Introduction
What is colic?
Babies cry a lot and it’s to be expected. But if you're finding that your baby is crying inconsolably for long periods of time and you’re not able to settle or soothe them no matter what you try, then it could be a sign of infantile colic - a common condition in otherwise healthy infants up to 4 months old which tends to self-resolve.1,2 Some other signs you may see are fist clenching or drawing knees up.3
What is the cause?
Although a clear cause of colic has not been identified, it has been suggested that it could be related to difficulties digesting food at a young age.4 Colic is estimated to affect up to 40% of infants across the world,5 so if you are also going through this with your baby, you should know you’re not alone.
The importance of breastfeeding positions
- Comfort for the baby: Finding the right position may help to partially alleviate the baby’s discomfort6
- Bonding with mother: The experience can help to calm the baby and help you feel connected7
- Improved digestion: Certain positions may reduce the risk of gas building up whilst feeding8
- Better latching and flow: Finding the right position will help to ensure that milk is flowing efficiently9
Common breastfeeding positions for clicky babies
Cradle hold
The cradle hold is a very common breastfeeding position as it is comfortable for both mother and baby10
- Sit comfortably with baby lying across your lap facing you
- Cradle baby's head in the crook of your arm
- Support the baby's back with your forearm
- Bring baby’s nose to breast level
- Use your other hand to help support the process11
Tip: use your other hand to guide baby to your breast to help with latching.
Football hold
This hold is great if you have had a Caesarean section. This hold is particularly useful for colicky babies as it helps with reflux.
- Hold your baby at your side, facing upwards
- Place the baby’s head near the breast on that side
- Lay your baby across your arm so that their back is supported, holding their head with your hand12
Side-lying position
This is also another position that is beneficial if you’ve had a Caesarean section.13
- Lie on your side with baby facing you (tummy to tummy)
- Tuck the arm you are lying on under a pillow
- Align baby's mouth to nipple level
- Support the baby's head with your free hand
- Allow baby to latch and feed comfortably14
Tip: use pillows or rolled-up blankets to support you and your baby.
Additional breastfeeding positions for colicky babies
Laid-back position
This is sometimes known as the “biological nursing”.15
- Lie back in a semi-reclined position, supported by pillows
- Lay baby on chest, tummy-to-tummy
- Gently guide baby to breast16
Cross-cradle hold
This is particularly good for premature babies or those with a weak latch.
- Sit comfortably with your baby across your body
- Cradle the baby’s head and neck in your hand
- Gentle guide baby to your breast17
Techniques for calm feeding of colicky babies
Burping techniques
- Over the shoulder: With your baby facing you, place them over the shoulder with their chin resting on your shoulder. Support the head with one hand and then gently pat or rub the baby’s back to encourage burping
- Sitting on lap: Sit your baby on your lap so they are facing away from you. Place one hand against their chest to gently support their chin and jaw. Lean the baby forwards slightly and with your other hand gently rub or pat their back
- Lying across your lap: Try lying your baby across your lap, facing downwards. Gently support their chin with one hand and use your other hand to rub or pack their back18
Using nursing pillows or cushions
Having some added support from nursing pillows or cushions can relieve strain on your back, neck, and arms during feeding time, which may help you feel more relaxed.
Skin-to-skin contact and kangaroo care
Named after how kangaroos keep their babies in their pouch, kangaroo care means that you allow for some uninterrupted skin-to-skin time by placing them on your bare chest. Skin-to-skin contact has a host of benefits – it can help regulate the baby’s heart rate and breathing, stimulate their digestion after feeding and help to relax them.19
Factors to consider when choosing a breastfeeding position
Baby's age and development
Depending on how old your baby is, they may need more head support than older infants. Consider the age and support needed for the baby to latch effectively.
Mother's comfort and condition
Your comfort is extremely important during feeding sessions. If you notice that you are sometimes leaning forward or that your back starts hurting during feed times, then try bringing the baby towards your body rather than leaning towards them.
Baby's latch and feeding ability
The position you breastfeed in should always allow for a good latch so that milk can transfer properly. Certain positions mentioned above allow for a free hand to help support the breast, which is particularly useful in babies with latching difficulties.
