Here is an overview of the reasons behind painful feeds, if you have more specif question that require more indepth answers please post on the Colic, Reflux, & Crying boards - http://www.index.php?
board=13.0Painful Feeds: Gastric Distress
Babies don’t come out as full human beings – sometimes their digestive systems need a little more time to develop. The worst thing about any gastrointestinal problems is that it sets ion motion a series of events and emotions that only make the problem worse and more difficult to deal with. Mum and Das often feel helpless and inept because they can’t
figure out the problem. They start questioning their own skills; that inse¬curity, in turn, affects their behaviour. They become tense, and while feeding are worried and anxious.
When parents tell me that their baby is “crying all the rime”, the first thing I suspect is some kind of gastric problem: wind, reflux (baby heart-burn) or colic (as opposed to either of the first two conditions, which are sometimes mistaken for colic). Infants’ digestive systems are very immature. They’ve been fed intravenously for nine months, and now they have to feed independently, so the first six weeks can be a tottering time.
Wind, reflux and colic are all different conditions, but it can he extremely confusing for new parents to differentiate between the three. Making matters worse, pediatricians Sometime use the umbrella term “colic to describe all three, among other reasons because even researchers don’t agree on what colic is. The following should help you understand as much as anyone knows:WIND
WHAT IT IS: Air that your baby swallows during feeding. Some babies like the sensation of swallowing, so they’ll gulp air even when they’re not eating. Wind can he very painful to a baby, just as it is to an adult. When that air gets trapped in the intestine, it causes pain, because there’s no way for the body to it break down. Your baby just has to eliminate it by passing wind or burping.
WHAT To LOOK FOR: Think of your own body and recall what it feels like to have wind. Your baby will probably bring his legs up to his chest. He’ll scrunch up his face. There will also he a definite pitch and tone to his cry-—it’s an intermittent crying and he’ll look like he’s panting as if he’s about to belch. He might also roil his eyes and wear an expression (between cries) that almost looks like a smile (which is why Grandma often insists that Baby’s first smile is “really” just wind).
WHAT TO DO: When you burp your baby, rub upward on his left side (the soft part under his left rib is where his stomach is) using the heel of your palm. If that doesn’t work, pick him up with his arms dangling over your shoulder and legs straight down. This gives the air a direct path. Rub upward, as if you’re smoothing a piece of wallpaper to get the air bubble out. You can also help your baby expel the wind by laying him on his back, pulling up his legs, and doing a gentle bicycling motion. Another way to encourage him to pass wind is to hold him against you and pat his bottom, which gives him a sense ofwhere to push. To relieve the soreness in Ins tummy, lay him across your forearm, face down, and put gentle pressure on his tummy with your palm. Wrapping a makeshift cumrner— bund around his middle by folding a receiving blanket into a 100-mm ( (four-inch) band and tucking it in snugly around his middle can also accomplish the same thing. Just make sure it’s not too tight.REFLUX
WHAT IT IS: Baby heartburn, sometimes accompanied by Vomiting. In extreme cases, there can be complications and the baby can regurgitate blood-tinged liquid. Heartburn is extremely painful in adults, and worse for babies because they don’t know what is happening. When your baby eats, food goes into the mouth and down the oesophagus. If the digestive system is working properly, the sphincter—the muscle that opens and closes the stomach allows the food to drop in and keeps it there. If the gastrointestinal tract is fully developed, there’s a rhythmic pattern of swallowing, and then the sphincter opening and closing as it should. But with reflux, the sphincter is immature and doesn’t close properly after opening. The food doesn’t stay down and, to make it worse, stomach acid comes up with it, burning your baby’s oesophagus.
WHAT TO LOOK FOR: One or more episodes of spitting up should not alarm you. All babies have reflux at one time or another, especially after eating. Some have it more often, and some infants are simply more sensitive tO digestive issues. When I suspect reflux I first ask: Was he breach? Did he have the cord wrapped around his neck during delivery? Was he premature? Was he jaundiced? Was he a low-birthweight baby? Did Mum have a C-section? Have any of the adults or other children in the family had reflux?
