Infantile colic is characterized by paroxysms of uncontrollable crying or fussing in an otherwise healthy and well-fed infant younger than three months of age with crying that lasts for more than 3 h per day and more than three days per week for at least three weeks. The condition can be profoundly disturbing to both the infant and the family. Among the many concerns an expecting or new mother may have, one of the most common and challenging is colic in breastfed babies-a condition that affects about one in five infants and can be both puzzling and frustrating.
In this article, we’ll explore what colic is and how it may be linked to mum's breastfeeding diet, including potential intolerance to certain foods. We’ll also share gentle tips on dietary adjustments, including foods to avoid, to help reduce colic symptoms.
Understanding Colic
Colic in infants is characterized by regular fits of violent crying, sometimes coupled with other physical features such as furrowing of the brow, clenching of the fists or pulling up of the legs towards the belly. There are no other signs of physical illness, and the baby continues to put on weight normally. Strangely, the baby appears happy and peaceful except when the colicky symptoms start.
According to medical research, infantile colic is defined as an infant crying intensely for three or more hours a day, three or more days a week, for three or more weeks. The peak of colic happens when an infant is about six weeks old and declines after it reaches three or four months of age. It can happen to any baby, whether breastfed or given baby formula, male or female, premature or full-term.
It’s important to note that colic is a condition that occurs in otherwise healthy babies and doesn’t seem to have any particular trigger. If your baby is intensely crying regularly, it’s important to rule out the possibility of a non-colic cause that is leading to pain or discomfort in your baby, such as illness. If your infant experiences excessive crying, you should schedule an appointment with your doctor to see if an underlying cause can be found instead of assuming that it must be colic. Together, you will be able to determine if your baby does indeed have colic.
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The Role of Diet
Understanding the actual cause of colic can be incredibly challenging, not to mention the frustrating aspect of it all. Recent studies suggest that a mother's diet may affect colic, especially when certain allergens are involved.
Bovine milk proteins can elicit symptoms of infantile colic in certain infants. Studies have shown that removal of cow’s milk from the infant’s diet may result in a significant reduction of the symptoms of colic in a certain percentage of infants. It is probable, though not proven, that atopic infants with severe colic would benefit most from the elimination of cow’s milk.
Cow's Milk and Other Allergens
There is increasing evidence that bovine milk proteins may play a role in the pathogenesis of infantile colic and that removal of cow’s milk from the infant’s diet may reduce the symptoms of colic in a small percentage of infants. Some studies have shown that when the mothers of infants who were being breastfed abstained from milk and other dairy products, the incidence of colic in their babies dropped sharply. This was confirmed by another study, which also demonstrated the reappearance of colic in a majority of such babies, after dairy foods were reintroduced into the mother’s diet. Many of these babies developed colic when their mothers were given whey from cow’s milk.
Other studies have focused on the elimination of potential allergens from the mother’s food. These included soy, peanuts, wheat, milk and milk products, tree nuts, eggs, and fish.
FODMAPs
In breastfed infants with colic a very common approach is for the breastfeeding mother to remove ‘gassy’ foods. This includes foods such as onion, garlic, cabbage, cauliflower and legumes/pulses - all of which are high in FODMAPs.
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One study found that crying-fussing times associated with infantile colic reduced by an average of 35% ( > 25% deemed clinically significant) in the low FODMAP diet and 8% in the typical Australian diet (not clinically significant).
Dietary Modifications for Breastfeeding Mothers
It has been suggested that mothers who breastfeed their infants should, with appropriate nutritional support, consider eliminating cow’s milk from the diet and avoid potentially allergenic substances such as caffeine, chocolate, eggs and nuts.
When cow’s milk intolerance is suspected to be the cause of a baby’s colic, it may be wise to allow the mother to stop ingesting milk and milk products for a period of one to two weeks. Within this period, a significant reduction in the rate of colic episodes will confirm the advisability of withdrawing dairy products from the mother’s diet for a time. Such breastfeeding mothers should receive adequate support. Breastfeeding should be continued.
General Dietary Recommendations
In more general terms, it is recommended that women eat regularly and frequently, at least three meals a day with occasional healthy snacks, and plenty of water. Eating at least three meals a day with additional small snacks. Limit foods and drinks with caffeine. Drink plenty of water each day. If you are thirsty you are not drinking enough.
If a woman who breastfeeds is on artificial sweeteners, she should check with a professional as to how much she can take each day without risk of its passing to the baby. Some women find that avoiding cruciferous vegetables such as broccoli, cabbage and legumes reduces the incidence of colic in their babies.
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Specific Foods
- Alcohol: Not drinking alcohol is the safest option during breastfeeding. However, you can have a very small amount of alcohol while breastfeeding. “Time it out so that you feed your baby right before you drink an alcoholic beverage, so that your body has enough time to flush out the alcohol before the next feeding.
- Caffeine: Caffeine and breastfeeding can be mixed but should be limited. Two to three cups of coffee, or 200-300 mg, per day is considered safe to consume while breastfeeding.
- Fish: Fish is a good source of protein and healthy omega-3 fatty acids, but choose the fish you eat wisely. Try to avoid fish that may contain high levels of mercury because this will pass into breast milk. Fish such as shrimp, catfish, salmon or light canned tuna are the safest.
- Honey: Yes, it is safe to eat honey while breastfeeding. Consuming honey in any form, raw or pasteurized, is safe for breastfeeding mums and babies. The recommended amount for women to consume is no more than 6 teaspoons due to the high sugar content.
- Peanut Butter: Some studies suggest that introducing peanut products while breastfeeding might lower the risk of your baby developing a peanut allergy. As long as you consume peanut butter in moderation, such as two sandwiches a day, it should not harm your baby. If you have concerns about food allergies, it’s always a good idea to consult your doctor or health visitor.
- Pâté: Eating pâté while breastfeeding should be done with caution. While breastfeeding, or during pregnancy, the consumption of meat and liver-based pâtés is discouraged because they are more likely to contain Listeria. If you’re craving pâté, you might want to consider vegetable pâté instead of meat-based pâté.
- Chocolate: Yes, you can eat chocolate while breastfeeding. Chocolate contains small amounts of caffeine and the stimulant theobromine, but the amount in chocolate is unlikely to affect your baby unless consumed in large quantities. Most people can enjoy chocolate in moderation without issues. However, if your baby shows signs like irritability or sleep problems, try reducing your chocolate intake. Symptoms should subside within 3 to 7 days.
- Sushi: Yes, you can eat sushi while breastfeeding.
Alternative Feeding Options
If breastfeeding is not possible, the use of a hypoallergenic formula should be considered. For bottle-fed infants, soy formulas may be effective in reducing the symptoms of infantile colic. However, the use of soy formulas in the treatment of infantile colic should be avoided because soy protein is an important allergen in infancy.
Additional Considerations
Studies rarely stratify populations into children prone or not prone to atopy and often reflect the referral bias of the particular institution or country. Most of the studies have, so far, involved a small sample size, and some of the studies have methodological flaws.
A well-designed study should include the use of a common case definition, objective outcome measures, appropriate washout times in crossover trials, adequate blinding and repeated blind challenges of the proposed intervention to account for spontaneous resolution with increasing age. Until results from such trials are available, no unequivocal recommendation can be made.