Colic and choosing the right formula

Would you believe that around 40% of infants aged from 2 weeks to 3 months are affected by colic? Even though infants who suffer from colic experience symptoms for only a few months, it still causes high levels of anxiety and stress for parents and the family. Since the condition is non-life threatening, it can be a wrongly undervalued cause for paediatric consultation. This could be because no one really knows what causes colic and is an ill‑defined condition. Various treatment options are available for colic, yet there is no standard care.

So what is colic? The most popular definition is an infant who is otherwise healthy and well-fed, but presents with irritability, fussing and crying that lasts for more than three hours a day for more than three days a week. Additional symptoms may include drawing up the knees, and excessive gas (cramping). Treatment options for colic include pharmacological products (such as lactase enzymes, colic drops etc.), nutritional and behavioural interventions.

Despite its frequent use, pharmacological and behavioural interventions for colic have been reported ineffective or inappropriate for the treatment of colic1. There is some evidence that supports some of the nutritional interventions for infantile colic. Since Baby Yum Yum is an online community and resource for parents and caregivers needing information and advice about formula feeding and nutrition, the focus of this post will be on the dietary options that could possibly help manage colic.

A change of formula would be your first line of treatment as a dietary approach. Here are some options:

  • Partially hydrolysed formulas: the effectiveness of partially hydrolysed whey based formulas (PHF) for the management of colic is debatable as most studies included other dietary changes as well. These formulas may be of some help to colicky babies when allergies are not suspected2. Brands include Similac Total Comfort.
  • Reduced lactose formulas: another option is to try a specifically designed infant formula with reduced lactose concentration. Some babies are lactose sensitive and have a reduced lactose absorption capacity, resulting in less lactose being absorbed in the small intestine and more lactose ending up in the colon where it gets fermented and produces gas. This ultimately leads to some of the symptoms associated with colic, such as cramping, flatulence, excessive crying etc. Using a formula with a reduced lactose concentration could assist sensitive babies and prevent gas development. Brands include Novalac AC.
  • Extensively hydrolysed formulas: If the two formula types above do not assist in the management of colic, one could consider using an extensively hydrolysed, casein protein based formula for infants struggling with severe colic or additional atopic symptoms. Brands include Novalac Allernova Smooth and Similac Alimentum.
  • Soya formulas: often used for colicky babies, but it is important to mention that there is no evidence to show that soya formulas assist with the prevention and management of colic.

For breast-fed infants with colic, it is suggested that the mother switch to a low allergen diet, avoiding cow’s milk and dairy food with appropriate intake of vitamins and minerals.  You will need to wait at least two weeks though to check the effectiveness of the diet. Any dietary changes should be made under the supervision or with the advice of a health care professional such as a clinic sister, pharmacist, dietician, GP or paediatrician3.

It is fantastic to see how many mommies and caregivers, whose baby has suffered or is currently suffering from colic, are willing to share their thoughts and advice.  This is ultimately the goal of Baby Yum Yum!  We thought it would be ideal to discuss and clarify how some of the options mentioned, mostly homeopathic remedies, could assist in managing colic:

  • Gripe water: these products often help to relieve stomach upsets temporarily by changing healthy pH levels (acidity) in the stomach, but do not treat the underlying problem. This is seen as a “band aid” approach to manage colic and other digestive problems such as reflux and constipation, and often provides little or no relief. Read the label and avoid products containing alcohol, sugar, sodium bicarbonate (baking soda), simethicone, herbal oils or extracts, or artificial flavours. Whilst gripe water is a familiar remedy for infantile colic that has been used since 1851, there are no studies that explore this as a possible treatment.
  • Colic/gas drops: drops often contain the pharmacological product Simethicone which requires constant dosing in order to have an effect. Over use could create a dependency and as mentioned above, this pharmacological intervention has been reported not to be effective or appropriate for the treatment of colic1.
  • Probiotics: limited evidence is available on the efficacy of adding probiotics to ease colic and the evidence that does exist is, on breast-fed and not formula fed infants.

Another issue that came up in our discussion on colic was how to treat constipation.  I think this is because often a constipated baby would present with similar symptoms as a colicky baby. If one pin-points which symptom is most severe, one would be able to use a more specific solution to manage the condition at hand, often addressing the other symptoms then too.  Look out for our next article which will be on constipation and how you can treat and manage it.

Resources: 1 Hall et al., 2011; 2 Vandenplas et al., 2014; 3 Savino et al., 2014

 

Disclaimer: This post is based on personal experience and personal brand preference of the content author and has in no way been paid for or sponsored. BabyYumYum reserves the right to its opinions and fully supports the notion of promotion that breast is best in line with the World Health Organisation (WHO) infant feeding guidelines http://www.who.int/topics/infant_nutrition/en/ Breast milk is the best food for infants. Good maternal nutrition is essential to prepare and maintain breastfeeding. If breastfeeding is not applied, an infant formula may be used according to health professionals’ advice. Preparation and storage of any infant formula should be performed as directed on the tin in order not to pose any health hazards.