Parenting Australia

Colic or Reflux or Just Overtired? What’s making your baby unsettled?

Many parents seek help and relief for their "unsettled baby" who "cries all the time" and report that the baby has "colic" or "reflux" and sometimes both! I immediately ask the parents if the colic or reflux has in fact been diagnosed by a paediatrician or their General Practitioner. Often the answer is “no” and the parents are only surmising that due to all of the well meaning advice from friends and family that this is the obvious diagnosis.

Upon finding that the colic or reflux hasn't been diagnosed by the health professional I set about investigating whether the poor little baby is actually just overtired and needing more sleep. An overtired baby can trick the parents into rightly thinking that they have reflux and colic by the way they respond to the delayed bedtime. First lets look at the usual signs of colic and reflux and then see how they mask overtiredness.

Colic: Is usually described as at least three hours of crying/screaming for at least three days a week, from about the age of three weeks until about the age of three months. Colic babies generally do a lot of screaming at different times of the day which is not generally consistent on any day, go red in the face while crying/screaming, roll up into a ball or pull their legs up, may or may not burp after a feed and do not respond to the usual methods of calming when really upset.

Reflux: Is a common thing amongst babies, where the contents of the tummy rise up and just burn the back of the throat without vomiting (silent reflux) or vomiting occurs with or without crying sometimes projecting across the room and all over mum and dad.

Reflux in a 'happy chucker'(a baby who doesn't cry when they vomit) is not generally a problem as long as the baby is still putting on weight and has at least 4 wet disposable/ 6 cloth nappies in 24 hours, therefore showing signs of hydration. The baby who has vomiting/projectile reflux and is in obvious pain while vomiting and not putting on weight or showing good signs of hydration is often in need of medical treatment.

The crying/screaming reflux babies may scream with every or most feeds and usually have an unsettled period in the day. They are not consistently unsettled every day and while mostly uncomfortable when lying down, will sometimes cope well with tummy-time and sleep. Reflux babies tend to arch their backs as if to stretch their heads away from their bodies due to the pain.

An overtired baby: Starts to scream 5 minutes after they have given you their tired signs and should be in bed, to let you know they are in overdrive. This screaming will lead to extra wind in the tummy and lead to parents to attempt some burping. When the burping doesn't work mum will think the baby is hungry and offer another feed, this may lead to some vomiting due to the tummy already being full and more screaming. By now the baby looks and acts like they have had 12 cans of coke and the extra feeds and screaming bring on more wind. By this time the baby is NOT going to sleep and mum, dad and baby are frazzled and frustrated. When this happens consistently during the day it is natural for the parents to think that their baby who "has a lot of wind and vomits all the time and screams at bedtime" has colic and reflux.

If the above sounds very familiar and you suspect your baby has colic or reflux there are some practical steps to try to prevent overtiredness before we look at your baby's signs of either.

• Be aware of your baby's suggested uptime for their age and identify your baby's tired signs so you can get them into bed within 3-5 minutes of being confident baby is tired.
• Make sure your baby feeds efficiently in their uptime. Demand feeds and empties the first breast before attempting the second. Or demand feeds from the bottle. Try sleeping then feeding, then playing, then sleeping.
• Ensure floor-play, including tummy time in every uptime even if for a short time.
• It is only necessary to burp baby for about 2 mins after a feed, it's ok if they don't burp with every feed. Not all babies have gutsy feeds.
• Some babies need a break in the middle of a feed, this is ok and prevents some vomiting.
• Try raising the legs at the head end OF THE COT ONLY if you suspect reflux, not the mattress, for SIDS (sudden infant death syndrome) reasons.
• If settling is needed, try rolling the baby onto their right side in order to pat their bottom.
• Firm wrapping and tucking in so baby feels comfortable and secure and doesn’t overstimulate themselves.
• It is sensible for all babies, especially unsettled ones, to be checked over by a Chiropractor or Osteopath to rule out spinal misalignment due to the birth process.

Tip: Understanding your baby's routine, suggested uptimes, tired signs, and settling basics will help you prevent your baby being overtired and identify if your baby has genuine signs of colic or reflux before you head off to the paediatrician.

© 2008 Natalie Ebrill- Sleep and Settle-Baby Sleep Consultant 0-5 yrs
RN, Child and Family Health Nurse. Mother of three.
I want to give you your life back! Would you appreciate being empowered with an understanding of your baby's needs and a gentle strategy that you apply to your baby/toddler's personality? Do you feel like you've read everything and nothing is working?
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