Introduction

Few things are more frustrating for new mothers than dealing with an inconsolable baby. You have comforted them, fed them and changed them, yet the crying seems unending. This could be a sign of colic, a common condition affecting 1 in 5 infants.¹

Colic is a challenging experience that many parents face in the first few months of their infant’s life, whether they are bottle-fed or breastfed. As a parent, it is not uncommon to wonder whether your feeding choices are contributing to your baby’s discomfort. Many mothers worry about the connection between breastfeeding and colic.

Could it be your diet? Is your breastmilk not providing the correct balance of nutrients? Could it be something else entirely? In this article, we will explore what colic is, the possible causes related to breastfeeding and practical solutions for mothers worried about their baby. 

What is colic?

Colic can be defined as frequent, prolonged periods of crying in an otherwise healthy and well-fed infant.² The “rule of 3” is used to diagnose colic:

• Crying for more than 3 hours a day
• Crying at least 3 days a week
• Lasting for at least 3 weeks² 

Modern healthcare professionals have dropped the last rule, however, as few parents wait 3 weeks before seeking help.² Colic begins during the first few weeks of life and peaks at approximately six weeks. The good news is it often resolves by the time your baby is 3 to 4 months old, but can persist for 12 months in rare cases.²

Parents need to remember that all babies cry. Healthy babies cry an average of 117 to 133 minutes per day in their first 6 weeks of life and around 68 minutes per day by week 8.³ Colicky crying stands out as it tends to be very intense, high-pitched and difficult to pacify. Other signs to look out for are:

• Clenched fists
• Drawn up knees
• An arched back as if in pain.
• Bloating and gas
• A rumbling tummy
• A flushed face²

Colic does not have a single known cause, which makes it difficult to identify a definitive way to manage it. The digestive issues that babies appear to develop suggest a link to feeding, however, studies imply colic affects nursed and formula-fed babies similarly.⁵ Regardless, uncertainty among breastfeeding mothers remains when they are advised by healthcare professionals to continue to breastfeed their colicky babies due to the health benefits of breast milk.⁵

Can breastfeeding cause colic?

The short answer is no. Breastfeeding itself does not cause colic.⁶ Breastfeeding is widely regarded as a good way to comfort a crying infant.⁷ However, certain factors related to breastfeeding may contribute to or worsen colicky symptoms in some babies. Let us explore possible connections between breastfeeding and colic and find practical ways to minimise colic while breastfeeding.

Maternal diet and baby’s food sensitivities

As a breastfeeding mother, what you eat could contribute to your baby’s colic. While breast milk is the ideal food for babies, it is possible that certain components in a mother’s diet can cause discomfort in some sensitive infants.⁸ One of the most commonly implicated foods is cow’s milk protein. Research has shown that some breastfed babies with colic may have an intolerance to dairy proteins that pass through breast milk.⁹

If your baby seems particularly gassy or fussy or experiences other symptoms like rashes, excessive vomiting or blood in their stools, it might be worth exploring whether food sensitivities are playing a role. Besides dairy, common culprits can include:

• Soy
• Wheat
• Eggs
• Peanuts and tree nuts
• Fish and seafood¹⁰

Also consider whether you have a family history of food allergies. Before making any dietary changes, consult with your GP. If food sensitivity is suspected, they might suggest an elimination diet where you temporarily cut out common allergens and observe whether your baby’s symptoms improve. If improvement occurs, you can gradually reintroduce foods one at a time to identify the cause.

Around 10% of young children are affected by food allergies or intolerances, with cow’s milk allergy being the most common allergy at between 2-3% in the first year of life.¹⁰ Very little is known about the direct link between breastmilk and food allergies– if one exists. If 

your baby is showing signs of colic but isn’t exhibiting other symptoms like breathing difficulties, diarrhoea or rashes, cutting foods out of your diet completely may not be necessary. Click here for colic-preventing diet tips for breastfeeding mothers. 

Lactose overload

Breast milk is produced in two stages: foremilk and hindmilk. Foremilk, the milk produced at the start of a feeding, is higher in water and lactose but lower in fat. Hindmilk, which comes toward the end of the feeding, is richer in fat and calories, helping to satisfy your baby and aid digestion.

If your baby doesn’t get enough hindmilk and mostly drinks foremilk due to frequent, short feeds, they may experience an imbalance that leads to discomfort.¹¹ Too much lactose from the foremilk can be harder to digest, leading to symptoms of colic such as gas, bloating and fussiness.^11,12

To help prevent this, ensure your baby feeds adequately from one breast for a significant amount of time before switching to the other. This allows your baby to get enough filling nutrients to help with digestion. Nursing on demand when your baby is hungry and avoiding timed or overly structured feeds can help your baby naturally regulate their intake.