Observing and responding to cues
Observing how comfortable your baby is during feeding is important. If you're noticing that they are fussing, or that they appear distressed, try changing breastfeeding positions. Respond to cues for readiness to feed and fullness to maintain a positive experience.
Managing colic beyond breastfeeding positions
Identifying triggers and modifying diet
In breastfeeding mothers, diet can affect the quality and nutrients in breast milk.
- Keep a food diary: By keeping track of what you eat and how your baby reacts, you may help you pinpoint potential triggers that worsen colic. This will help to guide you in what may be best to reduce or eliminate in your diet
- Excluding cow’s milk: Although the evidence isn’t concrete, some specialists suggest that colic may be linked to cow’s milk protein intolerance in babies. Several studies have shown that removing cow’s milk from the mother’s diet resolved or improved colic symptoms and in their babies20,21
- ‘Low allergen’ maternal diet: Excluding not only cow’s milk but also nuts, wheat, soy and fish has also been found to help further reduce distress in some colicky babies22
- Probiotics: Lactobacillus reuteri in particular has been found to reduce symptoms of colic in several clinical trials23,24
Creating a calm feeding environment
Creating a calm feeding environment is essential for colicky babies as it can help reduce stress, discomfort, and fussiness during feeding sessions.
- Choose a quiet and comfortable space: Try and find a peaceful room to help you and your baby relax without any distractions
- Stay patient: Breastfeeding babies that are uncomfortable due to colic can be challenging, but try to remain calm and patient throughout the process
- Consider using white noise: You may find that having some soft, calming noise or nature noises such as rain sounds whilst feeding can create a more peaceful environment
Seeking professional support
Seeing your baby distressed will no doubt affect parents as well, and professional help will provide you with some emotional support to navigate this. Paediatricians, lactation specialists and specialist nurses may be able to provide further guidance and reassurance.
Summary
It is important to remember that each baby is different, so try experimenting with these different breastfeeding positions to see how your baby responds. If you find yourself overwhelmed, try to remember that you are not alone and there is professional support that you can turn to for help.
References
- Indrio F, Dargenio VN, Giordano P, Francavilla R. Preventing and treating colic. Adv Exp Med Biol. 2019;1125:49–56.
- Sung V. Infantile colic. Aust Prescr [Internet]. 2018 Aug [cited 2023 Jul 22];41(4):105–10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091773/
- Mai T, Fatheree NY, Gleason W, Liu Y, Rhoads JM. Infantile colic. Gastroenterol Clin North Am [Internet]. 2018 Dec [cited 2023 Jul 22];47(4):829–44. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659398/
- nhs.uk [Internet]. 2017 [cited 2023 Jul 22]. Colic. Available from: https://www.nhs.uk/conditions/colic/
- Johnson JD, Cocker K, Chang E. Infantile colic: recognition and treatment. Am Fam Physician. 2015 Oct 1;92(7):577–82.
