As a mothercraft nurse I visit many homes with unsettled babies. Parents pacing the floor, pulling their hair out having tried every remedy and potions family and friends have suggested with little or no improvement. The nightmare some families go through with their babies often results in shattered confidence, mental and physical exhaustion which can lead to postnatal depression, family feuds and marital breakdowns.
So why are these babies so unsettled?
There may be several reasons why a baby is unsettled one of which may be what is commonly called 'colic'. So what is 'colic' any way? Good question. The pharmacies shelves have been filled with remedies for colic, special bottles and teats and liquids. So is it colic or something else that is causing so many babies to be unsettled? And if it is colic why aren't these remedies working as well as they should? Someone said it may be reflux but my baby doesn't vomit.
What is the difference between colic and reflux?
'Colic' is an unsettled baby with lots of wind. Reflux babies also have a lot of abdominal wind. If you look at the symptoms of colic they are similar if not the same as those of a baby with reflux. So what is the difference between reflux and 'colic'? I, and many health professionals will agree with me, believe that colic as it was commonly known is today known as 'silent reflux'.
A word from a Paediatric Gastroenterologist
Dr Bryan Vartabedian in his book Colic Solved says”..colic has evolved into one of our culture’s greatest urban legends – a mythical explanation meant to explain the seemingly unexplainable.” He goes on to say “I’m always amazed at the number of paediatricians who approach me after my presentation and comment, ‘I didn’t know that some of these symptoms pointed to reflux. For years we’ve been calling this colic.’...They’re well-trained practitioners who were never taught that inconsolable screaming, arcing, and pulling from the nipple where symptoms of anything other than colic. Like the babies suffering with this condition and the parents who try to console them, they’re victims as much as anyone else, trying to catch up with the advances in medicine that are now giving us explanations and answers.”
In otherwords Colic is now known to be Reflux.
What is reflux?
Reflux occurs when the acid content of the stomach rises into the oesophagus causing discomfort and burning. This understandably causes a baby to be very irritable. Babies may be seen to raise their legs, back arch and/or to cry inconsolably. Gastro-oesophageal reflux (GOR) is common in babies but often goes undiagnosed as many think it is colic. If untreated reflux can cause complications such as increased risk of SIDS, ear and respiratory infections, ulcerated oesophagus.
There are two types of reflux -
Frank reflux - where a baby will regurgitate frequently sometimes in large amounts.
Silent reflux - when a baby rarely regurgitates but is very unsettled. This type of reflux is rarely picked up and often goes undiagnosed. It may start from birth or it may develop later from three weeks or three months.
What to look for:
When visiting a family I look for things to determine whether a baby has a sleeping, feeding or a physical problem.
Does your baby snack or cliuster feed? (often falling asleep at a feed or have frequent short feeds, feeding under 3 hrs)
Is your baby hungry due to your low supply? Do you need to incurease your supply or tip baby up after a feed?
Is your baby difficult to settle or has an unsettled period during the day or night?
Is your baby able to self settle after the initial 30-45 mins cat nap?
Are you over handling your baby?
How long is your baby awake and how long do they sleep is it according to their age appropriate needs? (See our FAQ Questions relating to Sleep)
Does your baby have an infection - urinary, ear or chest infection?
Depending on your answers you may have a baby who suffers from reflux, hunger or one who just need to be taught how to sleep and how to self settle. Many babies have a degree of reflux. Not all babies suffer from acid reflux, some vomit frequently but are not bothered by it other babies don't vomit at all but are in terrible pain.
An irritable, unsettled baby if encouraged to sleep well between feeds and not cat nap may quickly become a more settled baby but if their irritable periods continue and they refuse to sleep they may be suffering from acid reflux. If you suspect your baby has reflux take a look at questions listed below.
How does one detect reflux
Firstly look at your family tree. Ask your parents on both sides if you or any of your siblings has 'colic' or were very unsettled or vomity babies. These are typical signs of reflux. If the answer is yes or maybe it is more likely that your child may also have reflux.
Is your baby very unsettled at a certain time of the day more than any other? Often in the 'witching' or 'arsenic' hour between 2 pm and 9 pm. Take into consideration whether they are over tired, over handled or possibly just hungry.
Is your baby often unsettled from one feed to the next? Dozing between bouts of uncontrollable crying?
Does you baby prefer sleeping in a rocker, over your shoulder,in a pouch or in an upright position?
When asleep are their periods where he/she wakes suddenly and cries out seemingly in distress? or is grunting in squirming in their sleep?
Does you baby back arch, pull their legs up, fight their wrap and generally look uncomfortable?
Do you use a dummy to help pacify your baby during these unsettled periods?
If you have a family history of unsettled babies and you answered yes to most of the above then read on to see if your baby has any other symptoms of reflux.
Some symptoms that can indicate reflux including silent reflux are:
irritability and pain
poor sleep habits typically with frequent waking
grunting, squirming and wriggling during sleep
arching their necks and back during or after eating or at sleep time
gulping, coughing or re swallowing hours after a feed
teary eyes when gulping
mouth filling with saliva, spit, frothing, excessive drooling
rattle wheezy chest
reoccurring unexplained croup
constantly needing to suck
swallowing problems, gagging, choking, coughing
gagging themselves with their fingers or fist (sign of oesophagus)
bad or acid breath
running or blocked nose
frequent red, sore throat without infection present
neck arching (Sandifer's Syndrome)
vomiting or projectile vomiting (seldom in silent reflux)
irregular, infrequent, watery or firm stool
pulling legs up as if in pain
If reflux is untreated it may lead to:
refusing food or accepting only small amounts despite being hungry or the exact opposite requiring constant small meals or liquid
poor weight gain, weight loss, failure to thrive
respiratory problems—pneumonia, bronchitis, wheezing, asthma, night-time cough, aspiration
frequent ear infection
chronic hoarse voice
erosion of dental enamel
Tips: Reflux babies are often happier when held upright and therefore sleep well on your shoulder or in a pouch this is not encouraged as long term sleeping problems usually follow.
Remember: Many reflux babies are unsettled only at certain time ‘the arsenic hours’ and sleep well after this time but if left untreated they may become unsettled all day which may eventually become all night as well.
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Disclaimer: Article on our website are for education purposes only. Please consult with your doctor to make sure this information is right for your child.