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Desperate about your young baby’s behaviour?

Sunshine follows rain, night follows day, cats sleep on newspapers and babies cry all evening. Such is life in all its glory. Every parent I see will accept that, when they announced that they were planning a family their news was met with smug grins and a threat of “just you wait for those sleepless night!” And yet, when those sleepless nights arrive before the ink is dry on the hospital birth notes, parents quickly come to the conclusion that their baby is unusual, broken, poorly or just plain naughty!

Erratic, fussy, irrational and impossible to soothe, the young baby is the same the whole world over and once you understand exactly why your little one keeps you on your toes (don’t you dare sit down) all evening, you will be more able to accept that what you need are coping strategies rather than a non-existent cure.

Colic is the name given to the particular pattern of crying and fussy behaviour seen in the Baby in the first 3-4 months of life. The pattern starts towards the end of the first week following birth and is characterised by regular, nightly crying bouts between about 5pm and midnight and then again between 2-3am and 4-5am. The baby draws up his legs and appears to be in pain. Suckling and rocking appear to help for short bursts but nothing gets the baby to sleep for long, until the end of that particular colic bout when baby falls soundly asleep.

It seems that colic has been around since the dawn of time and, from an evolutionary point of view, makes perfect sense for the survival of the species. After all, noisy babies get cared for, quiet ones get put in a corner (of a cave) and left alone …

You will hear all sorts of explanations for colic – wind, reflux, silent reflux, naughtiness, manipulation, poor milk quality, stress in the mother, but none of these make sense when looked at from a scientific, rational standpoint.

Colic simply means spasm and this is exactly what your baby is experiencing – painful gut spasm caused by high blood levels of hormones that make the smooth muscle of the gut contract. These hormones are circulating in all of us – they cause labour contractions, amongst other things. They are at their lowest between about 7am and midday, which is when your baby will be most settled and pain-free, and peak daily between 5pm and midnight and 2-5am. The evolutionary reason for a baby to be settled in the warm morning hours when the sun is up and mum is busy out hunting and gathering, and then demand to be kept very close in arms and soothed continually in the dark, cold nighttime hours are pretty obvious when you stop and think about it.

Happily, evolution has given us built-in soothing strategies – skin to skin, suckling and breastmilk, and when a baby comes to our boob all these three things happen together automatically. Suckling creates an endorphin release into baby’s bloodstream and, also, human milk contains endorphins. These natural opiates RELAX smooth muscle and therefore ease gut spasm, but they also wear off very quickly – in about 5-10 minutes. So the picture a mum typically sees is… baby in pain with gut contractions; baby gets driven through reflex behaviour to give suckling cues; baby suckles and produces endorphins at the same time as receiving a little endorphin-rich milk; baby’s gut relaxes; baby stops suckling; endorphin level drops off over about 10 minutes; gut contractions return; baby gets driven to suckle again, and so on and so forth. It is easy to see how mums think that somehow their breastmilk is actually causing the problem whereas, really, the baby is self-medicating on endorphins with each return to suckling.

People call this behaviour “cluster feeding” but in reality it is “cluster SUCKLING”. Because babies need to stay close all night to keep warm and safe, their highly-evolved, spasm-ing gut keeps them on high-suckle alert. Suckling alone produces endorphins and so babies do not actually need lots of milk during these hours – if they could get lots of milk every time they suckled overnight, they would either vomit huge amounts or you would be pushing them to school in a wheelbarrow in a few years! So, as mums correctly perceive, when a baby is at her most suckly, mum’s supply adjusts down. In the less suckly morning hours, mum’s supply adjusts up. In this way, babies can suckle as much as they need to and also get, over 24 hours, just the right amount of milk.

Now, how to deal with the problem. Firstly, it can help to know that there is no cure; only coping strategies until baby develops out of this very vulnerable state and is more able to cope for longer periods without skin to skin and suckling. This developmental stage arrives at around the 4 month mark. Next, it is useful to remember that colic is definitely not caused by wind or foods (with a couple of notable exceptions, for which, see later) seeping into the milk. In fact, all the weird and wonderful ideas you’ll hear about food really don’t bear scrutiny: human milk is made from our blood and our blood cannot become gassy, acidic or spicy and nor, therefore, can our milk. The trick is to keep endorphin levels as high as possible as this is what relaxes the painful gut. Now, as suckling raises endorphins and human milk contains endorphins, boobling will always be the most obvious solution, and you cannot put the baby to the boob too often. Baby will simply do lots of non-milk boobling and then, periodically, when a really bad spasm hits, he will draw a little endorphin-rich milk out to supplement his own suckling endorphins.