- Hoeve J. Clinical evidence of vestibular dysregulation in colicky babies before and after chiropractic treatment vs. Non-colicky babies. Front Pediatr [Internet]. 2021 May 28 [cited 2023 Jul 22];9:668457. Available from: https://www.frontiersin.org/articles/10.3389/fped.2021.668457/full
- Roth MC, Humphreys KL, King LS, Gotlib IH, Robakis TK. Breastfeeding difficulties predict mothers’ bonding with their infants from birth to age six months. Matern Child Health J. 2021 May;25(5):777–85
- Sorkhabi SSF, Kazemian M, Shamshiri AR. The effects of breastfeeding position and the change in nutritional habit on infantile colic: A randomized clinical trial. Researcher Bulletin of Medical Sciences [Internet]. 2021 [cited 2023 Jul 22];26(1):e12–e12. Available from: https://journals.sbmu.ac.ir/index.php/rbms/article/view/38205
- nhs.uk [Internet]. 2020 [cited 2023 Jul 22]. Breastfeeding: positioning and attachment. Available from: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/positioning-and-attachment/
- nhs.uk [Internet]. 2023 [cited 2023 Jul 22]. Breastfeeding positions - start for life. Available from: https://www.nhs.uk/start-for-life/baby/feeding-your-baby/breastfeeding/how-to-breastfeed/breastfeeding-positions/
- Cradle hold | wic breastfeeding support [Internet]. [cited 2023 Jul 22]. Available from: https://wicbreastfeeding.fns.usda.gov/cradle-hold
- Clutch or ‘football’ hold | wic breastfeeding support [Internet]. [cited 2023 Jul 22]. Available from: https://wicbreastfeeding.fns.usda.gov/clutch-or-football-hold
- nhs.uk [Internet]. 2023 [cited 2023 Jul 22]. Breastfeeding positions - start for life. Available from: https://www.nhs.uk/start-for-life/baby/feeding-your-baby/breastfeeding/how-to-breastfeed/breastfeeding-positions/
- Side-lying position | wic breastfeeding support [Internet]. [cited 2023 Jul 22]. Available from: https://wicbreastfeeding.fns.usda.gov/side-lying-position
- Trust) N (National C. NCT (National Childbirth Trust). 2022 [cited 2023 Jul 22]. Laid-back breastfeeding: benefits and uses | Baby & toddler, Feeding articles & support | NCT. Available from: https://www.nct.org.uk/baby-toddler/feeding/early-days/laid-back-breastfeeding-benefits-and-uses
- Laid-back or straddle-hold | wic breastfeeding support [Internet]. [cited 2023 Jul 22]. Available from: https://wicbreastfeeding.fns.usda.gov/laid-back-or-straddle-hold
- Cross-cradle or transitional hold | wic breastfeeding support [Internet]. [cited 2023 Jul 22]. Available from: https://wicbreastfeeding.fns.usda.gov/cross-cradle-or-transitional-hold
- nhs.uk [Internet]. 2023 [cited 2023 Jul 22]. How to burp your baby - Bottle feeding - Start for Life. Available from: https://www.nhs.uk/start-for-life/baby/feeding-your-baby/bottle-feeding/bottle-feeding-your-baby/how-to-burp-your-baby/
- Baby Friendly Initiative [Internet]. [cited 2023 Jul 22]. Skin-to-skin contact. Available from: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact/
- Iacovou M, Ralston RA, Muir J, Walker KZ, Truby H. Dietary management of infantile colic: a systematic review [Internet]. Centre for Reviews and Dissemination (UK); 2012 [cited 2023 Jul 22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK114276/
- Jakobsson I, Lindberg T. Cow’s milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study. Pediatrics [Internet]. 1983 Feb 1 [cited 2023 Jul 22];71(2):268–71. Available from: https://publications.aap.org/pediatrics/article/71/2/268/48142/Cow-s-Milk-Proteins-Cause-Infantile-Colic-in
- Hill DJ, Roy N, Heine RG, Hosking CS, Francis DE, Brown J, et al. Effect of a low-allergen maternal diet on colic among breastfed infants: a randomized, controlled trial. Pediatrics [Internet]. 2005 Nov 1 [cited 2023 Jul 22];116(5):e709–15. Available from: https://publications.aap.org/pediatrics/article/116/5/e709/68023/Effect-of-a-Low-Allergen-Maternal-Diet-on-Colic
- Savino F, Cordisco L, Tarasco V, Palumeri E, Calabrese R, Oggero R, et al. lactobacillus reuteri dsm 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics [Internet]. 2010 Sep 1 [cited 2023 Jul 22];126(3):e526–33. Available from: https://publications.aap.org/pediatrics/article/126/3/e526/66216/Lactobacillus-reuteri-DSM-17938-in-Infantile-Colic
- Szajewska H, Gyrczuk E, Horvath A. Lactobacillus reuteri dsm 17938 for the management of infantile colic in breastfed infants: a randomized, double-blind, placebo-controlled trial. The Journal of Pediatrics [Internet]. 2013 Feb [cited 2023 Jul 22];162(2):257–62. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022347612009201