
A mother with her infant at a Government hospital in Chennai during the `World Breast Feeding Week' in August 2004. — Photo: V. Ganesan
TWO WEEKS after our son Louis was born, three months ago, he started showing signs of colic.
At around six in the evening, he would cry loudly and inconsolably for no apparent reason, his back arched and his legs doubled up. Since our daughter Olive (now three) had done the same, we were not altogether surprised.
To add to the grief, my wife got mastitis, which we assumed was the reason each feed felt as if she were having her nipples slashed with razor blades. The antibiotics to treat it only made our son worse, upsetting his tummy. As we lurched towards meltdown and bottle-feeding, a health visitor suggested we visit midwives Chloe Fisher and Sally Inch, said to be the international queens of breastfeeding, at their drop-in clinic at Oxford’s John Radcliffe Hospital in southern England.
That they could help us with the mastitis seemed plausible, but I was sceptical when Fisher told us that the colic was also to do with my wife’s breastfeeding technique. No one had told us that colic had anything to do with how you breastfeed.
The ailment has baffled medical scientists seeking a biological cause. Only social, rather than medical, science seems to provide some clues. Most, if not all, babies in developed nations get some of the symptoms, yet it is rare or unknown in developing ones. A possible reason is that in the latter countries, babies are constantly held, fed effectively and on demand. Babies cry less whose mothers carry them for three hours or more, or feed on demand during the first two months. Another reason could be the lack of social support and the hard-working, stressful lives of pregnant mothers in developed nations.
It came, therefore, as a great surprise to me when Fisher told us that colic in the breastfed baby is primarily due to something as simple as not attaching the baby to the breast correctly, which means that the baby is unable to `drain’ the breast properly during feeds.
Fisher enunciated two principles: “First, don’t assume the breast is like a bottle. The milk is in the breast, not in the nipple, whereas with a bottle, the milk is in the teat. To feed effectively from the breast the baby must scoop in a deep mouthful of breast, whereas with a bottle, it can just suck on the end of the teat.
Wrong assumption
Second, people wrongly assume the middle of the baby’s mouth is halfway between the top and bottom lip. In fact, the middle is between the upper surface of the tongue and the upper palate.
For the baby to draw sufficient breast tissue into its mouth, it must be able to get its tongue well away from the base of the nipple and that won’t happen unless the breast is presented between the tongue and the upper palate.”
If the baby did not attach properly, the midwives told us, it would not drain the breast properly and would keep compressing the nipple between the tongue and hard palate, turning it into something resembling minced lamb.
Next came the other important point: “Only switch breasts when the well-attached baby comes off the breast spontaneously and seems completely satisfied,” said Fisher.
“In offering the second breast, let the baby decide whether he wants it. If the mother starts each feed on alternate breasts (regardless of whether the baby has had one or two at a feed), the breasts will get roughly even use.
The important thing is to allow the baby to finish the first breast first.” Failing to do this is the main cause of colic. Fisher also told us that the initial milk is low in fat and calories.
If you switch breasts before the high-fat milk has been drunk, the baby will take more from the second breast than he would otherwise have done.
Despite the relatively huge volume of liquid in its stomach, the baby will then be wanting another feed before long, because low-fat feeds are processed quickly, leading to a pattern of frequent feeding.
This can cause mental illness-inducing sleep deprivation, but worst of all, it will cause colic. Both poor attachment and breast switching result in the baby taking frequent, large-volume, low-fat feeds, which in turn lead to rapid emptying of the stomach into the large intestine.
If too much gets there too fast, there is not enough of the enzyme lactase to break the sugar in the milk (lactose) down. The gut turns into a malfunctioning brewery, with fermentation of the sugar in the excess milk creating gas and explosive poos. The crying, arched back, rigid tummy and irritability of colic follow.
I was flabbergasted. If all this were really true, why on earth was not everyone told about it, especially considering the damage done to the mental health of parents by colic? Fisher replied that she and Dr MikeWoolridge had published the hypothesis in the journal the Lancet 17 years ago.
Fisher believes she is right because she has seen thousands of mothers solve the problem by following their advice, but since the 1988 paper, her theory has been scientifically tested. Inch doubted that my wife actually had infectious mastitis or had needed antibiotics for it and easily proved her point.
Back pressure
The inflamed breast was due to back pressure within the ductal system of the breast, she said. Ineffective milk removal was not keeping pace with milk production so the milk could no longer be contained within the ductal system.
It was forced into the connective tissue of the breast, where it gets treated as a foreign protein, with subsequent inflammation and pain. All of which was of more than academic interest to us.
While we returned to the Thursday clinic for a booster course in attaching to the breast, from the first moment my wife did it properly, the pain was much less. From that very night our son was free of colic and within a week, the `mastitis’ was disappearing. — ©Guardian Newspapers Limited 2005
This story reprinted from: http://www.hinduonnet.com/seta/2005/04/07/stories/2005040700141700.htm
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