Reflux, Colic and a Witching Hour – Oh My!

I was recently called to help a third time mom who really wanted some help sorting through a few things. Her little one was about 3 weeks when she contacted me. He was eating nearly every hour and she was spending another roughly 6+ hours per day trying to get her baby to sleep for naps and at night. At the recommendation of a friend and hopeful to get some much needed sleep before her maternity leave was over, she called me.

colic newborn

colic newborn

I consulted with her several weeks while I was traveling. Her baby was making improvements, especially during the day. No more snack feeds and an appropriate schedule meant he was napping longer and getting much needed awake time during the day. Nights were still a struggle. Getting him to bed was taking 3-4 hours each night.

After working with and observing this mom and baby, I suggested she take him to the pediatrician. As a Newborn Care Specialist, Baby Nurse, Postpartum Doula and Infant Sleep Consultant, my role is non-medical. I had my suspicions as to part of the problem, but I am not trained to diagnose, only recognize when there is potentially something underlying that needs to be addressed.

My suspicions were right and the pediatrician said “he has some reflux, but not to rule out colic”. Some medication was prescribed and the baby did improve, but he still had somewhat of a difficult time going to bed until we made some additional tweaks to his schedule.

There were multiple things compounding with this baby causing him to have trouble. As a Newborn Care Specialist, Postpartum Doula, Baby Nurse and Infant Sleep Consultant I do see these things on a consistent basis and thought it may be helpful to other parents to provide my two cents on the topics.

 

REFLUX

Gastroesophageal reflux disease, other wise known as GERD. GERD occurs when food and contents from the stomach come back up (refluxes), typically causing the baby to spit up (1). There are variations of standard reflux which include Silent Reflux and Nocturnal Reflux.

Silent reflux can be harder to detect because the contents of the stomach don’t usually come out of the mouth (instead they are swallowed) and the baby may not show any signs of discomfort until they are around 3 months old (2).

Nocturnal reflux is reflux that is worse at night. Reflux can be worse at night for 3 reasons (3):

  1. Acid concentration in the stomach is higher at night.
  2. The baby is likely lying down, so there is no assistance from gravity to help keep the contents of the stomach down.
  3. While sleeping we don’t swallow. Saliva contains bicarbonate which neutralizes stomach acid. Meaning when we swallow our saliva neutralizes the acid that can be irritating to the esophagus.

 

Symptoms of reflux I have seen:

  • Irritable during or after feeding
  • Gulping, arching, and pulling away from breast or bottle
  • Baby has lots of burps
  • Inconsolable crying
  • Vomiting or projectile vomiting with most feeds
  • Blood in the baby’s stool
  • Frequent nursing. Sucking and swallowing is soothing to babies that have reflux. They tend to want to continually eat to soothe, but it overloads their digestive system and perpetuates the cycle.
  • Wanting to eat, but fussy while eating
  • Failure to gain weight or gaining weight too quickly
  • Family member that has or did have reflux (genetic factor)

 

Things that can be helpful in relieving reflux:

  • Making a reflux nest
  • Making some modifications to the breastfeeding mother’s diet, particularly removing dairy
  • Changing formula
  • Probiotics for mom, if breastfeeding and baby (infant probiotics and non-dairy)
  • Not allowing baby to snack feed, which continually puts stress on the baby’s digestive system
  • Keeping the baby elevated for 20 minutes after each feed
  • Changing the bottle used and pace feeding

 

COLIC

Traditionally colic is defined by the rule of 3’s and by a baby that cries uncontrollably for:

  • 3 hours per day
  • 3 days per week
  • For 3 weeks in a row

 

I do believe that the baby I was working with and most babies in general go through a few weeks that can be pretty difficult. Suzy Giordano, author of Twelve Hours’ Sleep By Twelve Weeks Old talks about this. (Great book by the way). She calls it the Two-Week Storm.  “Typically starting around 3-4 weeks for a singleton and 6-8 weeks for twins. “Easy”, “angel” or “perfect” babies may cry uncontrollably, have bad gas, struggle with intestinal cramps or be restless between feedings. The length and severity varies with each baby and may be related to immune or digestive system changes” (4).

It is my personal opinion that Colic is a blanket term. It is too widely used and is somewhat of a cop-out use by professionals. Yes, colic is a thing. There are babies that cry as describe above. But I wholeheartedly believe there are valid underlying factors such as critical brain development at a certain age, scheduling adjustments, the mother’s diet and reflux that contribute. You won’t ever hear me say “oh it’s colic. Just put him/her in their crib and let them cry. They will outgrow it around 4 months” (I have heard this). There are always adjustments that can be made to help the baby and family be much happier. 

 

WITCHING HOUR

Doing some research you may come across the term “witching hour”. For an infant, it is usually known as a period of time in the late afternoon or evening where the baby doesn’t seem to know what they want. It is a consistent time everyday where your baby will fuss and cry on and off for hours.

I do believe witching hours and colic are similar and go hand in hand. For a baby, early evening is a time where they are starting to process things that have happened during their busy day. It is also the end of the day, so they are tired.  I just don’t like to place blame and leave it at that. Too many new parents and their precious babies are struggling. It doesn’t have to be ‘normal’ and 3-4 hour struggles each night shouldn’t be normal.

If you and your baby need some help, please don’t hesitate to contact us. Most often there are things that can and need to be addressed – the baby’s schedule, the mother’s breastfeeding diet, formula, external stimulation, tongue/lip tie identification and learning the appropriate baby cues that will significantly improve, if not resolve completely, the reflux, colic and witching hour you and your baby are experiencing.

Resources:

  1. https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/symptoms-causes/syc-20351408
  2. https://www.livestrong.com/article/526686-silent-reflux-in-newborns/
  3. https://www.medicinenet.com/script/main/art.asp?articlekey=13834
  4. https://www.amazon.com/Twelve-Hours-Sleep-Weeks-Step/dp/0525949593/ref=sr_1_1?ie=UTF8&qid=1508179392&sr=8-1&keywords=twelve+hours+sleep+by+twelve+weeks+old

Disclaimer:

The content contained in this blog is for informational and educational purposes only. It is not intended as medical advice or to replace the advice of any medical professional. It is based on our opinions and experience working with newborns and their families. Other’s opinions may vary. It does not represent the views of any affiliated organizations. The reader understands that term “Babynurse” is often a word used to describe a newborn caregiver. However, unless otherwise disclosed, we are not licensed nurses in any state. By reading and/or utilizing any information or suggestions contained in this blog, the reader acknowledges that we are not medical professionals and agrees to and waives any claim, known or unknown, past, present or future.

© 2018 Bishop Enterprises, LLC All Rights Reserved

Leave a Reply

Your email address will not be published. Required fields are marked *