatments, as they tend to work really well in such cases.

However, treating addictions effectively can require many acupuncture sessions which can be too costly for many people. Therefore, I usually recommend my patients the book of Allen Carr: “Easy way to stop smoking”.

So far, all except one of my patients have been able to quit smoking after reading his book. Therefore, I can wholeheartedly recommend it to everyone who wants to quit smoking!

Looking for ways to help your baby with colic?

Check out my Shonishin Baby Colic Massage Course and learn how to help your little one!

7 Administration Of Antidepressants During Breastfeeding

In 1993, a team of scientists investigated the case of a 6 weeks old baby who suffered from colic. The baby’s breastfeeding mother was administered an antidepressant called “Fluoxetine Hydrochloride” (24).

The scientists found that the antidepressant was transmitted through the breastmilk to the baby. The result was that the baby developed symptoms like increased crying, decreased sleep, increased vomiting and watery stools. These symptoms improved once the infant was formula fed.

Please note however, that this is the only study to date that I could find about the effect of antidepressant on colic symptoms in babies.

What Can You Do?

When you are taking antidepressants while breastfeeding, ask the treating physician if that particular antidepressant could be transmitted through breastmilk. If that is the case, ask if there are alternative medications which have less of an impact on the baby!

If there are no other options, not even pausing the antidepressant during breastfeeding, talk to your pediatrician about switching to formula milk.

It is important though, that you do not just make a decision by yourself! Never stop taking antidepressants by yourself, without talking to an expert first! Likewise, do not just stop breastfeeding, without talking to your pediatrician first! Keep in mind that human milk is the best possible form of nutrition for your baby!

Can Breastfeeding Protect Against Colic If Done Correctly?

At the beginning, I have mentioned that some scientists claim that breastfeeding is a protection against colic, while others claim the opposite.

We have seen how, why they might have come to different conclusions. Breastfeeding has many facets. So it is not sufficient to look at breastfeeding as a whole. We need to look at the many things which can go wrong during breastfeeding.

If, however, a mother is able to eliminate the very factors related to breastfeeding, which might cause baby colic (for example, by holding her baby correctly or by attaching her baby correctly to the breast or by avoiding smoking), then breastfeeding could indeed become a protection against colic.

For example, a study by Engler and his colleagues found that exclusively breast-fed babies have a significantly lower incidence of colic attacks (25).

They also found that breastmilk contains melatonin during the night. They assume that melatonin in the breastmilk plays an important role in reducing colic, as well as in improving sleep.

Should I Stop Breastfeeding To Avoid Colic?

The simple answer is: no, absolutely not!

First, please note that colic in babies can have many reasons apart from factors related to breastfeeding! Because of that, you can never be sure if breastfeeding itself is the very reason which causes colic! In other words, even if you stop breastfeeding, your baby could still develop colic symptoms.

Next, keep in mind that the benefits of breastfeeding outweigh any possible negative effects by far!

Breastmilk is the best possible form of nutrition for your baby. It provides your baby with all the macro- and micronutrients that she so urgently needs for her development.

On top of that, it offers your baby tons of other health-related benefits.

Furthermore, keep in mind that switching to formula can actually make things worse for your baby! That is, because you do not know how your baby is going to react to cow’s milk, goat’s milk or soy milk.

If you believe that factors related to breastfeeding could be the cause for your baby to get colic, please talk to a doctor! Alternatively, ask a member of staff at the hospital where you gave birth to your baby! They will be more than happy to help you!

Summary

Many moms have asked me for reasons why breastfed babies can get colic.

The truth is, even breastfed babies can get colic and there are many reasons for this:

First, breastfeeding itself can be the problem: A baby may not be properly attached to the breast or she may take in lots of air during the feed.

Moreover, if the mother offers both breasts during one feed, or, if the baby drinks too much milk too quickly, the abundance of lactose in her intestines could cause colic symptoms.

Furthermore, a mother’s low perceived ability to breastfeed (i.e. low “breastfeeding self-efficacy”) could increase the likelihood of colic in babies. 

It does not mean that a mother with low self-efficacy is less capable of breastfeeding her baby. She just has not received proper training.

Next, some scientists found that a mother’s diet could cause colic symptoms in their breastfed babies. But the issue is controversial!

Moreover, breastfed babies might develop colic when their mother is smoking. This might not only be the case if the mother herself smokes! It seems to be sufficient to expose the baby to environmental tobacco smoke (for example, smoke from a smoking partner).

Finally, it is important to be careful with the administration of antidepressants while breastfeeding! They could be another potential cause of colic symptoms in babies.

Sources

(1) Zengin, H., Cinar, N., & Altinkaynak, S. (2016): Approach to infantile colic baby. In: Journal of Human Rhythm. 2016; 2(1), 1−5.

(2) Yalçın, SS., Kuşkonmaz, BB. (2011): Relationship of lower breastfeeding score and problems in infancy. In: Breastfeed Medicine. 2011 Aug; 6(4): 205-8.

(3) Aktas, S., Küçük A.D. (2018): Correlation between Infantile Colic and Maternal Breastfeeding Self-Efficacy, Breastfeeding Success and Breast Milk Amount. In: Journal of Tropical Pediatrics. 2018, Aug; 21.

