Pat

Enjoying your messages from Suid Afrika!  Especially intrigued with this 
explanation of colic attributed to Nils Bergman, recently seen in 
Bournemouth, England, at the UNICEF UK BFI conference, where he gave a 
brilliant presentation on the need for mother-baby togetherness.

When I practised in Zimbabwe as an LC, I had many breastfeeding moms who 
came in for help with "colic".  I don't know if this is a peculiarly 
southern African thing. They would describe babies who cried after 
breastfeeding, and for long periods.  The crying would turn into screaming, 
the baby wouldn't "settle", and the mother always said that the baby would 
draw up his legs, which was perceived as a sign of pain.  Sooner or later, 
some well-meaning friend, relative, or book (rarely a doctor) would give 
the explanation that what was wrong with the baby was "wind", or "colic", 
caused by "over-feeding", and would give dire warnings about putting the 
baby back to the breast after a normal "feed", because this would add wind 
on top of wind - so that the solution appeared to be to feed the baby less, 
not more.  There's a book written by Marina Petropoulos which has become a 
bible for mothers who want the best for their babies in that part of the 
world.  But the lady is a journalist by profession, not an infant feeding 
expert, and I always wanted to burn the section in her book on 
"colic"!  Some of these babies eventually failed to gain weight 
appropriately because they were being deliberately starved of food and/or 
comfort by their distraught mothers, adding to their stress.  One memorable 
baby was being fed exclusively formula by bottle (I wrote in to Lactnet 
about this I think) and experiencing the same symptoms.

Many years ago I heard a brilliant definition of colic given by an LLL 
mom  - persistent irritable crying with no known cause.    If you observe a 
colicky baby, you'll see that sure enough they cry, scream, go rigid, draw 
up their legs, kick, chew their fists, flail around, and show every sign of 
being severely distressed.  But my take on this is that these behaviours 
are caused by baby anger and frustration - not pain.  They can be stopped 
by - guess what?  - breastfeeding more, not less.  A really, really angry 
baby may need to be calmed down before he will latch, and sometimes if he's 
still angry, or wants a faster flow of milk (mom's let-down may be 
temporarily delayed by this very stressful situation) he may arch 
backwards, lose the nipple, and then scream even more.  Some mothers 
interpret this as the baby not "wanting" the breast, but I think it's just 
a logistical consequence of an arching baby.  So the mom may need to follow 
the baby around with the breast, as it were, to re-latch him quickly - and 
the nipple needs to be pointed up, to stimulate the palate, so the baby 
knows immediately that it's still there.  Who knows if the baby needs more 
milk, or simply needs the comforting feeling of being plugged in to 
mom?  Whatever the "cause" of the "colic", breastfeeding again - even for 
the nineteenth time - will fix whatever-it-is.  (With the bottle-feeding 
baby, I discovered that little plugs of milk were clogging up the hole in 
the teat, so the level of milk in the bottle wasn't going down, which the 
parents took to mean that the baby wasn't still hungry.  So I "expressed" 
them, and the baby was happy - nutritively sucking for a while, then 
non-nutritively sucking when he just wanted to suck).   My observation is 
that babies need huge amounts of sucking in order to become "organized" and 
to feel comforted.   The stressed baby may need even more, regardless of 
the quantity of milk, but the nice thing about breastfeeding is that IF the 
baby really does need more milk, then he can get it, and if he doesn't he 
can just hang out at the breast, gradually drifting with those little 
flutter-sucks occasionally until he can sleep - and some babies really need 
a lot of sucking until they become relaxed enough to sleep.

And then there's the whole question of a baby with bovine sensitivity 
wanting to spend all day at the breast because he needs a *lot* of 
comforting, and is spitting up and producing lots of stools because he's 
actually getting a whole lot more milk during the course of the 
comfort-sucking.  But that's a different issue, and the over-feeding is a 
symptom, or a consequence, not a cause.

I would hate to disagree with such a lovely advocate of mother-baby 
togetherness as Nils, and it could well be that babies in the first few 
days may only "need" the quantities described.  But that is no reason to 
limit time at the breast.  There's more to breastfeeding than just the 
milk.  My understanding of Nils' presentations and talks is that he 
consistently promotes the needs of babies for uninterrupted skin to skin 
contact with the mother, and unrestricted access to the breast. Could it be 
that the reporter of the report is combining her own understanding of colic 
with Nils' words, adding two and two, but maybe coming up with more than 
four?

Pamela Morrison IBCLC
now in Rustington, England


At 02:37 19/12/2005, you wrote:
>Date:    Sun, 18 Dec 2005 21:46:27 +0200
>From:    Pat Torngren <[log in to unmask]>
>Subject: Separation of newborn from mother causing colic
>
>Dear Everyone,
>
>I am busy working on a translation into English of an article interviewing
>Dr Nils Bergman, on Kangaroo Mother Care.  In the course of this, I
>came across the material below, on the causes of colic in babies, some
>of which was new to me (it may not be to others here, but in case it
>might be, I am sharing it):
>
>"Colic, according to Nils Bergman, can be caused by too much food
>being given at any one time, or by the fact that the normal digestive
>process in the newborn baby stops when it is separated from the
>mother.  According to him, the natural situation would be one where
>babies feed approximately every 90 minutes, and consume 30 mls,
>which in turn corresponds to the volume of the excretion reflex.
>
>"In breastfeeding counseling, one often hears people talk about several
>excretion reflexes taking place during one feed. But according to
>Bergman, this is a reflex that occurs because the baby is not fed often
>enough, and then is given too much at one single feeding.
>
>"On day one after the baby has been born, the stomach can contain 5
>ml.  By the time the baby is a week old, its stomach can hold 30 mls.  If
>the stomach is filled with more than 30 ml, the excess content goes out
>either by excretion or by the baby beinging up some of the milk.  If
>neither of these happen, the excess milk gets stuck in the stomach and
>the stomach muscles then become stretched.   That causes colic,
>explains Nils Bergman.
>
>"Also if the baby is separated from its mother after it has fed, its level
>of stress hormones increases due to the stress being separated from
>her, and as a result the digestion stops, which can also cause colic. The
>proper digestive processes in a baby are totally dependent on the fact
>that it should not separated from its mother."
>
>We always seem to come back to the same beginnings -- never
>separate mothers and young babies!
>
>Best wishes,
>Pat (Cape Town)
>
>------- End of forwarded message -------

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