Colic

My baby has colic. What can I do?

As if those first 3-4 months of parenting are not difficult enough with frequent feeds and lack of sleep - a baby with colic seems inconsolable and it is simply an exhausting, stressful time for parents, who wonder if they will ever survive their way through it.

Colic is sharp abdominal pain/cramps babies experience in their digestive system. It may take a few days or weeks for babies to develop colic, but it can continue right through until they are 3-4 months old, (when their digestive system has developed sufficiently to cope) by which time it normally begins to resolve. Your baby may experience constipation or have a change in colour in their stools. Usually their body language will be the best giveaway: pulling their knees up towards their chest (or even stretching them out) and crying.

You may find that your baby experiences a pattern of colic - often worse at night. Or perhaps your baby experiences it throughout the day. Here are some things that you can try:

• If you are breastfeeding: try eliminating foods that disagree with you and consider the foods that you eat a lot of in terms of elimination in case it is affecting your baby. Also consider eliminating foods that have been known to cause colic, such as milk/dairy products, alcohol, tea, coffee, spices (including chillies and pepper), onions, garlic, broccoli, cabbage, cauliflower, brussel sprouts, capsicums, strawberries, oranges, grapes. Sometimes egg whites or fruit with stones (eg. cherries, apricots) can also be to blame. You may like to eliminate these one-by-one to identify what might be the main culprit. Don’t allow your baby to become too hungry before breastfeeding, otherwise he/she may gulp air prior to feeding. Try different feeding positions so that your baby is not swallowing both milk and air at the same time.
• If you are bottlefeeding: your baby may be swallowing air when feeding. Try finding a teat with a smaller hole (for a young baby) or a bigger hole (for an older baby) There are teats that are sold particularly for babies with colic. There is also on the market formula for babies with colic. Your baby may have trouble with dairy products, so it might be worth discussing with your doctor, midwife or plunket nurse the idea of trying a soy-based formula to see if this might make a difference. Just like breastfeeding mothers, try different feeding positions so that your baby is not swallowing both milk and air at the same time.Offer a dummy after feeding time. The sucking motion can assist your baby’s digestive system, and is soothing.
• Frequent feeding may be something you need to consider when your baby has reflux (we will discuss reflux next week), but it’s worth noting that when you have a baby with colic, it can be tempting to offer a feed in order to comfort your baby - but frequent feeds can cause continuous discomfort due to being overloaded with milk. Try other ways to comfort your baby.
• Comforting your baby instead of feeding: place your baby in a swing, go for a drive in the car, walk or rock your baby, offer a dummy or your finger at the roof of your baby’s mouth to suck (which in turn helps the digestive system as indicated above), play relaxing music. It’s difficult, but try to relax as much as you can although your baby is clearly distressed. If you become distressed, your baby will only become more uptight.
• Positioning & burping: burp your baby more often - and always after a feed, carry baby upright over your shoulder so baby’s tummy is lengthened, or try lying baby across your lap while rubbing baby’s back. Sometimes pressure helps colic: try a rolled up towel on your lap and placing baby’s tummy across it. On the other hand - pressure can also aggravate colic, so placing baby instead over your knees so there is no pressure on your baby’s stomach may be something you might like to try instead.
• Treatment: You could try some homeopathic remedies for colic (found in your local pharmacy) or fennel seed /dill tea. Be careful with gripe water as it may contain alcohol.
• Bowel Movements: Sometimes colic precedes a bowel motion from your baby. You can help by massaging your baby’s stomach in a gentle, circular clockwise motion or hold your baby in a semi-squatting position, pulling baby’s knees up gently while baby’s back rests against your stomach.
• Looking after Yourself: When your baby is not crying with colic, make sure you take some time out for yourself. Get some rest, do something you enjoy. A baby who cries continuously is draining, so you must get help and support so that you can take time out away from baby - leave the house and have some time out on your own or with good friends/family to revitalise you. Don’t try and cope with this on your own.
• Warning Signs: See your doctor if colic persists - especially inconsolable crying (where your baby simply cannot be consoled no matter what you try). Also see your doctor if colic is accompanied with vomiting, diarrhoea, constipation or dry nappies.

