Breastfed babies typically experience colic at a lesser rate than their formula-fed counterparts. Despite this, breastfeeding and colic symptoms are common in the first few months of life as breastfeeding is established. Colic is defined as an otherwise healthy infant experiencing intense periods of inconsolable crying lasting for at least three hours a day and occurring at least three times a week. Colic symptoms in a breastfed baby are typically due to one of three things: a lack of hind milk, overactive letdown and foreign proteins in the mother’s milk.
Human milk changes not only throughout the day but during a feeding, as well. When the baby first latches on and begins to feed, the breast produces what is known as fore milk, which is low in fat and high in lactose. After the baby has finished the fore milk, the mother’s breast produces what is known as hind milk, which is rich with good fats. If the mother switches breasts before the baby is finished feeding from the first breast, this can cause the baby to receive too much lactose and not enough fat to process it, causing colic-like symptoms as a result of intestinal upset. To remedy this, the mother should always allow the baby to nurse for as long as he or she wishes on one breast before offering the other.
Symptoms linking breastfeeding and colic can also be caused by what is known as overactive letdown reflex. This is when the baby receives too much milk too quickly, which can cause him to become fussy. Classic signs of overactive letdown are coughing and choking at the breast. This issue can be rectified by feeding from the same breast two or three times in a row, which will slow the milk production during a feeding. Reclining while feeding can also help, because gravity decreases the rate of milk flow.
Research indicates that foreign proteins in the mother’s milk, mainly cow’s milk proteins, are a primary link between breastfeeding and colic symptoms. It is important to note that a baby showing intolerance to milk proteins won't necessarily become lactose intolerant. The intestines of a baby under a year of age are not prepared to digest cow’s milk proteins, which is why the American Academy of Pediatrics (AAP) specifies that no child under 1 year old should be given cow’s milk.
If a breastfed baby is experiencing colic pain, and overactive letdown and lack of hind milk have been ruled out, lactation consultants often recommend that a mother eliminate all milk products from her diet for 10 days. More often than not, the colic symptoms will diminish. If there is a change for the better, the mother can slowly reintroduce milk products into her diet. Different babies can tolerate different levels of cow’s milk proteins and even those who cannot tolerate them at all often outgrow this stage rather quickly, even within a few months.
The link between breastfeeding and colic is often the result of the delivery of the milk and the mother’s diet rather than the breast milk itself. Switching to formula is often not helpful in dealing with colic. Formula digests at a much slower rate than breast milk, and this can increase the intestinal pain associated with colic.