Breastfeeding And Colic Sleep Patterns

Overview 

The extraordinary adaptations of human milk are remarkable. Breast milk goes through biochemical transformations while being ingested; the texture progressively changes during a pumping or feeding session, evolving from a watery foremilk to a creamier hindmilk. Additionally, human milk has the ability to fulfill the evolving nutritional requirements of a growing baby. The proportions of fat and protein vary over time to meet the higher energy needs of mobile infants. Recent studies indicate that its composition aligns with the mothers’ circadian rhythms, providing breastfed babies with an advantage in terms of neurological development and sleep patterns.² 

The connection between breastfeeding and colic

Infantile colic poses a significant challenge for new parents and accounts for 10% to 20% of visits to paediatricians in the early weeks of an infant's life. It is estimated that colic affects between 5% and 40% of infants worldwide. This condition usually appears around the second or third week of life, reaches its peak at around 6 weeks, and typically resolves by the time the infant is 12 weeks old. Colic is characterized by inconsolable crying, irritability, and unexplained screaming.

These episodes of fussiness, which tend to occur more frequently in the evenings, are typically accompanied by the infant appearing red-faced, drawing up their legs, and clenching their fists. The criteria to define infantile colic include episodes of crying that start and stop without any obvious triggers, lasting for at least 3 hours per day, 3 or more days a week, for a minimum of 1 week, without any signs of failure to thrive.⁴

Indications of colic can encompass tightly clenched hands, legs curled over the stomach, a curved back, a swelling in the stomach, gas release, a distressed or in pain facial expression, and a face that turns red or darkened after extensive crying.⁵

Researchers have yet to fully comprehend the precise cause of colic in infants. Nevertheless, numerous factors could contribute to it, including abdominal pain or discomfort stemming from trapped gas, reflux, food allergies, intolerance to milk protein, improper feeding practices, excessive stimulation, early manifestations of migraine headaches, and emotional responses such as frustration, fear, or excitement. It may also be linked to an underdeveloped digestive system.⁵

Breast milk composition and its impact on sleep 

In adults, melatonin is produced at night, but this does not happen in infants. Melatonin has both a sleep-inducing and muscle-relaxing effect on the gastrointestinal tract. It is possible that breast milk, containing melatonin, could potentially improve infants' sleep patterns and alleviate symptoms of colic.¹ Comparative data shows that breastfed babies sleep, on average, 45 minutes longer each night and experience less colic compared to their formula-fed counterparts.²

Some interesting discoveries have been made regarding substances found in breast milk that change in response to the mother's circadian rhythms. These substances include amino acids, melatonin, trace elements, and nucleotides, which are important for biological processes. Breast milk contains four amino acids, known as "wakefulness" amino acids because they are precursors to neurotransmitters associated with activity, reaching their highest levels during the daytime and their lowest levels at night. On the other hand, tryptophan, a precursor to melatonin known for causing drowsiness, peaked during the night.

While these circadian rhythm indicators were not present during the colostrum phase of breast milk (except for tryptophan), they appeared to contribute to the neurological development of newborns during the transitional and mature milk stages. Studies reported that the melatonin breakdown product exhibited clear circadian rhythms in breastfed babies and that the rhythm was linked to the mothers' levels of tryptophan. In addition to its precursors, melatonin itself follows circadian rhythms in breast milk and its levels increase during periods of darkness.

This is particularly important in the early weeks of a baby's life when they are not yet producing their own melatonin. As melatonin functions both as a sleep-inducing agent and a relaxant for gastrointestinal muscles, breast milk melatonin could play a significant role in the early development of sleep cycles and the reduction of colic.²

Infants who are fed formula tend to have a lower likelihood of waking up easily during sleep. It is believed that differences in infant sleep patterns may be caused by the difficulty in digesting cow's milk formula, leading to longer and deeper periods of sleep for formula-fed infants. On the other hand, breastfed infants need to feed frequently day and night. Despite the difference in the number of awakenings, studies have found no significant difference in total sleep duration between formula-fed and breastfed infants.

It has also been observed that breastfeeding mothers get the same amount or even more sleep compared to formula-feeding mothers. However, breastfeeding at 6 months has been associated with more frequent night waking and difficulties sleeping alone. Breastmilk contains melatonin, which may contribute to better sleep quality. Breastfeeding is also known to provide protection against sudden infant death syndrome (SIDS), particularly for exclusively breastfed infants.