Other tricks that will stimulate your baby to produce her own endorphins are massage, skin-to-skin, rocking and jiggling, firm bottom patting, car rides, warmth (such as a bath), and stimulating her senses with certain white noises such as the hoover! Just remember that endorphins have a very short half-life, so every time you stop doing the soothing, you have about 10 minutes or so before the spasm and crying will return. Simply put, if you stop soothing your baby, your baby will stop being soothed!

Trying to cure a baby of his colic is like trying to cure him of being a baby. He will grow out of it at about 3-4 months no matter what you do (everything or nothing) when his immature nervous system stabilises. Of course, if you try different remedies, whichever one you are trying when baby is 3 months old will be hailed as a miracle cure and you will urge all your friends to try it.

Some great news about colic is that the baby who spends all evening and night soothe-suckling and in close skin to skin contact at the boob is less likely to get infections or suffer SIDS. Colic also seems to badly affect the brighter, more sociable babies – again, all that time in arms being rocked and talked to brings dividends. So much so that, even if your baby seems much calmer than your average baby, it is worth treating her as if she were really colicky and keeping her in arms as much as possible.

Colic can be more obvious in the atopic baby so, if you have eczema, asthma, hay fever or migraines on either side of the family, then your baby may be more severely affected. Many atopic people are sensitive to dairy, and cow’s milk protein is one of those rare exceptions where tiny food proteins can pass into mum’s milk and cause upset in very sensitive babies. The atopic mum might find that cutting out all dairy in her diet may possibly cut down the severity of the colic bouts. However, it is also very possible that the teeny weeny exposures to dairy proteins via breastmilk might actually help prevent dairy sensitivity when older. Remember though, the idea that the foods you eat can make your baby windy or cause your milk to be too acidic or spicy is simply not true – mums milk comes from your blood and your blood cannot be windy, acidic or spicy!

So, to sum up, your highly evolved baby survives the early, vulnerable first months by ensuring he spends long periods in arms, suckling. This arms-seeking behaviour is driven by painful hormonally-triggered gut spasms, particularly in the evening and night hours. As well as keeping him safe, this prolonged in-arms, soothing phase of life forges strong bonds and developmental leaps in language and socialisation. The mum who can just can trust her own instincts to pick up her baby up and soothe him continually helps rather than hinders this stage, and her milk carries soothing, gut-relaxing endorphins to ease the pain.

Your colicky baby will almost certainly turn into an outgoing, physically active baby (the more severe the colic, the more the baby may be likely to fit this personality type) who is an utter delight to mother (although you’ll need your wits around you as the little trouper raids every cupboard in sight!) There is light at the end of the tunnel – best to batten down the hatches for 3 months and emerge when the storm has passed and the sun is shining!

“There was never a child so lovely, but his mother was glad to get him asleep …”
Ralph Waldo Emerson

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Ask Rachel – Using Bottles

On an almost daily basis, people introduce me as an independent midwife and lactation consultant when I would never describe myself as either! In fact, I struggle to describe myself in any particular way – some days I am like this, and some days I am like that and some days I barely know who or what I am!

Always looking slightly from the outside of any particular pigeonhole, I avoid belonging to tribes. They seem, to me, to be about exclusion as much as about inclusion and this makes me feel deeply uncomfortable. I can sign up to some elements of a club, but am always at variance with others and so then feel at conflict with the other club members. If I belong to any tribe, it is the one where its members could sign the “any other” category.

So it is with feeding our babies. If you are known as a mum who suckles her baby, it is ten to one that people assume you also an “earth mother”, that you demand feed and co-sleep, that you “baby-wear”, and that you do not want a routine-led household.

If you bottle-feed, then there is an assumption that you want a more separate relationship from your baby, that you will start weaning at four months, that you rigidly work towards a four hourly schedule for feeding etc. etc.

So what about those “any other” mums who want to mix and match? Those who suckle their babies but want to work towards a daily routine in due course or those who bottle feed their babies but want to co-sleep, throw out the clocks and “wear” their babies until they are ready to sit their GCSEs?

Today, I speak to those mums who use bottles (always or occasionally) for feeding their babies but want to better fit in with their baby’s naturally evolved way of being.

Q. What sort of bottles should I buy?

A. Once you step into the world of “Baby”, you really are at the mercy of advertisers. Their job is to make you believe that their product is best. They have many thousands of pounds to spend and they are good at their job. The latest fashion is for bottles that “stop colic” and teats that are “more like a breast”. Don’t be fooled! Anti-colic gimmicks in a bottle are just that, gimmicks. Furthermore, they require additional cleaning and sterilising. Remember that colic is hormonally driven and an evolutionary, inbuilt protective strategy to ensure survival. Read my other blogs for lots about colic and evening crying behaviour and you will see that a bottle really couldn’t and shouldn’t cure your baby of being a baby.

