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Is it colic, reflux or an allergy? How to help an unsettled baby


We all know how distressing it is holding an unsettled baby in your arms, hearing heart-wrenching cries that just don’t stop. You would do anything to help them – and to finally get some peace and quiet! But because the symptoms of colic, reflux or an allergy are all so similar, it is often very difficult (even for specialists) to determine which one is to blame! Here’s some info from Karina Savage that might help mums work out what’s to blame and how to help an unsettled baby.

A baby can’t tell you when something’s wrong with them, but they certainly show you when they’re uncomfortable by being irritable, showing signs of tummy pain, regurgitating milk or solids, arching their back and passing wind. Trying to help an unsettled baby can be hard. And while it’s normal for babies to cry – between the ages of six to eight weeks, it’s normal for babies to cry for up to three hours per day- there are times when there might be something more to their crying.

Many times, a baby’s symptoms are due to one of the below issues:

  • Colic
  • Relfux
  • An allergy, such as cow’s milk

Colic: Signs and Symptoms

Colic affects around one in five babies, but there’s not a lot known about it. Most professionals define a colicky baby as one that’s healthy and well fed, but cries excessively (meaning more than three hours a day, at least three days a week!). Often the most intense crying happens around the ‘witching hour’ –  late afternoon and evening, and this pattern tends to last for more than three weeks.

What you need to know about colic:

  • 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
  • A colicky baby sounds distressed, but will 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: Sign and Symptoms

Reflux describes the passive flow of stomach contents (think breastmilk and formula!) that travel from the stomach into the oesophagus. It’s common in healthy infants younger than one year, whose muscles may may not have developed enough to control the flow- basically, the oesophageal sphincter relaxes and allows acidic stomach contents to come back up. This means lots of vomiting!

What you need to know about reflux:

  • It’s normal for babies to vomit or spit up, which improves in most babies by 4-6 months of age and the majority at walking age
  • Reflux may be diagnosed without clinical investigation (eg through 24-hour pH monitoring to test acid in the oesophagous).
  • Reflux may be treated with medications such a Losec and other common medicines (which can be ordered as liquid suspensions!)

Milk allergies

A cow’s milk protein allergy in infants can cause very similar symptoms to reflux – think vomiting, regurgitation and irritability. For this reason it can be confusing and difficult to determine whether a baby is experiencing actual reflux or a cows milk allergy reaction.

What you need to know about being allergic to milk:

  • A dietary trial of removing cows milk and soy products may improve symptoms of colic, cows milk protein allergy
    • For breastfeeding mothers, this may mean removing all cows milk protein and soy protein from her diet for 2-4 weeks
    • Formula fed babies may be changed to a soy free formula as advised by a health professional (sheep and goat milk are not suitable)

Ways to help reduce a baby’s vomiting

Thickening breastmilk

Research suggests thickening expressed breastmilk in a bottle for an unsettled baby can help to reduce the amount lost in vomits. Good thickening options include breastmilk fortifier or baby rice cereal, easy to grab from the supermarket or pharmacy. If you’re breastfeeding and using thickened milk to supplement, use the thickened milk for the times of day when your baby’s symptoms are most problematic.

Thickening formula

Infant formulae known as “AR” or “Anti Reflux” can be purchased from supermarkets or chemists in a pre thickened consistency that’s OK for most babies. 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. Good thickening options include regular baby rice cereal or corn based thickeners

Feed smaller amounts, more frequently

Small, frequent feeds and keeping your baby upright after eating may help prevent them feeing overfull and regurgitating milk. This can help an unsettled baby.

Use medication prescribed by a professional

Medications aim to reduce acidity of the stomach contents so that if a bub’s stomach contents do come up, it’s not as painful for baby. There are different types of medication available, including antacids act to neutralise or buffer the amount of acid present in the stomach. Acid suppression therapy (eg. Losec/Nexium) works to reduce the amount of acid actually produced in the stomach.

How long is this going to last?

Babies with colic and reflux will often improve after the first 6 months and continue to improve over the next few years of life, depending on natural development or medication. This means there is light at the end of the tunnel when it you’re trying to help an unsettled baby. 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.

When to see your Doctor

  • Your baby’s irritability, crying or fussing lasts more than three hours total per 24 hours, for more than three days of the week
  • If your baby shows signs of dehydration, including dry skin, fewer or no wet nappies, yellow smelly urine, hard poo
  • If you feel your baby’s growth and weight gain is being affected by the amount of milk they are expressing in vomiting

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