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Unsettled babies

Babies can be unsettled due to several causes; Colic, Reflux and Cow milk protein intolerance being the most common ones. It is often seen that there can be more than one cause for being unsettled.

Colic – is when air is stuck in your baby’s tummy after feeding. Babies usually swallow air during breast/ bottle feeding which is burped out or passed as wind post feeding. You can use following medications, if general measures do not work.
• Biogaia is probiotics or healthy bacteria taken once daily and
• Infacol/ Infant’s friendly/ Padbury mix (herbal) on and off when your baby is unsettled. Both Infacol and Infants friendly contain medication called ‘Simethicone’ which works by bringing small air bubbles together to form large one which are easier to burp or fart.

Reflux – is when the milk rises up from stomach to food pipe (oesophagus). There is a valve (gastro-oesophageal valve) between the oesophagus and stomach which prevents milk regurgitating upwards. However, this valve is sometimes not fully mature and hence reflux is not always abnormal. Oesophagus usually does not have acidic contents as opposed to stomach which produces and stores gastric acid. When the acid rises to oesophagus, it burns it and leads to pain. Reflux can manifest with obvious spilling, posseting, or vomiting of milk after feeds, or milk seen in the mouth long after feeding. At times it can be just silent reflux when the milk comes to upper oesophagus only and babies are noticed by parents to make swallowing movements. This can present with baby’s being unsettled, uncomfortable and in pain. Good thing about reflux is that it usually last only for first few months before the valve matures. Occasionally, when babies have certain neurological problems this reflux may last longer than few months and would require further surgical assistance.

Overfeeding is the most common cause of reflux. In other words, putting more milk than what stomach can hold on to, would lead to milk regurgitating up before it is passed forward. Exclusively breast fed babies can also be overfed. Babies usually comfort themselves by sucking on their hands when they are in pain and this can at times be miscued as being hungry by mothers. This leads to cluster feeding and snacking. More amount or more frequent feeds leads to overfeeding which leads to more reflux, more pain, more being unsettled, more sucking at their hands and in turn would lead to over feeding again. So it can be a viscous cycle.

Hence, general measures for colic and reflux would be as follows,
• Avoid overfeeding. Stick to 3-4 hourly feeding and if babies are unsettled earlier then try dummies.
• Ensure you burp babies well after each feed. You can try different techniques for this.
• Keep upright for ~ 30 minutes post feeds.
• Elevate the head end of the babies bed by 15 degrees. This helps by keeping the milk down in stomach due to gravity. This can be done by placing a folded towel under their mattress or something under the legs of their bed at the head end. Ensure that your baby is at the lower end of the bed and can’t slide more to bottom under the sheet to avoid risk of being suffocated under the sheets.

If you are not benefitting with these general measures than we may have to consider Anti reflux formulas, milk thickeners, or medications to resolve your babies pain. Milk thickeners that can be used are Karicare, Aptamil, Gelmix, Supercol, TC Max etc.

Also, Reflux can be managed with medications like Losec which predominantly works by reducing the acidity. This medication does not decrease the physical amount of reflux but it does reduce to acidity which in turn reduces the pain. Having said that, it would decrease the overfeeding component and the distress which in turn possibly reduces the physical amount of reflux, which parents often report. This medication comes in tablet form and can either be crushed and give with spoonful of milk or can be compounded into liquid form in some pharmacies.

Cow milk protein intolerance – This is allergy towards the proteins in the cow’s milk. This condition usually lasts for about 12 months only and is not necessarily lifelong. This can manifest with blood in stools, unsettled babies, other associated allergic conditions like eczema and nasal stuffiness. Occasionally, this condition can be seen in exclusively breast fed babies as the cow milk proteins from the mothers diet can trickle in small amounts through breast milk. In exclusively breast fed infants, mothers are advised to restrict dairy and soy products in their diet. However, mothers are allowed to consume goat milk products if their struggle to give up dairy products completely. In formula fed babies, we can switch to more hydrolysed formula or to goat’s milk. The hydrolysed formulas are still cow milk protein based but these proteins are broken down in to smaller units called amino acids which are easier to digest. Cow milk protein intolerance is different from Lactose intolerance in which there is deficiency in production of an enzyme called ‘Lactase’ which helps us to digest lactose in milk and dairy products. This can again be either congenital absence or secondary due to other reasons.