What you need, quite simply, is a device for holding the milk, and then a good feeding technique. Stick to a simple bottle that is cheap to replace regularly and you won’t go far wrong. Your bottle will need to be thoroughly washed and sterilised every time you use it (if you only bottle feed your own milk then a hot wash with soapy water will suffice), so the plastic will not last for ever. Tiny cracks develop over time and these can harbour bugs. If your bottle is looking well-loved, buy a new one.

Teats are an important buy so choose smartly. The “closer to nature” type are nothing of the sort and can interfere with the normal feeding motion of the tongue. See the pictures here for the type of teat I am talking about – all fancy promo and nothing positive for baby:

When a baby boobles, he gets a lot of boob flesh into his mouth and then compresses it. This causes a good, broad pressure from the boob against the roof of his mouth and, over time, the palate develops a great shape for both speech and hearing. Babies who suckle on teats miss out on this broadening and spreading of the palate and the speech can be less clear and the baby can be more prone to ear problems. The “closer to nature” style teats look great but actively prevent the baby getting the broad part of the teat into the mouth and working it, so the baby is forced to slide back onto the thin nipple of the teat. If he tries to suckle on the broader part then, often, the teat deforms and milk splurges all over the best rug, missing the bemused cat by inches!

Look for a teat with a high, fat bulb beneath the nipple bit. Get the teat out of the pack and squeeze it (you know you want to anyway!) The bulb should be easy to squeeze when the teat is on the bottle, and there should not be any deforming of the teat under the retaining ring. The idea is that the baby works the bulb and the nipple bit sits right back against the soft palate. That will give your baby a more normal work-out for the tongue and jaw and, whilst you will not be able to fully replicate the way a baby is evolved to suckle on a boob, you will have a better chance of him broadening his palate for speech and hearing. Have a look at these pictures to get an idea of what I mean by a high, fat bulb:

Q. What sort of formula should I use?

Here again, you are at the mercy of multi-million pound companies, all competing for your attention. The dangers here are potentially greater than with teat buying. So, here is some really important information for you to read, re-read and read again …

The law in this country states that ALL infant formula milks MUST offer your baby her complete nutritional requirements. Notice that I did not say “minimal requirements”. So every formula marketed, including those made from goat’s milk or soya MUST, by law, give your baby absolutely every vitamin, mineral, carbohydrate, protein and fat that she needs. Sure, not one of them gives your baby the protection to fight infection or a whole host of other stuff in mum’s milk, but you know that! What you almost certainly do not know is that the milk manufacturers add a heap of other stuff, over and above the legal limit, in order to be able to boast to you and make you think that their milk is superior. But the other extra stuff is not only “surplus to requirement” but we genuinely do not know if it is ok for babies. The companies do not provide adequate evidence to say that their magic ingredient is safe to give eight times a day for many months to your baby. The “not needed” stuff adds cost to the milk which goes into further promotion and new products in order to boost profits.

Remember that, no matter how annoyed you feel about that midwife who bent your ear about breastfeeding, she does not make a single penny out of you if you choose to suckle. She gets the same wage whether you booble for a week, a month or a year. Nor does she lose out if you choose to formula feed. It is no skin off her nose. This is the very opposite of the formula folk. Every extra tin of their milk that you buy, goes towards their profit margin. If you drift towards another brand, they lose out. This is why the manufacturers advertise so hard and why they add unnecessary ingredients – it’s a marketing dog-eat-dog world out there!

In essence then, if you buy the supermarket own-brand formula, your baby will get all her nutritional needs completely and totally met. Buy one of the top brands and your baby will get more than you bargained for, and not necessarily in a good way. Your posh formula may well be a more risky choice for your baby’s health than your supermarket cheapo.

Avoid buying according to your tribe (and those well known brands are very tribal – some are more popular amongst the middle classes and some amongst the working classes and some amongst vegetarians) and, instead, buy thoughtfully for your baby. If you can’t bear to see your friends turn their noses up at your choice, either don’t tell them what milk you use, lie (lying is not illegal if you are not the president of the United States) or transfer your formula to a sterile, air tight container so no-one has any idea of which brand you have chosen. Which formula brand you choose is your business alone and mothering is tough enough without the unsolicited opinions of other people to contend with.

Finally, don’t be duped into thinking that you should choose your formula and then stick to it. Most women, and most healthcare professionals, believe that changing formulas leads to tummy problems. This is no more true than I get tummy ache if I have toast for breakfast and rice for lunch (my tummy ache is caused by pigging out on vast quantities at each meal and then topping off with chocolate ice cream).

In fact, because each formula is slightly different in taste and texture, you could be doing your baby a favour by ringing the changes now and then (or even through the day or week). Exposure to different flavours (through mum’s milk or by using different formulas) can make life easier when it comes to weaning. The baby who has had the same flavoured meal six to eight times a day for six months can really struggle with the complex flavours of family foods. The companies which make formulas also make endless expensive but very bland weaning foods to give to those babies whose palates have never been challenged.