Oversupply of milk 

If your milk flows too quickly or in large amounts, it can become hard for your baby to nurse comfortably. This is also called overactive letdown.¹² Babies can end up gulping milk too fast, swallowing excessive air, or even choking, leading to gas and discomfort that may contribute to symptoms of colic.¹²

These strategies can help slow the flow of milk:

• Express a little milk before feeding: e.g. using a breast pump. This can reduce the initial forceful flow and make it easier for your baby to latch comfortably
• Breastfeed in a laid-back position: Try reclining while nursing so that gravity slows the milk flow
• Offer smaller, more frequent feedings: By feeding more often, your baby may take in less milk at a time, reducing the chance of gulping and swallowing too much air

Other potential causes of colic in breastfed babies

Here are some other potential contributors to colic-like symptoms not directly related to breastfeeding.

Digestive issues

Newborns’ digestive systems are still developing, but it has been suggested that this may contribute to babies suffering from colic.¹³ In colicky babies, the microbiome or tiny organisms naturally found in a baby’s guts have been observed to be fewer in number compared to colicky babies.

These organisms help keep the environment in the gut balanced, have anti-inflammatory properties and help with digestion.¹³ Microbiome imbalance is also thought to cause the speed at which food travels through the gut to slow down (gastroparesis).

This immaturity and inability to digest food properly can lead to gassiness, bloating, and discomfort. Some babies are more prone to excessive gas because they don’t burp or pass gas efficiently. 

To help relieve digestive discomfort, you can:

• Burp your baby while feeding to release trapped air
• Keep your baby upright after feedings for about 20-30 minutes to aid digestion
• Gently massage your baby’s tummy or move their legs in a bicycle motion to help release gas

Many babies simply need time to grow out of these digestive issues, which often resolve as their system matures around 3 to 4 months of age, however, recent studies suggest a link between colic and an irritable bowel syndrome (IBS) diagnosis later in life.¹⁴

Reflux (GORD)

Some infants experience gastro-oesophageal reflux disease (GORD), a condition where stomach contents come back up into the oesophagus, causing discomfort and irritation.¹¹ Symptoms of reflux can cause discomfort and, like colic, may include frequent spitting up, irritability during or after feeds, arching of the back, or refusing to eat. Strong evidence to suggest a link does not exist, however, and studies have shown that anti-reflux medication does not reduce crying.¹¹

What can you do to help your colicky baby?

While colic can be incredibly challenging, there are several strategies you can try to ease your baby’s discomfort and help prevent crying episodes:

• Hold and soothe: The position you hold your baby during colic episodes can provide much-needed comfort. Many babies with colic respond well to being held, rocked, or carried in a baby carrier. Skin-to-skin contact, swaddling, or using a pacifier can also provide security that helps calm a fussy baby

Click here for breastfeeding position recommendations for colicky babies. 

• Burp your baby after feeds
• Adjust feeding techniques: If you suspect your baby’s colic is linked to feeding, try adjusting your breastfeeding technique. Ensure your baby can access both foremilk and hindmilk by letting them finish one breast before switching. If overactive letdown is a problem, try different positions to slow the flow.
  
  Try feeding your baby on demand rather than sticking to a rigid schedule to help ensure your baby gets the nutrition they needs without becoming too full or gassy
• Try probiotics: Some studies suggest that certain probiotics, such as Lactobacillus reuteri, may help reduce colic symptoms in some babies by improving gut health.¹¹ Before giving your baby probiotics, it is essential to consult your GP
• Practise patience and self-care: Remember colic is temporary, even though it can feel overwhelming. Most babies outgrow colic by 3 to 4 months, so light is at the end of the tunnel. Do not forget to take care of yourself. Enlist help from family or friends, take breaks when needed, and remember that it is okay to feel frustrated or exhausted

When to seek medical help?

While colic is usually harmless and resolves on its own, there are instances when a baby’s excessive crying may be a sign of an underlying medical issue. Call NHS 111 or consult your GP if:

• Your baby is not gaining weight or feeding well
• There is blood in your baby’s stool or severe diarrhoea
• Your baby has a fever 
• Nothing seems to stop crying episodes
• Your baby still has symptoms of colic after 4 months of age

Call 999 if your baby has an unusual, weak or high-pitched cry or appears lethargic.

Summary

Colic can be difficult for any parent, and it is normal to worry about whether breastfeeding is contributing to the problem. The reality is that colic is rarely caused by breastfeeding itself. Factors such as milk composition, overactive letdown or maternal diet might play a role in some cases. However, colic appears to be the result of a combination of factors which we are still learning about.

By understanding potential causes and trying different ways to soothe your baby, you can navigate this challenging period with more confidence. Find comfort in knowing that colic is usually temporary, and with patience and support, you and your baby will get through it.