Dummies, Bottles & Blankets?

What is your opinion on babies/children having dummies (pacifiers), bottles or blankets for comfort?

There is a lot of opinion out there on this topic - so it is a great question. Research shows that dummies (or pacifiers) could actually help prevent cot death (SIDS). However, it is recommended they are not given up to newly born babies until they have perfected sucking when breastfeeding, and are able to suck/breastfeed effectively, otherwise, problems with breastfeeding might occur. My personal viewpoint on dummies is that they are useful for helping babies learn how to self-soothe when going to sleep - or if they wake up and need to return to sleep. It also may help to soothe an awake distressed baby - the sucking motion actually helps babies with colic and it is comforting. What I don’t agree with is dummies used for large amounts of time during a baby/child’s ‘awake time’. It inhibits their communication to you - which initially is crying/grizzling, then becomes baby noises and words. By ‘plugging up their mouths’, we may be delaying their speech/language development.

We have discussed the stage in a baby’s life that might be a good time for a dummy/pacifier to be introduced - but when is a good time to stop? My advice would be to start weaning them from their dummy between 9 - 12 months. During that time, I would restrict the use of their dummy to bedtime only, and at the same time, ensure good sleep habits are in place (see our previous advice on sleep).

If dummies are continued after this age, two things can happen; a real dependence on the dummy from your child that creates a habit that is difficult to break, and the older your child gets, the more the dummy starts to cause your toddlers mouth to form abnormally and cause speech problems.

If I’m honest, I’m not a huge fan of comfort blankets, but some mothers prefer them to dummies. My only advice would be that you do not offer the blanket to your child for comfort unless it is bedtime/they are in bed. Secondly, that you do try to wean them (once they are breastfeeding effectively) from it at a similar stage as you might wean a baby from a dummy. Otherwise, you will face ongoing battles as your child gets older.

With regards to bottles, Plunket advise that they are exchanged for ‘sippy cups’ by age 12 months. This is to aid their development. Personally, since children this age are now drinking from this kind of cup during the day (mostly water), I don’t see any problem with offering a bottle to a baby as part of their relaxing bedtime routine. However, at some stage between 12 and 18 months, this needs to be exchanged for a cup if you still want your child to be having drinks before bed (not a good idea if you’re potty training when they reach 2 years old!)

Again, if you leave it any later than this, their understanding grows. I have seen 3 and 4 year old children still having a bottle before bed an their parents giving it in order to avoid the battle that ensues! Don’t create that situation for yourself - it’s easier to wean them while they’re still young.

However, if your child is well into toddler hood, still with a dummy, comfort blanket or depending on night time bottles, and you’d like to know the best way to get rid of them, I cannot fault television’s super nanny and her technique for bundling these items up with your child and offering them to the fairies in exchange for a fairy present (something they really want). I have seen lots of variations of this, and if done in a positive way with lots of praise, it seems to work. An alternative might be a reward chart - bet either way, a child at this stage needs an incentive to give up their most loved item!

Sleep Part 3

We’re having problems getting our toddler to go to bed at a reasonable time - in his own bed. What are your recommendations?

Similar to babies, toddlers also need a nice, calm routine in the evening. There is no point expecting a child to be ready for bed after lots of raucous fun and activity. Also watch their diet - have they filled up on sugar or junk food in the evening? After dinner, have a calming routine that is the same or similar every night, such as a warm bath, stories, kisses and cuddles, then bed. It will also help to talk to your child, explaining in advance what will happen so they are prepared, eg. “We’re going to have a nice warm bath, then you can choose two stories, then it’s bedtime.”

Decide on what is a reasonable hour for your family. This may range from 6:30 - 8pm. As your child goes through to a school age, you might allow an 8:30/9pm bedtime before they enter Intermediate School. But unless it’s a rare occasion or school holidays, you are not doing yourself or your child any favours by putting them to bed later in the evening. Your child needs a lot of sleep, and are usually early-risers having to get up for morning activities such as kindergarten or school. If they are tired, it won’t help their development or their concentration when learning, and you may find their behaviour improves drastically just by putting them to bed earlier in the evening.

