THE CRYING BABY

Babies cry a lot, and this is a common presentation to medical care. There are significant potential effects on breastfeeding/chestfeeding. This page will cover only the breastfeeding/chestfeeding related aspects of the crying baby.

 

On average, infants in the first 6 weeks of life cry for 2 hours a day, decreasing to 70 minutes a day by 12 weeks. Fussiness during feeds is common, and therefore many families will stop breastfeeding/chestfeeding in an attempt to improve the crying. Many crying babies will either be completely normal, or have colic. Medical professionals often recommend treatment for either gastro-oesophageal reflux disease or cows' milk protein allergy (or both), but there is a high risk of overdiagnosis.

Colic

20-30% of babies in the UK fit criteria for colic in the first 6 weeks of life, decreasing to 11% by 2 months of age and 0.6% by 3 months. Rate of colic is no different between breastfed and formula fed babies. No treatments have reached the evidence threshold required for NICE. There is growing evidence that L. Reuteri probiotic may reduce crying time in breastfed babies only - an infant preparation is available to the public in the UK. Specifically, dietary modification in breastfeeding/chestfeeding parents (and changing formula in formula fed babies) does not affect crying time, according to Cochrane review.

Gastro-oesophageal reflux disease (GORD)

First line management of suspected GORD in a breastfed/chestfed baby is expert face to face breastfeeding/chestfeeding support with positioning and attachment. NICE recommends infant gaviscon as second line (which can be difficult for families to administer to breastfed/chestfed babies but can be mixed with sterile water or expressed milk and given before feeds). NICE recommends ranitidine or PPI as third line, although Cochrane review casts doubt that they are effective in this population and there are associated risks.

Cows' milk protein allergy (CMPA)

CMPA is much less common in breastfed babies than in formula fed babies (0.5% of breastfed babies, and 2-3% of mixed or formula fed babies), and may cause symptoms only when formula is introduced for the first time. If this is the case, and the family is open to it, stopping formula and returning to breastfeeding/chestfeeding is likely to resolve the symptoms.

If a breastfed/chestfed baby has symptoms suggestive of CMPA, the breastfeeding/chestfeeding mother/parent should eliminate cows' milk protein from their diet for 2-4 weeks, and then reintroduce it for 2-4 weeks - both elements are required before diagnosis can be made and an elimination diet resumed, as up to 15% of babies have suspected CMPA, but less than 5% will have confirmed CMPA after elimination and re-challenge. The exception would be if symptoms are very severe or IgE-mediated, when re-challenge may not be appropriate, particularly outside of hospital.

If the breastfeeding/chestfeeding mother/parent has eliminated cows' milk protein from their diet they should have a dietitian review. Meanwhile they should be advised to take 1000mg of calcium daily, and a vitamin D supplement. If an older baby with CMPA is advancing on the milk ladder the breastfeeding/chestfeeding mother/parent can also trial resuming a normal diet.

For an overview of the general assessment of the crying baby, see this blog

ABOUT US >

Thank you for visiting the Hospital Infant Feeding Network. This website is a repository of relevant knowledge and best practice resources for health professionals. To join the conversation, ask questions and share your experiences please join us on Facebook or Twitter.

 

We will be running Q&A sessions on various topics, which will be advertised on our social media sites. Please email if you have ideas or want to get more involved. We welcome health professionals passionate about supporting breastfeeding/chestfeeding and lactation in the hospital setting to join our steering group, please get in contact if this is you!

You may have noticed that we use 'additive' language on our website to refer to lactation and human milk feeding. This means that we might refer to 'breastfeeding/chestfeeding'. Chestfeeding is a term that some non-binary people use to refer to feeding their child at the chest if the word breast is not congruent with their gender identity. Using additive language helps reduce a feeling of exclusion for non-binary and transgender people, without taking away from the importance of words like breastfeeding and mother. We do not always use additive language - for example when using infographics created by other organisations or referring to scientific research that didn't use additive language as this may not generalisable. There is a much more detailed description of the additive approach here.

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