Becoming a new parent brings with it a host of challenges, not the least of which is learning your baby’s needs and how he or she expresses those needs.
Yet a baby with colic can test the most prepared and loving parents. Colic is a condition defined as intense and unexplained crying in a healthy baby that lasts at least three hours a day, more than three days a week for at least three weeks.
Bryan Vartabedian, MD, a pediatric gastroenterologist at Texas Children’s Hospital, discovered these challenges when his own daughter had colic. As a member of both the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the American Society of Gastrointestinal Endoscopy, he still said dealing with it personally gave him new perspectives.
“For years I’ve treated babies with marked irritability, but having a child of my own with colic really changed the way I looked at it,” he said. “That’s what drew me to write Colic Solved and focus my attention on colic.”
Since delving into the condition, possible causes and ways to treat it, he has learned a great deal, much of which he includes in his book Colic Solved – The Essential Guide to Infant Reflux and the Care of Your Screaming, Difficult-to-Soothe Baby.
Dr. Vartabedian spoke with dailyRx to share some of what he has learned in his research into colic and things parents can do to cope with the condition and to treat their colicky bundle of joy.
When you first started out, were you certain that colic was related to gastrointestinal discomfort - with both your daughter and as a clinician?
The way we look at colic has really changed over the years. In 1954, when this was first described, when a baby screamed for (extended) periods of time, more than three hours a day for three days a week, we put a label on it called “colic.” But since that time we’ve learned a lot more about what’s going on inside of a baby. We’ve learned that there are treatable causes like acid reflux and milk protein allergy that can be behind it, and so the way we see colic is changing. Perhaps one of the most interesting developments has been the fact that colic may be related to a baby’s intestinal flora, or changes in the baby’s intestinal flora.
Can you talk more about the remedies for colic?
Part of the things we’re learning about colic is its connection with the intestinal microflora. We are seeing that probiotics may have a connection with treating colic. There is one in particular by the name of Lactobacillus reuteri, which has been proven to decrease crying in colicky breast-fed babies in as little as one week. So the results are pretty dramatic, and those are babies that were compared to babies receiving placebos. What’s exactly causing those babies [to improve] with Lactobacillus reuteri is unclear, but the fact is that the effect is interesting and it raises a lot of questions about this vague condition we call colic.
I know there’s been a lot of research coming out about bacteria in the gut, and the bacterial makeup of our guts. Is it possible that the probiotic is doing something to “reconfigure” the bacteria in a better way for the baby?
Absolutely. When a baby is born, they are born with an entirely sterile intestinal tract, so over the course of the first few weeks of life they go from zero organisms in their intestinal tract to 100 trillion. So it stands to reason that there is a lot happening inside that baby’s gut. We know that, depending on what bacterial flora that baby gets, it can impact their health going forward. It can impact their risk of developing allergies at age two and things like that.
We think the Lactobacillus reuteri may be playing a role in populating the lining and potentially displacing or removing bad bacteria. There have been studies supporting the idea that Lactobacillus reuteri displaces some of the bacteria that produce gas. And so you’re right, it may be reconfiguring what we call the “footprint” of a baby’s intestinal flora. Again, we are just starting to understand some of this stuff at this point, but these results in the study with Lactobacillus reuteri are exciting.
Is it true that babies who breastfeed tend to have less colic?
Certainly with milk protein allergy that’s the issue, but you see colic in both breastfed and bottle-fed babies. Certainly the breastfed baby has a healthier bacteria microflora than the bottle-fed baby, and so increasingly we’re using probiotic strains like Lactobacillus reuteri in predominant formulas like Gerber Good Start Soothe to make the babies’ bowel movement and intestinal flora closer to that of a breastfed baby. Breastfeeding remains the best option for parents.
You’re probably familiar with Harvey Karp’s theory on colic, that has more to do with underdevelopment of the baby and that you can use the 5 Ss to help calm a baby. Can you talk about that theory?
Harvey Karp’s theory that there’s a fourth trimester of brain development is very interesting and there’s probably some truth to it. I’ve always argued that there’s a fourth trimester of gut development as well, but he doesn’t mention that in his book. Just like a baby’s arms and legs are uncoordinated when they’re born, and they kind of move funny – so too is the squeezing and emptying of the stomach uncoordinated. There’s a lot of maturation that happens during the first several weeks of life that brings a baby from that newborn state up to a more mature level.
With respect to Harvey’s “shushing” noises, we know that white noise does affect and help a baby regardless of what’s causing their pain. So I definitely support and encourage moms to use neutralizing white noise, like from a washing machine or a hair dryer, because those things do settle a baby’s central nervous system. I just want to add that I don’t think that’s an excuse for not looking for the cause of a baby’s irritability. We really want to partner with our pediatricians to make sure that we don’t have a treatable cause of that baby’s irritability like reflux or milk protein allergy.