Ideally, good sleep habits need to be developed in your child’s first year of life. If that hasn’t happened, you have a bigger and louder child to deal with, which makes your job a lot more difficult. Many families have a battle with their child going to bed at night. It is unpleasant and exhausting, and can interfere with your relationship with your husband/partner if they are climbing into your bed in the middle of the night, or refusing to go to sleep anywhere but with you. The more firm you are early on, the easier this habit will be to break.

There are two ways to help your child go to sleep at a reasonable time in their own bed. There is the long, “easy” way - or the short, “difficult” way. The first is that you remain in your child’s room, returning them to their bed each time they get out, and after your first initial kisses, cuddles and ‘goodnight’, you do not speak or interact with them - even to tell them off. At this point, your actions speak louder than words, and if you engage with your child vocally, the message is not heard! This option may be easier for parents because they may feel there is less distress from the child since you are present in the room, and you don’t leave until your child is asleep. The alternative is that you don’t stay in the room, but you do return your child to their bed if they come out. This option can have its benefits in the long run because in my experience, your child gets the message quicker since they have less of your attention.

It can be an exhausting, upsetting experience for everyone concerned, but it is temporary, and the benefits far outweigh the process in my opinion - not only for you, but also for your child.

It will require agreement from both parents/caregivers so they can lend support to one another. It will also require strength, being firm, and a determination to see it through. I would recommend parents take turns putting your child to bed alternate nights - it is too confusing for a child if you take turns returning your child to his/her bed. Your child may run to the other parent during this time. It is important that the other parent does not get involved or engage with the child, but only lends support to their partner, when the cihld is out of the room - hugs and words of encouragement help tremendously!

And it’s important to remember that the more firm you are, the more you stick to your plan, the fewer nights you will have to do this. If it takes more than a few nights for your child to go calmly into their bed and stay there until they’re asleep, it may be that you have engaged with your child or not remained firm with them.

Be encouraged - the goal is the prize!

Sleep Part Two

Can you explain more about the timing of the routine and how to move my baby into it?

In our last ‘Question of the Week’ we discussed how to get our babies off to sleep and how to create a routine that your baby recognizes. In terms of setting a routine, the first thing you need to establish is the frequency of feeds your baby requires. As an example, your baby might be into 4hrly feeds. An example of your day ideal routine might go as follows:

7am Feed
8am Awake time
9am Sleep
10:30am Wake
11am Feed
12 midday Awake time
1pm Sleep
3pm Wake
3:30pm Feed
4:30pm Awake time
5pm Possible nap (if your baby is young and needs it)
5:45pm Wake/Awake time
7pm Feed
8pm Sleep
11pm Wake for a feed
3am Your baby may wake for a feed

Although these awake/sleeping times are good, you can adjust this kind of routine to suit your baby and your household, for instance you might have school children to pick up at 3pm, so you may have to put the baby down for their 2hr afternoon nap a little earlier so that you can pick up your other children.

As your baby gets older and requires less feeds, you may increase your morning nap to 2hrs (later you’ll reduce this morning nap until your baby is just having an afternoon nap - relish the afternoon nap as long as possible!) and drop the 5pm nap. And when your baby is sleeping through the night, you can drop the 3am and 11pm feeds so that baby sleeps approximately 12hrs.

Things that influence your baby’s sleep patterns: growth spurts - so that your baby is waking more often and needing more feeds at that time (go with it - your baby needs it!), starting solids, colic, reflux, a change in routine - such as family coming to stay, outings you might plan that interrupt the routine and so on. Your baby’s routine is not fixed in concrete! If you or your baby needs to change things temporarily, that is part of life! But aim to get back into baby’s routine once everything has settled down.

