The Phases of Colic

“He’s probably just hungry.” 

“Have you tried swaddling him, all my kids loved that!” 

“Try a bit of chamomile tea in his bottle.” 

Oh, wow! Swaddle my baby??!! What a novel idea! Why didn’t I think of that over the last 4 weeks of relentless crying?” I’d say inside my head, while outwardly smiling and nodding, holding back tears of fatigue and utter misery.  Our son had colic and it was horrible.

Before I begin discussing the phases of coping with a colicky baby – let’s make sure we are all on the same page. I promise I won’t reference Webster’s dictionary, but some level of defining is necessary.

What is colic exactly?

There are no formal diagnostic criteria for colic.  But in an effort to provide a “diagnosis,” many physicians and researchers use “the rule of 3’s.”  If an infant is otherwise healthy, younger than 3 months of age, cries for greater than 3 hours per day for more than 3 days per week, it is presumed that the baby has colic.  The diagnosis may often be made retrospectively – meaning after the crying has already run its course, which is completely unhelpful.  So, there you have it…for all intents and purposes, colic is crying…lots and lots of crying!

We should’ve known we were in for a treat when the nurse said, “well, that’s a unique cry!”

Treatment

Nothing.  You do nothing.  Pediatrician does nothing.  The End. 

Haha. Tricked you! 

If you’re deep in the trenches of colic right now (and anything like me), you probably skimmed through the blog to the “treatment” section, lucky for you it’s right up top.  I get it…you’re completely desperate and hoping someone has a magical solution that you haven’t already tried.  This is a natural reaction. I’ve been there too.

But, that’s the very nature of colic.  If something were actually wrong – it wouldn’t be colic – recall, this is an “otherwise healthy infant.”  So, assuming you’ve had your baby checked out by a pediatrician and all is well (which is amazing and horrible news all at once), then you’re dealing with colic.

And so begins the first phase of colic.

Denial

You’d think that finding out nothing is wrong with your baby would be reassuring.  In all honesty, you are incredibly lucky to have a healthy baby.  Now that my baby has stopped crying and I can actually hear myself think, I can appreciate how true this is.  

As it turns out, however; in the depths of colic, this information is the opposite of reassuring.  It means that for the next 3-12 months, your baby is going to cry non-stop regardless of what you do.  The toll this takes can be difficult to imagine for parents who haven’t experienced it.  As a point of reference, recordings of babies crying have been used to train Navy SEALs to endure torture.  It is possible that this is just a myth circulating in colic support groups, but having personally made it through colic, it wouldn’t surprise me if it’s true.

Anyway, it is upon receiving the wonderful news that there is nothing wrong with your baby that the denial phase often begins.  

“Not my baby.  This can’t be colic.  Have you seen the grimace on my baby’s face?  Have you heard his cries?! He must be suffering! Someone has to do something!”

Now, I feel like here is where I should mention that my husband and I are in healthcare.  He is a physician and I’m a physician assistant.  We’re normally level-headed, strong believers in evidence-based medicine.  We use reputable resources such as UpToDate, Pubmed and websites of professional organizations like the American Academy of Pediatrics or the American College of Obstetrics and Gynecology for recommendations.  

The white coat makes me look legit!

But when modern medicine failed to tell us what we wanted to hear, and the pervasive cries of our son penetrated our skulls deeply enough to jostle our brains up a bit – we turned to the second best place to get medical information – mommy blogs and Google.  

So, there we were in “fringe medicine” territory – a place neither of us ever imagined going. 

If you’re not familiar with “fringe medicine” – it is a term used to describe unproven treatment options.  If you delve far enough into this territory you’ll find inhabitants such as anti-vaxxers, essential oil healers and Reiki masters.  

And it is here where I learned to ignore my pediatrician’s advice (and disregard his 12 years of education plus fellowship in pediatric critical care) and join the hoards of desperate moms with crying babies who were cutting milk and soy out of their diets.  

So for nearly 9 weeks I continued my charade of denial and choked down my morning coffee with the vile creation that is dairy free/soy free creamer, a milky water of sorts.

As it turns out, my son did not and does not have a milk protein allergy and dairy free/soy free creamer is truly the most vile substance in the dairy aisle.

Onto phase 2.

Disappointment

This phase is a real bummer.  

Remember all the hopes and dreams you had while gestating that little colic monster for nine whole months?

Some of my fantasies included getting beautiful newborn photos. I imagined he’d have cute, little pursed lips, a smooshy face and wrinkly skin.   I booked ours well in advance. 

Other fantasies included strolling our fancy bassinet stroller downtown, perhaps stopping for some brunch, taking him out for a quick feed and a burp.  Awww.   

Mere days before delivery! Already imagining the strolls I’d be taking and brunches I’d be brunching!

The reality is that colic is the destroyer of all parental newborn fantasies.  Honestly, it is okay for you to mourn the loss of what you had dreamed of before she was born.  As hard as it can be to empathize when you are suffering, try to keep in mind that there are far worse realities for parents out there.  I know it is hard to be thankful for your healthy, screaming baby; but trust me when I say, someday you will be very thankful.  

The most memorable moment of the disappointment phase for me actually occurred during a brief reprieve from the screams.  Our little bundle had fallen asleep, I looked over at him in his peaceful slumber and turned to my husband through tears and said, “THIS is the one we get? Out of all the sperms that could have reached the egg – this is the one??”  

In the moment, I actually meant it.  I even recall envisioning the little sperms swimming toward the egg – and thinking, this little jerk pushed all of the good ones out of the way.  Typical colic sperm move.  Only thinking about himself before he even becomes a zygote. 

