Colic: what formula is best?

You can feel so helpless when your baby’s suffering. Here’s what you should know about colic and formula feeding. If you are currently living through the waking nightmare that is a baby with colic, all we can say to you is: we feel for you; it WILL eventually end; and the only way out of this tunnel is through it.

But that doesn’t mean you should accept it. Do what you can to ease the symptoms. Because nobody knows what causes colic, nobody can guarantee that any solution will work, but everything (safe and reasonable, obviously) is worth trying. Something may just work, and then you can finally get your life back!

Colic is diagnosed by the “rule of threes”: three hours of crying, at least three times a week, lasting at least three weeks. It usually starts at about three weeks of age but doesn’t usually persist – thank goodness! – past three months. It’s more often observed in the late afternoon or early evening, but it doesn’t have to occur at that time to meet the diagnostic criteria.

Whichever way you diagnose it, it is absolutely horrible to live through and is a significant source of stress for new parents, so much so that psychologists advise you to seek help fast if your baby has colic. You may become so frustrated and feel so helpless that you entertain fantasies of becoming violent with your child. Try very, very hard to find another adult to hold your baby, even if it is just for a short while if you are starting to feel that desperate. Call Lifeline to talk on their 24-hour helpline: 0861 322 322.

Know that you are not alone in this mystery ailment of infancy. Some estimates say up to a quarter of all babies have regular bouts of unexplained uncontrollable crying. Allegedly, you have twice the chance of having a baby with colic if you smoked during your pregnancy. But other than that science isn’t particularly helpful. Even the name just means “pain” (thanks for that, doctors, we kind of suspected as much!). It certainly looks as if babies are in pain – arching their backs and crying hard, often passing gas while they do so.

We do know colic is as common in breastfed as in formula-fed babies. Gripe water and colic drops can help, as can massage, bicycling legs, holding your baby angled slightly more upwards when feeding, and giving lots of burp breaks. Some parents add probiotic drops to their baby’s formula to see if that helps digestion.

But let’s talk about what baby is eating.

Lactose a culprit?

There is at least a theory that the lactose in breast or formula milk can upset some babies’ stomachs. Interestingly, lactose intolerance shows up much more strongly in some human population groups such as Africans and Asians. Northern Europeans consume more dairy in their diets and may have adapted to it over the millennia – one theory is that, because they live in less sunny parts of the world, they need to get more vitamin D from dairy than those of us lucky enough to live in sunny climates.

Lactose is a sugar found in milk. Our bodies use an enzyme, lactase, in our small intestine, to break lactose down into glucose and galactose. These sugars can be absorbed by the body and turned into energy.

Some people have too little lactase, meaning that not all the lactose they consume gets turned into glucose and galactose. Some stays as lactose, trapped in the digestive system, where it bubble-bubble-toil-and-troubles, fermenting and causing gas build-up. The other symptoms it could cause are bloating, pain, nausea and vomiting, and diarrhoea.

If your baby’s on formula, and if your paed agrees, it’s definitely worth switching to a reduced-lactose formulation such as Novalac AC to see if it helps.

What is lactose-free or lactose-reduced formula?

Lactose-free milk is milk that has had the lactose entirely removed via an enzymatic process that has pre-converted the lactose into glucose, or has replaced the lactose with a different carbohydrate, namely sucrose (Similac Total Comfort is one such product). Lactose-free milk and formula tastes a little sweeter because sucrose is sugar, so look for one that is sucrose free.

What is used instead of lactose?

“Some infant formula companies use glucose, maltodextrins and hydrolysed corn starch as the carbohydrate alternative to lactose in lactose-free infant formula,” says Lindsay Durham, a specialist paediatric dietitian (www.paediatricdietitian.co.za).

“Polysaccharides such as maltodextrins and corn starch are digested in three stages – first in the mouth where the salivary enzyme amylase starts to break them down; next in the small intestine where the enzymes (pancreatic amylase, lactase, sucrase and maltase) break the carbohydrates down further into simple sugars such as glucose and, lastly, carbohydrates that have not been digested and absorbed by the small intestine pass into the colon where they are partially broken down by intestinal bacteria.”

Durham says formulas that use maltodextrin and fructo-oligosaccharides (prebiotics) are the best alternative to lactose. “They pass intact to the lower gut where they stimulate the growth and activity of probiotic bacteria, increasing the overall health of the gastro-intestinal tract.”

Reduced-lactose formulas, such as Novalac AC, just have some of the lactose taken out, so that a baby still needs to practise digesting lactose, but in smaller quantities. This is thought to “prevent colonic fermentation and reduce excess gas,” according to Novalac’s international website.

Why is lactose important?

According to Kath Megaw, one of our experts and a specialist paediatric dietician, a baby is born with almost no lactase enzyme but within the first few weeks, as a response to the high lactose content found in breast milk, the body starts to produce lactase enzyme. The sugars derived from lactose help feed the good gut bacteria and are very important for the development of a healthy gut and healthy immune system.

“Colic is diagnosed by the “rule of threes”: three hours of crying, at least three times a week, lasting at least three weeks.”

At the beginning of a baby’s young life, there will be more lactose than lactase. This does not mean your baby is lactose intolerant and the worst thing to do would be to remove lactose from the diet. The minute you remove lactose from the diet your baby will produce less of the lactase enzyme and this you actually encourage an artificial lactose intolerance.

By three months, your little one’s lactase enzyme starts to match the lactose content of breast milk, which is way higher than any normal cow’s milk formula. It peaks between six and 12 months and by two years old it plateaus and may even decrease. The enzyme will decrease over the years and by adulthood we all have less lactase enzyme as technically we should be eating full solid diets.

A very small percentage of babies are born with a metabolic lactase deficiency. This is a potentially life-threatening condition and is called primary lactase deficiency. These babies will get severely ill if they have lactose and are the cases where all forms of lactose must be avoided. They can’t have breast milk and need to be on a soya or 100% lactose-free formula. These formulas use maltodextrin as the alternate carbohydrate in the milk. The process of digestion is similar to sucrose, but gentler to the rise in blood sugar and more in line with breast milk than sucrose (table sugar).

Babies may be temporarily lactose intolerant after a bout of gastro and so a lactose-free formula can be used for two to four weeks post illness; however, it’s important to give lactose again so that the gut can make lactase enzyme again. Avoid long-term use of lactose-free formula and never stop breastfeeding unless your child has been diagnosed with a primary lactose intolerance by your paediatrician.

So, in essence, there is therapeutic use for lactose-free formulas in cases of a metabolic disorder called primary lactose intolerance and for two to four weeks post gastro illness.

The takeaway? You want to mimic natural breast milk as closely as possible and breast milk does contain lactose. It is important that your baby’s gut learns how to break down lactose and to this end, it is recommended that you use a reduced-lactose formula rather than lactose-free as you try to figure out what is causing your poor baby distress. Also, lactose-free contains sugar, which you want to avoid as it contributes to digestive discomfort. As always, seek medical care if you’re worried – and keep your eye on the light at the end of the tunnel!

Disclaimer: This is not a sponsored post and is based on personal experience and personal brand preference of the content author. BabyYumYum reserves the right to its opinions and fully supports the notion of promotion that breast is best in line with the World Health Organisation (WHO) infant feeding guidelines. Breast milk is the best food for infants. Good maternal nutrition is essential to prepare and maintain breastfeeding. If breastfeeding is not applied, an infant formula may be used according to the advice of health professionals. Preparation and storage of any infant formula should be performed as directed on the tin in order not to pose any health hazards.

Also read:

Best formula and remedies for colicky babies in South Africa
What’s behind a formula tin label?