(4) Mohammadi, D., et al. (2017): Analysis of the Concept of Successful Breast-Feeding. In: International Journal of Medical Research & Health Sciences. 2017, 6 (10): 65-75.

(5) Inch, S. (2006): Breastfeeding problems. In: Community Practitioner. 2016, May; 79 (5): 165-167.

(6) La Leche League GB: I think my baby’s got colic. Accessed on 05/15/2019:  https://www.laleche.org.uk/i-think-my-babys-got-colic/

(7) WHO/UNICEF: Breastfeeding counselling: a training course. Participants manual. Part One. Sessions 1-9. WHO/CDR: 93.5; UNICEF/NUT: 93.3. https://www.who.int/nutrition/publications/infantfeeding/bf_counselling_participants_manual1.pdf

(8) Newman, Jack (2009): Colic in breastfed baby. In: Pathways to family wellness. 2009, Summer.

(9) Evans, K.; Evans, R. and Simmer, K. (1995): Effect of the method of breast feeding on breast engorgement, mastitis and infantile colic. In: Acta Paediatrica. 1995, Aug; 84 (8): 849-52.

(10) Livingstone, V. (1996): Too much of a good thing. Maternal and infant hyperlactation syndromes. In: Canadian Family Physician. 1996, Jan; 42: 89-99.

(11) Dennis CL, Faux S. (1999): Development and psychometric testing of the Breastfeeding Self-Efficacy Scale. In: Research in Nursing & Health. 1999; 22 (5): 399–409.

(12) Hill David J., et al. (2005): Effect of a low-allergen maternal diet on colic among breastfed infants: a randomized, controlled trial. In: Pediatrics. 2005 Nov; 116 (5): e709-15.

(13) Jakobsson I. and Lindberg T. (1978): Cow’s milk as a cause of infantile colic in breast-fed infants. In: Lancet. 1978 Aug 26; 2 (8087): 437-9.

(14) Jakobsson I. and Lindberg T. (1983): Cow’s milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study. In: Pediatrics. 1983 Feb; 71 (2): 268-71.

(15) Lust KD, Brown JE and Thomas, W (1996): Maternal intake of cruciferous vegetables and other foods and colic symptoms in exclusively breast-fed infants. In: Journal of the American Dietetic Association. 1996 Jan; 96(1): 46-8.

(16) Iacovou M., et al. (2018): Reducing the maternal dietary intake of indigestible and slowly absorbed short-chain carbohydrates is associated with improved infantile colic: a proof-of-concept study. In: Journal of Human Nutrition and Dietetics. 2018 Apr; 31 (2): 256-265.

(17) Gordon, M., et al. (2018): Dietary modifications for infantile colic. In: Cochrane Database of Systematic Reviews. 2018 Oct; 10: 1-81.

(18) Evans RW, et al. (1981): Maternal diet and infantile colic in breast-fed infants. In: Lancet. 1981 Jun 20; 1 (8234): 1340-2.

(19) Gulbahtiyar Demirel, RN., et al. (2018): Factors Affecting Colic in Infants and the Applications of Mothers in Turkey. In: International Journal of Caring Sciences. 2018 May-August; 11 (2): 1301-1310.

(20) Søndergaard, C., et al. (2001): Smoking during pregnancy and infantile colic. In: Pediatrics. 2001 Aug; 108 (2): 342-6.

(21) Canivet, CA., et al. (2008): Infantile colic, maternal smoking and infant feeding at 5 weeks of age. In: Scandinavian Journal of Public Health. 2008 May; 36 (3): 284-91.

(22) Reijneveld, SA (2000): Infantile colic: maternal smoking as potential risk factor. In: Archives of Disease in Childhood. 2000 Oct; 83 (4): 302-3.

(23) Gaffney, KF. (2001): Infant exposure to environmental tobacco smoke. In: Journal of Nursing Scholarship. 2001; 33 (4): 343-7.

(24) Lester, BM. (1993): Possible association between fluoxetine hydrochloride and colic in an infant. In: Journal of the American Academy of Child and Adolescent Psychiatry. 1993 Nov; 32(6): 1253-5.

(25) Engler, C. A., et al. (2012): Breastfeeding may improve nocturnal sleep and reduce infantile colic: potential role of breast milk melatonin. In: European Journal of Pediatrics. 2012 Apr; 171 (4): 729-32.

Medical Disclaimer: The information on this page is not intended to diagnose, prevent, mitigate, treate or cure any disease! It is not personal medical advice. We recommend that you ask a doctor whenver you are looking for medical advice!

ABOUT THE AUTHOR

Nathalie Kaufmann

Nathalie has 15+ years of experience in Traditional Chinese Medicine (TCM), acupuncture, reflexology, Shonishin baby massage techniques, Western and Eastern massage techniques (including TUINA), as well as herbal medicine and nutrition.

She has a degree in TCM (including nutrition) and a postgraduate diploma in Herbal Medicine. Moreover, Nathalie used to work for the highly respected Asante Academy in North London and was in charge of the Maternity Acupuncture Clinic at the Whittington hospital in London. She is also a member of the British Acupuncture Council, the official regulatory body for TCM in the UK.

Today, Nathalie runs her own company and has a broad customer base in London, where she specializes in the treatment of babies and children as well as gynecologic and fertility-related issues in women.

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