>I am rather new to the list as a participant and as a LC. I am fascinated by
>all the information I have read already about infant colic and OVERSUPPLY.
>Since I am new, I am wondering if you all would do me a favor and give me a
>brief overview of the mechanisms of oversupply as it relates to infant colic.
>I would also appreciate your hints and recommendations on the remedies that
>have worked for you all.
>
>Thanks very much.
>
>Betsy R.N.C, CLC.

This is a bit of a pet subject of mine, so here goes a (hopefully) brief
version!

Too much milk taken by the baby too fast results in rapid transit time in
the gut - so much so that the digestive capability is overwhelmed and much
of the lactose in the feed doesn't get digested and absorbed, but continues
on to the lower bowel. This situation is exacerbated by the large feed
being relatively low in fat (ie large volume of 'foremilk', but I hate this
division, as there is no actual boundary between fore and hindmilk, rather
a blending as the let-down reflex occurs). A higher proportion of fat in
the feed would help slow the digestive system down.

When the undigested lactose reaches the lower bowel, the bacteria in there
(normal flora) digest it but this produces gas, resulting in 'wind' in the
bowel and colicky pains, explosive and/or frothy motions, etc. ie the
symptoms we often see as 'colic'. Typically, a baby like this is having
*more than 10 wet nappies a day, lots of dirty ones* and passes 'wind' a
lot. This helps distinguish this situation from undersupply and hunger. In
my experience, these babies are usually thriving and stacking on heaps of
weight (although Woolridge has found that it could be bad enough that they
are not gaining well) but crying a lot of the time.

*****The mother's *perception* is that the baby is always hungry and they
usually call because they think they have an undersupply.*****

Unfortunately, the baby resembles one with lactose intolerance, and many
have been treated for this, including being taken off the breast. But this
is simply *lactose overload*, and more problems will possibly be created by
this sort of management (like breast refusal later). Even tests done on
stool samples will be positive for reducing substances - they are in many,
many normal breastfed babies. It is only the artificially-fed baby that is
consistently negative because of the delayed gut transit time due to
foreign protein taking so long to break down.

The aim of management is to slow down the rate at which breastmilk is
travelling though baby's system. This may mean feeding just one breast per
feed for a while, so baby drains the hindmilk from that breast efficiently
and gets a more balanced feed. In extreme cases, the mother may need to set
aside a time period, eg 3 hours (adjusted according to severity of problem,
etc) and every time baby wants to feed, she offers the same side. Then she
switches breasts for the next time period. These babies often want to suck
very frequently because sucking is comfort to them (about the only one they
know) and also helps to shift the gas inside them along the digestive tract
(and helps relieve spasms of pain). Sucking causes peristaltic waves
through the whole gut. Each time baby returns to the same breast, he gets a
lower volume, higher fat feed to help slow the system down.

Mothers should be given a couple of cautions when trying this management -
one is to watch for blocked ducts when a breast that is used to being fed
from frequently now goes several hours without this, and also that this
strategy is *temporary* until supply is under control and baby is more
settled.

A good paper to read is:
Woolridge MW & Fisher C, 1988, Colic,"Overfeeding", and Symptoms of Lactose
Malabsorption in the Breast-Fed Baby: A Possible Artifact of Feed
Management,  Lancet 1988 ii: 382-384

This has been a bit rushed and not really brief (I don't think I know the
meaning of the word!). I hope I haven't missed anything vital. I'm sure
someone else will fill in if I have.


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Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Nursing Mothers' Association of Australia Breastfeeding Counsellor
Perth, Western Australia.   mailto:[log in to unmask]
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