Dear Doctor

My four month old baby seems to be having stomach pains and I’m certain it is not colic as that phase passed over a month ago. This has been going on for about a week now.

Is it something I’m eating that affects the breast milk? She seems to have no trouble passing stool, however, there’s a way she twists and turns and eventually cries that says she is in pain.

Once, she even vomited a little which really got me worried. She has no fever, however, so it’s all confusing to me.

Betty

Dear Betty,

Small babies do tend to have stomach discomfort or pain, also termed as colic. In fact, every baby has intermittent bouts of being unduly irritable or crying very loud or being fussy for no apparent reason.

This is fairly common among babies, said to begin by 2 weeks of age and resolve slowly, spontaneously by six months or so. People mostly presume it to be acute abdominal pain or discomfort (hence the term colic), but it is not known for sure why it happens, because a baby cannot tell what is causing distress.

The problem can begin either in day or night. The baby cries or becomes unduly irritable, arching the back, clenching of fists, abdominal distension, abdomen becoming tense, these are the other symptoms.

Various causes are postulated as to why a baby has colic. A still developing weak digestive system causing muscle spasm as food or milk enters it, lack of gut microbes which help in digestion, bloating due to gas, air swallowed while mouth is open, intolerance to lactose present in milk, particularly with cow milk, heart burn due to reflux of milk and acid towards wind pipe causing discomfort, weak developing nervous system which is agitated by much lights or sound, hormones that cause tummy ache or a fussy baby, all these are possible causes.

As a baby is exclusively fed on milk for first few months and the systems including digestive system are still getting set, he has irregular bowel habits. He may pass stool after a feed or not pass it for 2, 3 days together. The resultant discomfort causes pain, bloating sensation.

Infections of the stomach or bowels can also cause abdominal pain in an infant. The risk is more in babies who are on bottle feed or other top feeds. This happens when the bottle or cup used for feeding a baby is not very clean causing germs to grow. Allergy to cow’s milk can also cause flatulence.

Regarding mother‘s diet, studies show that a baby may have allergy to milk proteins consumed by the mother in form of milk or milk products. Similarly if histamine (allergy producing substance) is high in mother’s milk due to foods like fish, avocado, bananas, processed food like chips, e.t.c. there is greater risk of infant colic in the baby.

Breast feeding is ideal for a baby. But if a baby is on top milk and has colic, it is better to change the milk, say from cow to soya milk or formula feed. The baby’s bottle should be very clean, nipple changed frequently.

Burping is important after each feed. Put a lukewarm water bottle on the baby’s tummy or put him in a warm bath, these measures will soothe him and relieve any discomfort present. Keep as close to baby as possible, a baby sleeping close to the Mother feels more secure and comfortable and is even relieved of aches and pains.

There are various kinds of herbal and other preparations available to help in infant colic. But ideally a small baby should be given those only if very necessary, because there is risk of allergy or side effects.

Dr. Rachna is a specialist in internal medicine at Ruhengeri Hospital.