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Year : 2021  |  Volume : 2  |  Issue : 2  |  Page : 32-33

Infantile colic in exclusive breast feed babies: A clinical dilemma

1 Independent Consultant Paediatrician, Kolkata, West Bengal, India
2 Independent Public Health Researcher, Srinagar, Jammu and Kashmir, India
3 Independent Public Health Researcher, Dehradun, Uttarakhand, India

Date of Submission21-May-2021
Date of Acceptance16-Jun-2021
Date of Web Publication23-Aug-2021

Correspondence Address:
Sudip Bhattacharya
Independent Public Health Researcher, Dehradun
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jssrp.jssrp_8_21

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Many newborns and infants on exclusive breastfeeding who appear to be healthy report to the emergency room with a sudden start of intense intermittent crying lasting 2-3 days with no obvious clinical explanation. They may also have moderate gaseous distension of the abdomen, abdominal wall contractions, and the refusal to sip their mothers' milk on occasion. Because the onset is rapid and is linked with abdominal distension, a surgical aetiology is frequently explored. Because vomiting is almost never present, the potential of obstruction is ruled out. Even so, an ultra-sonogram is frequently performed to rule out surgical causes of intermittent intussusception. What should be done in this situation? It is necessary to obtain a complete food history from the mother. Surprisingly, in clinical practice, almost all of these instances have a history of the mother eating chicken, mutton, or another spicy food within 24–48 hours after the onset of these atypical symptoms. Around the world, different societies have distinct dietary restrictions for nursing women. Caffeine, spicy meals, raw foods, cold foods, and sikhye are the most commonly self-restricted foods among Korean women. Cold, hot, and spicy meals are traditionally suggested to Asian moms to avoid because they are bad for both the mother and the infant. Similarly, foods such as pork, green chilies, and tomatoes are prohibited among Hispanic mothers despite the lack of supporting evidence. According to the research, maternal dietary components are eliminated in breast milk, either partially or completely. Some are well tolerated, while others cause GI intolerance or allergic reactions in the newborns gastrointestinal tract. Breastfeeding intolerance is characterised by abdominal bloating, colic, indigestion, and a change in stool colour, texture, and odour. More evidence-based study on this topic is needed, and it should be done briefly to help parents relieve their anxiety and save out-of-pocket medical expenses by ruling out surgical causes or emergency hospital visits or admissions.

Keywords: Abdominal colic, infantile colic,breasfeeding

How to cite this article:
Ghatak N, Saleem SM, Bhattacharya S. Infantile colic in exclusive breast feed babies: A clinical dilemma. J Surg Spec Rural Pract 2021;2:32-3

How to cite this URL:
Ghatak N, Saleem SM, Bhattacharya S. Infantile colic in exclusive breast feed babies: A clinical dilemma. J Surg Spec Rural Pract [serial online] 2021 [cited 2023 Mar 31];2:32-3. Available from: http://www.jssrp.org/text.asp?2021/2/2/32/324484

Exclusive breastfeeding up to the age of 6 months is promoted by all government and nongovernment health agencies in India and all over the globe because of its overwhelming scientific evidence. Even having strong supporting evidence for breastfeeding, report reveals that the prevalence of EBF at five months of age are 43.7% from southern part of India and 54% from North-east India, respectively.[1] While this figure is even less when we compare with the rest of the world (37%) for children of 6 months of age,[2] which is quite worrisome. The benefits of breastfeeding are enormous for the child and the mother and it helps prevent gastrointestinal infections and other gastrointestinal complication at an early age. In our clinical practice, we observe that many neonates and infant on exclusive breastfeeding who are apparently well present with a sudden onset of excessive intermittent cry throughout the day for 2-3 days without any obvious clinical cause. Sometimes, they even have mild gaseous distension of the abdomen, giving pressure to the abdomen (like Valsalva), contractions of the abdominal wall, and occasionally refusing to suck mothers' milk.

As the onsets is sudden and associated with distension of the abdomen, surgical cause is often considered as the differential diagnosis. As vomiting is usually absent in all cases, possibility of obstruction is ruled out. Still, to exclude the intermittent intussusception, an ultrasonogram can be done, which exclude the surgical causes.

In this scenario, what needs to be done? The maternal detailed food history needs to be taken. Astonishingly, in clinical practice, it is observed that almost in all such cases, there is a history of chicken, mutton, or some other spicy food intake within 24–48 h of onset of these atypical symptoms.

