Tears before bedtime
Baby Whisperer, Sharlene Poole, offers her expert opinion on colic and reflux...
Babies from a very early age can suffer from sore tummies and they're often diagnosed with colic or reflux or labeled as a ‘windy baby’. These babies are often unsettled, show physical discomfort, cry or seem unhappy quite frequently throughout the day. They can be difficult to feed, which of course has flow-on effects. They find it hard to settle to sleep or difficult to sleep for long-enough periods to be content and able to cope with the next feed.
What I have come to believe about newborn babies over the years is that a lot of what is happening is avoidable; the babies are trying to tell us (their parents or caregivers) that something we are doing to care for them is not quite right for them personally.
If we look at colic first, when I started working with newborns I believed colic to be a bona fide condition. I was convinced it was something unexplained that they would grow out of by three months of age and there was little we could do to prevent or cure it. Now I believe differently.
There was one baby I was caring for in the UK who was the catalyst for me changing my mind about colic. This baby, a very visual girl and very knowing, was always settled for the start of each day but unsettled in the afternoons and evenings until midnight each night. Every evening I would hold her and pace from 6pm until midnight. I talked to the mother’s midwife; I talked to an older maternity nurse who had worked with newborns for more than 40 years and still I struggled to find solutions to change what was happening every day.
Finally, when she was around five weeks old I talked to an osteopath, I read a book about consistency to the day through routine and I started to implement changes to how I cared for her from the start of the day. I suggested the mother reduce her dairy intake. I started waking the baby in the mornings (because she was sleeping so much due to her unsettled evenings) and started winding her more frequently through each feed – what a difference I found! No longer did I have a baby who was unable to settle to sleep, frequently crying and pulling up her legs in discomfort. She was settling to sleep in the evenings and was therefore less sleepy in the morning – a better balance for her 24-hour day, which suited her personality and digestive system.
From experiences like these, I created a mental checklist for babies who are unsettled from very early on:
- What are the baby’s bowel motions like?
- Is the baby very visual and ‘wide-eyed’, not the classic sleepy newborn?
- Does the baby sleep a lot in the morning but is very wakeful in the afternoon and evening?
- Does the mother have a fast flow of milk, resulting in the baby gulping a lot during
- each feed?
- Does the mum stop and wind the baby throughout and after each feed?
- How much wind does the baby have? How many burps in a cycle?
- How long is the baby awake for each feeding and sleeping cycle, and how long do they take to settle to sleep?
- What is the family history with allergies/intolerances?
- Can they lay the baby on her back to play and are they happy to do so?
From this list I can determine whether a baby can be helped purely by my intervention along with the parents' input, or whether they have reflux. This brings me to reflux. When I meet a baby who has possible or diagnosed reflux, I once again work with the mother through the list above. We trial a few things like diet changes, increased winding and implementation of good sleeping practices and this helps me determine whether it is a mild form of reflux or a form that needs medical assistance and medication.
Reflux happens after a feed, when the milk comes back up through the baby's oesophagus, sometimes bringing acid from the stomach, which causes the baby pain. Babies with reflux suffer after every feed and struggle to lie flat despite being well-winded. They struggle to settle to sleep on their back, and often need to be held.
There are babies who will spill but then there are also babies who have what is known as 'silent reflux', where the feed comes up the oesophagus, but not out. The babies who spill are a little easier to read and diagnose. Babies with silent reflux are harder to diagnose because they don’t show such obvious signs.
While I believe many babies do need help for reflux through medication, I also believe that mild reflux can be exacerbated if some of the points on my checklist are not being addressed. For example, a baby who is not sleeping well due to being overtired, not feeding well or not getting all of his wind up will also not tolerate the discomfort they might get from mild reflux. They're just like adults – when we are tired we are less tolerant and more likely to react to situations that we would normally handle quite well!
The good news is that all babies grow out of the severity or frequency of their unsettledness but we can also help them. It's not normal or necessary for babies to have to cope daily with discomfort or pain. Seek help as soon as you know you have a problem. Talk to your doctor and get a second opinion if you don't get solutions that you are happy with. The changes can take a few days to a few weeks to implement so it's worth getting onto it as soon as you can.
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