Tips for helping baby into a routine such as this one:
1. Gradually move baby into the routine, even if it is simply 15-30mins each day moving into the routine you have chosen based on baby’s feeding and sleeping needs
2. Keep a record of baby’s sleep/feed/wake times to help you to gradually move them into that routine
3. If baby is hungry, try a bottle of warmed, sterelised water to keep baby going even if it’s just for 15 minutes. But be prepared: baby might get cross at this! Obviously don’t keep a baby hungry for the sake of a routine, an empty belly is not a nice experience for a little baby!
4. Don’t be afraid to put them down a little earlier or a little later for sleep to get them heading towards their routine. And don’t be afraid to wake them so that they will settle into a routine. Try opening their door and leaving it open when it’s time to wake so they may wake naturally - but if that doesn’t work, it’s okay to pick them up. This is part of helping baby into a routine, and is necessary if this is the way you have chosen for yourself and your baby.

The benefits of having a baby in a routine are:
Ÿ as a mother, you feel more on top of whether your baby is getting sufficient sleep and sufficient feeds
Ÿ when your baby is crying or grizzling, it is not such a guessing game as to what they need
Ÿ you can plan your day more easily, knowing your baby’s needs and sleep patterns
Ÿ you can find time for a nap yourself because you know how long baby might be asleep for, and your sleep will be less broken - you’ll feel more rested

Sleep Part One

I expected our baby to be sleeping through the night by now, and I am exhausted - is there anything we can do to help him get into a better sleep routine?

My first recommendation is to have a routine. The most ideal is the sleep-feed-wake/sleep-feed-wake routine. This is because it is good for your baby to get used to settling itself off to sleep when awake rather than feeding your baby to sleep before putting them to bed. The reason for this, is that they will often stir during their nap time, and if they have not learned to settle themselves off to sleep, they make wake prematurely, getting insufficient sleep.

Most parents agree that this is easier said than done! It is true, it does take some determination on your part, and the older your child gets, the more ingrained habits become (such as feeding your baby off to sleep) and the more difficult it is for you to change that habit. So it’s important that you get onto this routine as early as possible. There are two ways that I would recommend getting your baby off to sleep. The first is recommended by the Baby Whisperer which is called the Pat-Hush technique, which is quite self-explanatory. It means standing by your baby’s bedside soothing them while they remain in bed, until they drift off to sleep. The other technique is recommended by Plunket, which is that you allow your baby to cry, but you go in to soothe them (not picking them up and taking them out of their cot) every ten minutes, letting your baby know that you are still there and have not abandoned them - but it is time for bed! Your first day at this your baby may cry for up to an hour (if they are used to other ways of getting off to sleep, eg. being fed), with ten minute intervals of relief from your comforting/soothing them! But if you persevere, your baby will learn and you’d be surprised at how quickly this becomes a new pattern for them. The crying reduces and they fall asleep within ten minutes, then their crying becomes grizzles or even happy noises, and eventually your baby goes down in their cot quite happily. Of course, some parents may not agree with allowing their baby to cry, so in that case, they may prefer the Pat-Hush technique.

I would discourage you from getting into other habits such as rocking your child to sleep, as this causes an enormous burden for you - suddenly you have this baby that will only go to sleep if they are rocked. I have known parents who tell me their baby will only sleep if pushed in the pushchair, or driven around in the car! Usually these are desperate measures for very tired parents, who have stumbled across something that has actually worked and their baby has gone off to sleep - and therefore, they’ve found it “easier” to continue this habit. It is so important - for your sake, and your baby’s (so they get sufficient sleep) that you work through this process of teaching your baby to settle themselves off to sleep. Otherwise when you are out and about, visiting friends or family - you will have an overly tired, grumpy baby on your hands, which will make you and your baby miserable! Suddenly your life will completely revolve around your baby’s sleep issues - and this could carry on for the best part of your baby’s first year of life!

Another important aspect of routine is doing the same thing every night before bed. This might be a last feed for the day, a warm bath (relaxing baby bath oils are helpful), perhaps a story as baby gets older, kisses and cuddles, then bed. And try to keep your baby’s bedtime roughly the same. He/she may not know that it’s 7pm, but their body will get used to being awake for so many hours, and they will fall into a pattern of feeling tired leading up to that time and will recognize the signs that it is bedtime with a routine such as the above.

To read more about the Baby Whisperer’s advice on helping babies into a sleep routine - click on the following link: http://www.cbsnews.com/stories/2006/02/20/earlyshow/living/parenting/main1330940.shtml