You are a savvy, modern woman so resist the pull of the advertisers and buy smart, not posh, and vary the formula when the mood takes you. Finally, if you want more information on smart bottle feeding, including how to give a feed in a way that reduces wind, vomiting and over-feeding, take a look at chapter 5 in my book “Your Baby Skin To Skin”.

Stuffed!

Three days on from Christmas and my stomach is stretched beyond comfort and my head is aching from lack of sleep (I lay awake until 3am on Boxing Day doing the maths to work out if 2017 is a prime number – it is, as I had suspected for a couple of weeks now). I swear that I will not over-eat ever again and that I will swim my socks off regularly until all those extra unnecessary calories are burned.

One of the questions I hear every week from at least one parent is “How do I know when my baby has had enough milk?” If you have not spent much time in the company of babies, this would seem an easy question to answer: when a baby stops suckling, he has had enough! But, as all new parents know, it is not that straightforward. Babies suckle in weird ways: in the evening (and sometimes all through the day) they can spend over an hour boobling merrily away, suckling for a short while before dozing for a longer while and then waking and having another good nosh. Rinse and repeat ad nauseum.

Then they come off, immediately start rooting and squeaking again, go back on, decide it was a bad idea; come off again; yell and wiggle some more, have another good go on a boob or two, come off and and then chuck back what seems like a week’s worth of milk before diving back onto the boob all over again. Occasionally, when I have over indulged over the festive season, I think, somewhat wistfully about the Roman love of the vomitorium and how much easier it might have been be than all the post-Christmas exercise. Some babies seem to have retained the Roman habit! When my first son was tiny he could vomit so splendidly that it seems that I might as well simply run around the room gaily squirting my milk directly at the walls and soft-furnishings and cut-out all that time spent lovingly nursing my boy!

The idea put about by health care professionals that babies “feed” for half an hour on each boob and then come off and settle happily for a couple of hours is quite obviously information about an alien species. This may be how babies hang loose for those first couple of days in hospital but, within a week of being at home, things are very different. I will look at the causes of the constant evening boobling and nonsense in the next blog but let’s think about that vomiting.

Many mums are now told that their babies have “reflux” and that they can medicate it away. If their baby displays the rest of the miserable picture described above but doesn’t throw back any milk, they may be told that their baby has “silent reflux” which can also be medicated away. I sometimes have groups of mums at the local South Oxfordshire drop-in with 100% hit rate for reflux (silent or otherwise). Some pharmaceutical companies are laughing all the way to the bank at the same time as many parents are crying all the way to the shops to buy yet more useless medication.

Reflux simply means “bringing back”, so it is perfectly accurate as a diagnosis when there is vomit all down your back but that does not mean that the vomiting is abnormal or needs medicating. If your clothes are a sick-free zone then, if your baby is doing the suckle-squirm-yell-suckle dance all evening then chances are that your baby has the normal, healthy and life-protecting horror we used to call “colic” (about which much, much more next time).

So, if your baby is peeing lots, being happily dirty with a nice splurge of yellow or greeny-yellow poo every day or so and is otherwise well, then the vomiting is simply nature’s highly evolved way of ensuring that your little one does not over-eat. Why does she take down too much in the first place? Because, your milk contains lots of gut-soothing endorphins which calm her hormonally-sensitive gut from its immature spasms. She takes down the milk, gets the gut-calming benefits from the endorphins and then splurts back the unneeded milk. And, of course, being permanently at the boob, snuggling away, keeps your tiny one warm and safe from all those hunting bears in the forest which come out at dark …

Now human milk is also highly evolved (natch) and is super thin and easy to throw back. Babies need to keep their stomach only lightly full because, if it stretches up too much, it can make breathing more difficult. Evolution is about survival so stop worrying that your baby is a slightly wonky model that needs fixing and accept that, whatever it looks like, evolution has actually put some pretty damn fine protection strategies in place. No need to try to cure evolutionary protective strategies with medicine that can make your baby constipated. No need to give thickened formulas which stop the protective vomits. You will soon find that your baby will gain weight even when he is a happy chucker: my biggest vomiter – number one son – also gained weight the best. He just was very, very colicky and so soothe-suckled far more for those great milk endorphins and the needed to off-load all the unnecessary de-endorphinised milk.

If you have a baby that pees loads, vomits regularly, is otherwise well but gains weight very slowly, there may well be a pesky posterior frenulum (some people call this a tongue-tie but that is not my favourite term). I will cover tongue-tie in due course but, for now, if you think this is you, get checked by a specialist.

In short, lots of pee tells us that your baby is getting and keeping down plenty of milk and the vomiting is just your baby’s way of being a Roman!

Now, where did I put that last mince pie?