Colic Newborn

Acid reflux is a condition in which the stomach contents reflux back up the esophagus, the tube that carries food from the mouth to the stomach. In adults, once food has been swallowed, it is abnormal for it to regurgitate back up the esophagus toward the mouth. If this occurs on a chronic basis, it causes heartburn. This is the term used to describe the pain adults experience with acid reflux.

However, acid reflux is not abnormal in infants. The system used by the body to prevent regurgitation of food from the stomach uo the esophagus is quite sophisticated. It involves the coordination of the swallowing motion of the esophagus, which moves food into the stomach, and a circular band of muscle at the base of the esophagus that acts as a valve to prevent regurgitation of food. This system is immature in infants and does not work well. Hence, babies are spitters. Think about it. Babies often spit up their feeds to one degree or another and we consider it normal. Yet spitting is actually regurgitation of food, a behavior that would be abnormal in an adult.

So, acid reflux, spitting, is quite common and normal in infants during the first several months of life. Unlike adults, infants seem protected from the painful effects of reflux. Some physicians have suggested that perhaps the infant with colic lacks this natural protection and is crying from heartburn, such as Zantac and propulsid.

The premise of this theory is that the crying associated with infant colic syndrome results not from pain but from nonspecific irritability, a kind of underfined distress. It argues that the nervous system is immature at birth and, as a result, is highly sensitive to external stimuli. The colicky infant, then, is at the hypersensitive end of the spectrum and he or she cries as a reaction to continual nervous system stimulation. As the nervous system matures, the theory goes, the sensitivity and thus the crying recede.

This theory is the basis for the famous hands-off approach to excessively crying infants. Proponents believe that there is no specific treatment for colic except to wait it out. Further, they argue that the things parents usually do in the attempt to assuage their children's distress - holding, rocking, walking, talking, and so on - only increase the problem by adding to the stimuli assaulting the baby's immature nervous system. They recommend that the parents simply put down the inconsolably crying baby and walk away. In very extreme cases, some believers recommend sedation.

Some physicians believe that abdominal cramps cause colic, though they usually make no attempt to explain the source of such cramps. Often they are pragmatists more interested in using a medication that works than in determining underlying causes. This can be a angerous approach, for it turns out that the single medicine shown to have an effect in relieving colic is one called dicyclomine hydrocholoride, known more familiarly by its trade name, Bentyl. This medication is an antispasmodic intended for adults, and its side effects include drowsiness and lethargy. Physicians who prescribe it for colic do so on the assumption that it relieves the mysterious, undocumented abdominal cramps. It is just as possible, however - and iss my own belief - that it is the side effects, not the antispasmodic effect, that reduce crying - by sedating the infant, or medicinally inducing sleep. Thus, the fact that Bentyl reduces colic in some excessively crying infants in no way confirms that these infants were suffering from abdominal cramps.

But this point is a technicality compared with the other consequences of the use of Bentyl in infants. In fact, no one knows how often these side effects occur when used in young infants or how intense they might be. Even more alarming, however, are the recent reports of serious, life-threatening side effects - differing from those showing up in adults - from the use of this drug in infants under three months of age. Episodes of apnea, seizures, coma, and even death have been reported with the use of Bentyl in this age group.

Clearly, the risks of using this drug for infants far outweigh any possible reductions in excessive crying. Forunately, infant colic syndrome can be treated and prevented effectively without the use of any medicaion whatsover.

This is the familiar myth whose growth was traced earlier in the blog. As I explained there, the theory is linked to the observation that many babies with colic pass a great deal of gas. This observation is accurate, but physicians who subscribe to the theory that gas is the cause are putting the cart before the horse. Babies with infant colic syndrome do not cry because they have gas: they have excessive gas because they cry so much.

One of the main sources of excessive gas is swallowed air. Babies who cry a great deal, for whatever reason, swallow a lot of air. Further, the action of increaseing abdominal pressure will cause gas in the rectum to be passed. If you look at strenuously crying babies, you will see that they indeed increase the pressure on the abdomen by hardening it: as a result, gas is passed from the rectum.

Any baby who cries for a significant amount of time for whatever reason will therefore build up intestinal gas and pass gas rectally. Clearly, it is the crying that causes the gas, not vice versa.

It has been found that in nursing mothers who drink cow's milk, a small amount of the protein in cow's milk shows up in the breast milk. Physicians who believe that infant colic syndrome is caused by cow's milk protein allergy oint to this as the source of the problem in colicky infants who are breast-fed. These doctors treat infant colic syndrome by putting the mothers on a milk-free diet. Three studies in the pediatric literature have measured the effectiveness of this approach. One study showed no benefit whatsover. Two studies showed an improvement in 35 percent of the cases. Again, however, these studies included babies with vomiting and diarrhea, rendering the results invalid as a measure of allergy in healthy babies. My own studies contradict the notion that restricting milk or any other substance in the mother's diet reduces crying in colicky infants.

Manipulating the diet of a nursing mother is not only of no benefit; it can be hazardous as well. Successful breast-feeding depends on a well-nourished mother. and fooling around with the mother's diet can affect the nutrition of both baby and mother.

Caffeine, however, is an exception to my rule. I urge nursing mothers to eat what they wish but to eliminate caffeine from their diets. Caffeine consumed by nursing mothers does enter breast milk in very small amounts. Most physicians do not feel that this amount is large enough to harm the breast-feeding infant, but because some adults are very sensitive to the effects of this drug. I assume that some babies are, too. In a baby with a heightened sensitivity to caffeine, even a small amount of the substance might produce irritability