One of the chapters in your book focuses on the seven signs of reflux in your baby. Without giving away your whole book, can you do a quick outline of what those signs are and what parents should be watching for?
There are a number of signs that parents can look for to tell them that their baby has reflux. One of the most obvious is pulling away from the bottle. When babies have painful swelling from acid reflux, they pull away, just like when you and I have a sore throat. Babies with reflux will have lots of hiccups and like to be on their bellies as opposed to their backs. When they are on their back, that valve that connects the stomach to the intestines is in the most dependent position, so fluid can move up and down.
A lot of babies with reflux will have chronic congestion, and sound like they have sinus irritation or allergies. So parents will get rid of the cat or the dog when it’s really just acid reflux causing the upper airway to get a little bit swollen. These are some of the things that parents can look for to know if their baby has acid reflux.
Let’s say a new parent with a child about 6 weeks old comes to you tearing their hair out. They’ve waited two weeks to come to you, and you can see their bloodshot eyes. Walk me through the first steps that you would take them through.
The first thing I’m going to do is to make sure these parents have appropriate expectations for what a normal baby is going to do. You’d be surprised at the number of parents who will take a baby that’s kind of irritable and want a perfect baby. Then I’m going to look for treatable causes of that baby’s fussiness because I want to make sure that I’m not recommending conservative measures to fix a problem when in fact it’s something that requires a special formula. Then I’m going to ask them to use some of the conservative measures that we talk about to treat colic and irritability, like soothing white noises, frequently burping a baby, keeping them upright for 20 minutes after feeds, elevating babies’ heads while in their beds.
Regarding formulas that claim to reduce colic or bottles that claim to be colic-reducing, is there anything to those claims?
I can’t speak specifically to each bottle system that has those claims, obviously, but the most important thing for parents to remember is that with respect to bottles and bottle systems, what worked for your sister-in-law may not necessarily work for you. A baby’s pallet and the shape of their mouth is going to be very different, so the Playtex Drop-In system may work well for one mom whereas the Dr. Brown system may work for another.
There’s a lot of marketing surrounding the passage of air inside the bottle, but the most critical element is that baby has a good, healthy latch with that bottle system. Parents want to look for squeaking and squacking noises around the nipple; if they’re hearing a lot of that, it means the baby is sucking in air around the bottle system. It may mean that the flow system is not enough for that baby to get the milk that they want. Matching a bottle system and your baby for their specific needs is the most important thing.
It sounds like you can use that same benchmark in breastfeeding: if you hear your baby smacking a lot, you may need to adjust your hold or the baby’s latch.
Exactly right, the same goes for breastfeeding babies. A little occasional squack is normal for a breastfeeding baby, but if there’s a lot of dribbling or if you hear a lot of air coming in around that latch and there doesn’t seem to be a good seal on it, the first thing I would do would be to visit with a good lactation consultant who can help you change positions or use some tools to help that latch improve.
Is there anything that parents can do before colic even hits that is sort of a “best practice” in terms of parenting or feeding?
So you’re asking me if there’s anything we can do to prevent it, and I don’t have a good answer for that. When it comes to things like reflux and allergy, there certainly are some things we can do: if there’s a strong family history of milk protein allergy, we should be using a partially broken-down infant formula to prevent that allergy from developing. If there’s a strong family history of acid reflux, we might be using those anti-reflux measures earlier in that baby. But in respect to the non-specific colic irritability, there’s nothing we can do to prevent that from taking hold.
One thing that I’ve always found interesting about the research of colic is that, supposedly, you see more colic in Western countries than in other countries, including less-developed countries. Is that data accurate or is it a common myth, and if it is true, do you have any theories as to why that is?
There are some studies showing that colic definitely varies by culture and is greater in Western cultures. I’m not well-versed on the methods used in those studies, but it’s clear there are some differences from culture to culture. There are a lot of things that happen within certain cultures – the way we feed, the environments we have our babies in, and the types of tools we use to feed our babies, be it breast or bottle – so I think there are a lot of factors that make it very complicated in assessing those studies.
At what point should a parent go see a pediatrician if their child is incessantly crying? Some parents might think it’s their own fault and wait two or three weeks and some parents might go in as soon as their child starts crying.
That’s a good question because a lot of parents are concerned that something serious could be going on, and, truthfully, babies don’t have a lot of ways to tell us when something’s going on. Sometimes crying is the only way they can do that. So it is important for parents to partner with their pediatricians to look for those treatable causes and to rule out the bad things that can be going on. Protracted crying should be discussed at the 2 week visit or beyond, whenever it develops. Certainly when the baby drops off with feeding, that’s something to talk to their pediatrician about. Excessive spitting up or regurgitation or a decrease in urine output or poops are things you should be talking to your doctor about.