Worldwide, several studies have been done on the effect of maternal food on the component of breast milk. Worldwide, several studies on the effect of maternal foods on the component of breast milk have been done. Fukushima et al. reported that an exorbitant amount of bovine milk peptides are secreted in breast milk after regular ingestion of 200 ml of bovine milk regularly for half a month. In contrast, less amount of excretion of ovalbumin after ingestion of eggs for the same duration. It is clear from the above study that the excretion of different protein in breastmilk is quantitatively different.[3] Another study also detected the presence of nonhuman peptides and proteins in human milk.[4] The link between fish consumption and high docosahexaenoic acid in breast milk has also been noticed. Maternal consumption of Vitamin C in diet is also associated with secretion of the same in mothers' milk.[5] In another study from Haryana, India, has shown p, p'dichlorodiphenyltrichloroethane (DDT) and p, p'-dichlorodiphenyldichloroethylene (DDE) in breast milk, though that too in a very negligible amount.[6]

One observational study was conducted By Kidd et al., and it showed that exclusion of some food products in maternal diet such as caffeine, cruciferous vegetables (e.g., broccoli and cabbage), garlic and onions, spicy foods, gluten, and beans reduces the cry and fuss of the exclusively breastfed infants.[7] Different societies have a different dietary restriction for lactating women around the globe. Jeong et al. in their studies done on a group of Korean mothers reports that the most common self-restricted foods among lactating mothers were caffeine, followed by spicy foods, raw foods, cold foods, and sikhye.[8] Traditionally, Asian mothers are advised to avoid cold, hot, and spicy foods as those foods are unhealthy for the mother and baby.[9] In a similar context, foods like pork, green chillies, and tomatoes are discouraged among the Hispanic mothers with no supporting background evidence available.

Our experiences are quite like the study conducted By Monica Kidd et al. We observed the correlation is with spicy meat and abdominal colic. It may be due to the protein component of the chicken/mutton or the onion, garlic, or the spices used to cook it. Sometimes, a child reports to the emergency room with sudden onset colic even without a history of maternal intake of any meat, but a spicy fried product made of onion and garlic. For determining the exact cause and mechanism of discomfort, extensive studies on a large scale should be conducted.

From the shreds of evidence from the studies mentioned in the text above, it's evident that maternal food components are excreted in breast milk either partially or as a whole. Some can be well tolerated and some cause gastrointestinal intolerance or allergic manifestation of the neonatal gastrointestinal system. Intolerance to breastfeeding is manifested clinically by abdominal bloating, colic, indigestion, change of stool colour, texture, and smell. The taste and smell of breast milk can also be changed because of the intakes of some food product like garlic and onion. As a result of this, infants refuse to suck and frequent regurgitation has been noticed. It requires further research on that topic.

From our clinical experiences and observation, dietary restriction is required. However, it must be evidence based and should be very brief. It can reduce sudden-onset excessive cry of the newborn and infants. It can also reduce the anxiety of the parents and reduces their medical expenses to rule out surgical causes or emergency hospital visit or admission. However, the list must be short; otherwise, there will be compliance issues and the mother will be nonadherent to exclusive breastfeeding. If the list of the commonly offending food is available, the sensitization of mothers can be started since the period of pregnancy. The name of those food items can be written with a diagram on the antenatal card of the mothers, if we can address issue in a proper direction then the rate of EBF can be increased further.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Ogbo FA, Dhami MV, Awosemo AO, Olusanya BO, Olusanya J, Osuagwu UL, et al. Regional prevalence and determinants of exclusive breastfeeding in India. Int Breastfeed J 2019;14:20.  Back to cited text no. 1
UNICEF. The State of the World's Children 2012. Children in an Urban World. New York, NY: UNICEF; 2012.  Back to cited text no. 2
Fukushima Y, Kawata Y, Onda T, Kitagawa M. Consumption of cow milk and egg by lactating women and the presence of beta-lactoglobulin and ovalbumin in breast milk. Am J Clin Nutr 1997;65:30-5.  Back to cited text no. 3
Zhu J, Garrigues L, Van den Toorn H, Stahl B, Heck AJ. Discovery and quantification of nonhuman proteins in human milk. J Proteome Res 2019;18:225-8.  Back to cited text no. 4
Bravi F, Wiens F, Decarli A, Dal Pont A, Agostoni C, Ferraroni M. Impact of maternal nutrition on breast-milk composition: A systematic review. Am J Clin Nutr 2016;104:646-62.  Back to cited text no. 5
Mehta RV, Sreenivasa MA, Mathew M, Girard AW, Taneja S, Ranjan S, et al. A mixed-methods study of pesticide exposures in Breastmilk and Community and Lactating Women's perspectives from Haryana, India. BMC Public Health 2020;20:1877.  Back to cited text no. 6
Kidd M, Hnatiuk M, Barber J, Woolgar MJ, Mackay MP. "Something is wrong with your milk": Qualitative study of maternal dietary restriction and beliefs about infant colic. Can Fam Physician 2019;65:204-11.  Back to cited text no. 7
Jeong G, Park SW, Lee YK, Ko SY, Shin SM. Maternal food restrictions during breastfeeding. Korean J Pediatr 2017;60:70-6.  Back to cited text no. 8
Kim-Godwin YS. Postpartum beliefs and practices among non-Western cultures. MCN Am J Matern Child Nurs 2003;28:74-8.  Back to cited text no. 9


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