A yes to any of those questions points to a higher chance of reflux. If she has reflux, your baby will have trouble getting through her feeds. She might splutter and choke, because her sphincter has stayed shut, making it impossible for her to get food down in the first place. Or, she might spit up or even projectile-vomit a few minutes after eating, because the sphincter didn’t close once the food went down.
Sometimes you’ll also see a watery cottage-cheese spit~up as long as an hour after a feed, because the stomach is in spasm and whatever is on top comes back up through the oesophagus. She might have explosive poos. Like a windy baby, she might also gulp air, but with reflux the gulp is accompanied by a little squeaky noise. Reflux babies are often hard to burp. Another key sign is that the only way they feel comfortable is when they’re sitting up or are held upright on a shoulder. Any attempts to lay them down result in bouts of hysterical crying, which is why a red flag goes off in my brain when a parent tells me, “He’s happiest when sitting in the swing” or “He’ll only go to sleep in his car seat.”
The vicious cycle with oesophageal reflux is that the more tense a baby is and the more crying he does, the more likely it is that he’ll have a spasm and that the acid will conic up his oesophagus and make him even more uncomfortable. You try every trick in the book and nothing calms him. Chances are, you’re trying the wrong tricks . You may tend to jiggle him up and down to comfort him, which only helps the acid move up the oesophagus. Or you’ll think, needs to burp,” so you pat his back, which also pushes the acid up through his, undeveloped sphincter. You might attribute his crying and his discomfort to this or that—usually colic or wind—with-out realising he has heartburn, which requires a very specific kind of management. You get confused and abandon your routine because you’re having trouble reading his cues. Meanwhile, your baby is exhausted. He gets hungry again from all that crying (which takes a lot of energy), So you try to feed him again. But before you know it, he’s uncomfortable, maybe spitting up, and the cycle continues.
WHAT TO DO: If your pediatrician says it’s colic, get a second opinion from a pediatric gastroenterologist, especially if the adults in your family or other children, have gastrointestinal problems. Reflux runs in families.
Often a health history and thorough examination is enough to diagnose the problem.. Most babies are diagnosed without lab tests. In extreme cases or if your doctor thinks there might be complications from your child’s reflux, various tests may be performed - X-ray with a barium swal¬low, ultrasound, endoscopy, esophageal pH study. The specialist will determine if your baby has reflux, gauge its severity, and can usually esti¬mate how long your baby’s reflux will last. She will also give you medica¬tions and guidelines to manage it.
The most common treatment for reflux is medication: baby antacids and relaxants. That part is in the doctor’s hands. But there are also things YOU can do besides taking him for rides in the car or getting him addicted to that darn mechanical swing:Elevate the cot mattress.
Raise it to a 45-degree angle by using a baby wedge or a couple of books—anything, as long as the head is higher. Babies with reflux do best when propped up and swaddled.Do not pat your baby when burping him.
If yOU pat you’ll make him vomit or he’ll start crying, which starts the vicious cycle. Rather, gently rub in a circular motion on the left side of his back. The reason to rub is that if you pat his back, which is where his oesophagus is, it irritates an already inflamed area. Rub upward with baby’s arm straight over your shoulder so there’s a clear passage up the oesophagus. If after three mm-utes, he doesn’t burp, stop burping him. If there’s air in there, he’ll start being fussy. Gently lift him forward and the air will probably come out.Pay attention to feeds.
Avoid overfeeding your baby or feeding him too quickly (which is more likely to happen on a bottle). If a bottle-feeding takes less than twenty minutes, the hole in the nipple may be too large. Switch to a slow-release nipple. If he starts fussing after a feed, use a dummy to calm him rather than feed again, which will only make him more distressed.