Arousal from sleep plays a vital role in preventing potentially fatal cardiac or respiratory episodes associated with SIDS. Introducing formula to encourage longer sleep duration may disrupt the physiological processes essential for successful breastfeeding and increase the risk of SIDS for infants who have difficulty in waking up. Commonly held views linking infant sleep to feeding practices often lead to advice from family and peers to introduce formula or solid foods. Breastfeeding mothers are more likely to accept fragmented sleep as normal for their babies, while formula-feeding mothers view infant night waking as a problem that needs to be solved.³

Tips for mothers on how to ensure effective breastfeeding and reduce colic symptoms during nighttime feedings 

It is crucial for healthcare providers, such as paediatricians, nurse practitioners, and primary care providers, to address parental anxiety by discussing colic and assuring parents that it is a harmless disorder. Parents should also be educated about returning the infant to the crib, to avoid shaking or causing harm while trying unproven remedies. Additionally, pharmacists should advise against the use of dicyclomine and similar agents as they are more likely to do harm than good.

The most convincing evidence for effective treatment strategies includes eliminating potential allergens such as dairy, eggs, fish, nuts, soy, and wheat from the diets of breastfeeding mothers and switching bottle-fed infants to hydrolyzed formulas. Weaker evidence also supports supplementing breastfed infants with Lactobacillus reuteri, but it does not endorse the use of these probiotics for formula-fed infants.⁴

Seeing a doctor is typically unnecessary for colic, but you can speak with your health visitor for guidance and support. Here are some suggested interventions for soothing your baby:^6,7

• One of the most effective treatments is to hold your child. Holding them for more hours, even when they are not fussy, can result in less fussy behaviour in the evening
• You can place a warm water bottle on their stomach, ensuring it is not too hot
• Embrace or cuddle your baby when they are crying excessively
• Maintain an upright position when feeding to prevent them from ingesting air.
• Make sure the baby is receiving enough "hindmilk" during each feeding, rather than just "foremilk." This can be achieved by making sure one breast is emptied before offering the other or only offering one breast at a feeding and fully emptying it
• Burp your baby after each feed and try to hold them upright as much as possible
• Gently rock your baby on your shoulder
• Rock your baby gently in their Moses basket, crib, or take them for a walk in their pram
• Keep a food and crying diary to evaluate if their diet is affecting their baby's colic symptoms
• To aid digestion, gently rub your baby's stomach in a clockwise direction, as this aligns with the natural direction of the intestines
• You can lay your baby tummy-down across your knees and gently move your legs to massage their abdominal area
• If your baby is bottle-fed, they may have an allergy or reaction to the formula they are currently consuming and may need to switch to a different formula
• Give your baby a warm bath
• Provide some soothing background noise to distract them
• Continue with regular feeding

You may also encounter suggestions like:

• Trying anti-colic drops and using herbal and probiotic supplements
• Making dietary changes if you are breastfeeding
• Chiropractic care may be worth seeking as applying gentle pressure to your baby's spine (spinal manipulation) or skull (cranial osteopathy)

Supporting mothers

Fortunately, colic is a temporary issue that does not have any lasting effects on your baby. However, this does not make it any less challenging for you. It can be difficult to care for a constantly crying infant, and it is understandable if you feel overwhelmed or frustrated.

Your emotions are valid, and if you find it difficult to handle, reach out to a trusted friend or family member. Ask them to look after your baby while you take a break and leave the house to clear your mind and calm down. If you do not have someone you trust to help, put your baby in a safe place, like their crib, and step out of the room.

It is okay to take a few minutes for yourself while your baby remains safe. Remember that shaking a baby can cause serious harm and even death, so it is important to avoid doing so. Take some deep breaths and remind yourself that the crying phase will not last forever.⁵ Parents of colicky babies need a lot of support and encouragement. It is not the time to try to be a perfect parent, but rather to rely on your support system and ask for help when needed.

Try to prepare meals in advance or have frozen meals ready so that you are not distracted during the difficult evening hours. Take turns with your spouse or another family member to hold the baby during the toughest times of the day. If you feel overwhelmed, talk to your healthcare provider, as having a colicky baby can be overwhelming for any parent. Try to sleep when your baby sleeps so that you can rest during their fussiest times. Look for support groups in your area specifically for new mothers.⁶

Summary

In conclusion, breastfeeding and sleep colics share a complex relationship that demands careful consideration and informed decision-making by parents. While breastfeeding offers numerous benefits, understanding and addressing the potential impact it may have on sleep is crucial for promoting optimal health and wellness in infants.