Don’t rush to give him solid food.
Some experts suggest giving solid food earlier than six months when a baby has reflux, but I disagree (see Solid Advice, page 142 The BW solves all your problems). If you fill his tummy too much, it will give him even worse heartburn. He’ll stop feeding if he has pain.Try to stay calm yourself
Reflux tends get better at around eight months, when the sphincter is more mature and your baby is eating more solid foods. Most babies outgrow reflux in the first year; the most severe cases can continue through age two, but they’re definitely in the minority. With those serious cases, you just have to accept that your baby isn’t going to conform to a normal eating pattern - at least not for now. In the meantime, take the steps you can to make him comfortable and know that at some point he will outgrow it.COLIC
WHAT IT IS: Not even doctors agree about what colic is or how to define it. Most consider it a complex clustering of symptoms characterized by loud, excessive, and inconsolable crying, which seems to he accompanied by pain and irritability. Some see it as an umbrella that covers: digestive problems
(allergies to food, wind, or reflux), neurological problems
(hyper-sensitivity or highly reactive temperament) , and unfavourable environmental conditions
(nervous or neglectful parents, tension in the home. Babies diagnosed with colic can have any—or all—of these conditions but not all will necessarily have true colic. Some pediatricians still use the old 3/3/3 rule: three nonstop hours of crying, three days a week, fir three consecutive weeks, which statistically adds up to about 20 per cent of all babies. Pediatrician and colic researcher Barry Lester, author of For Crying Out Loud
, calls colic “a disorder of crying”. He puts it simply: “Something is making that kid cry in an unusual way and whatever it is, it also impacts on the rest of the family.” Lester agrees that only about 10 per cent have true colic~severe bouts of loud crying that last for several hours at a time, often at the same time of day every day~ and with no apparent reason. First-born infants seem to be affected with colic more often than later children. It usually begins within ten days to three weeks alter birth, and lasts until three or four months of age, at which time ~t generally disappears on its OWO.
WHAT TO LOOK F()R: When a mother suspects that her baby is “colicky”. I first rule out wind and reflux. Even if they are considered subsets of colic, at least you can take steps to alleviate them, which we cant say about colic. One important difference between colic and reflux is that despite their crying, colicky babies put On weight, whereas many babies with reflux lose weight. Also, with reflux, your baby will tend to arch backward during a crying spell; with wind, he pulls his legs up; and both spells typically occur within an hour or less of the last feed whereas colic isn’t necessarily related to feeds. Some studies now suggest that colic has nothing to do with stomach pain at all (even though the word colic
comes from the Greek word for colon). Instead, it’s caused by a baby’s inability to console himself when dealing with all the things that bombard his senses.
WHAT To DO: The trouble is, all babies cry. They cry when they’re hungry or upset or when you change their routine. I’ve helped “cure” so-called colicky babies by putting them on a structured routine, teaching the parents how to tune in to the baby’s cues, modifying feeding techniques if necessary (changing nipples if the baby is bottlefed or the position of the baby’s body during feeds, changing the way the baby is burped), and rul¬ing out food allergies (changing formulas). But in those cases, we obviously weren’t dealing with true colic.
Your pediatrician might prescribe a mild sedative (knock—out drops), advise you to avoid over stimulating your baby, or suggest various tricks of the trade like running water, the vacuum, or your hair dryer to (distract your baby. Some will also suggest breast—feeding more frequently, which I categorically don’t
recommend, because if the problem is in your baby’s gastric system, overfeeding makes it worse. Whatever the suggestions, remember that true colic has no “cure”. You pretty much have to ride it out. Some parents are better equipped than others to do this. If you’re anything but a “Confident” parent (see pages 68—71 BW solves all your problems), a colicky baby might be a bad fit. In that case, call in the reserves. Get all the help you can. Take lots of breaks so that you don’t get to the breaking point yourself.BW solves all your problems p109