Did I mention I was sleep deprived?

The regret phase comes next.  And this one is a REAL doozy.

Regret

I will never forget the day I slumped over my kitchen island and cried so hard I couldn’t breathe.  My son was in his swing, screaming of course.  As I stood up in an attempt to compose myself, I looked out my back window and saw a lovely woman walking her dog on the path behind our house.  My poor dog hadn’t been on a proper walk in months.  Unless I wanted to subject the whole neighborhood to my son’s shrill cries, I thought it better we stay indoors.  

I watched her walk into the distance and wondered if she even appreciated the freedom she had. “Oh how nice! Walk your dog past my house at a time like this!!” I felt so bitter.

And suddenly I was hit with the biggest pang of regret.  It was as if every good thing that had ever happened in my life flashed before my eyes.

Now, there I was, crying almost as loudly as my own baby, bracing my exhausted body on the cold, hard slab of early 2000’s beige/brown granite.  Why did the previous homeowners pick this granite, anyway?  And why didn’t I notice how ugly it was when we bought this house just 5 months ago? Perhaps it was just colic once again casting its hideous hue on my once vibrant life!

I wondered if I had made the biggest mistake of my life.  I USED to be able to walk my dog.  I USED to sleep at night.  I USED to take baths and plop one of those ridiculously expensive bath bombs into the tub.  Now I’d never be able to justify the cost of a bath bomb for a 5 minute bath.  (Realistically during colic you can expect a 60 second shower).  

Life as I knew it was over but all I had experienced of my new life as a parent was colic, so of course I felt melancholy for my old life!  If you’re in this phase, recognize that feelings of regret are normal.  Who would electively choose this colicky life?  NO ONE.  

And while we’re at it – it’s okay to wonder if you actually love your baby.  This is not even exclusive to parents of colicky babies.  Some people fall in love with their baby immediately, and that is truly wonderful.  Some of us need some time to get to know our babies, and our love for them develops more gradually.  This is an enormous life change, further complicated when you have a baby who is torturous to be around.  Don’t feel badly if you’re not an “exploding heart eyes emoji” right now – it will come!  It really, really will.  

And last but not least, the final phase.

Acceptance

This phase is somewhat short-lived, probably because many of us will end up spending most of our time cycling in and out of the prior phases.  

Some days you might feel like you’ve accepted your fate, but then a mom from your mommy group will come along and tell you how a spell caster cured her baby’s colic with an ancient spell and you’ll get sucked back into the denial (false hope) phase again.  

If I had to do it all over again, I’d skip over all the other phases and move directly into the acceptance phase.  

It would save me a lot of money on gadgets that don’t work (*cough* $1200 bassinet *cough*).

The snoo never quite worked for us! I’m planning a full review on the blog soon!

I’d never have slugged down that disgusting coffee for weeks.  

And I’d have bypassed the complete uselessness that regret serves in our lives at any time.

The point to this story is that you will get through this…trust me!  And your story will be uniquely yours.  It’s okay to try every possible thing to help your baby, it’s okay if you never accept that it’s colic until it’s over.  It’s okay if you give up dairy because it makes you feel a shred of hope in an otherwise hopeless situation.  It’s okay to keep searching for answers.  It’s okay if some days you regret ever having a baby.  

Just know that someday your baby will stop crying.  You might not believe it at first but hours and then days will go by and they’ll have only cried when they’re tired or hungry or need a diaper change.  And you’ll test out the waters and go out in public.  You’ll finish a whole shopping trip at Costco, baby in tow and give your husband a high five on the way out.  You’ll walk your dog again.  Maybe you’ll even pass the lady who walked her dog by your house on that one horrible day and give her a smile.  You’ll get family pictures taken and the photographer will comment on how good your baby is and you’ll laugh to yourself. You’ll even sleep again.  Your baby will smile and laugh at you and giggle when you tickle him, give you open mouth kisses and splash around in the bath tub.  And regret will never cross your mind again – (until they’re teenagers, I hear).

We finally got the photos!

The very best thing about colic is that every day after colic is better than the last.  And you’ll never have to mourn the loss of the newborn stage because that was pure crap! 

We get out for walks!

 

5 Tips for Surviving Colic

These tips will not cure your child’s colic but they may help YOU get through it. I have listed them starting with what I feel is most important, however they are indeed all important. Some tips may seem
like common sense…perhaps you’ve already realized some of them yourself; however, if even one of these is new to you and helps you at
all, great!

1) Join a colic support group 

By the time I had my son Everett, a number of my friends had recently had babies (none of whom had colic). While these ladies were experiencing what appeared to be blissful newborn-dom, I was deep in
the trenches of colic. Now, I love my friends dearly, but if you’re anything like me, the last thing you want to hear about is how someone else’s baby is constantly napping or just slept through the night for the first time. My baby was screeming and seemed to never be sleeping!

I did not want to burden my friends in their time of overwhelming joy, or for them to feel guilty about sharing their own experience with me, but I had to talk to someone.

This is where colic support groups play a huge role! There are colic support groups that meet in the ‘real world,’ but I found the online support groups to be more accessible (“thank you, Facebook”). Someone was always there to unite in cyberspace solidarity at any hour of the day or night while I was bouncing, shushing, nursing or rocking. I ended up meeting a mom who lived nearby, and she turned out to be a great source of strength for me. We texted each other at all hours of the night, even outside the Facebook group and have talked about
meeting in person someday. I was able to share some of my most vulnerable thoughts and feelings with her and she did the same. The support group was my saving grace!

One important disclaimer, as you may already be aware, is that a lot of misinformation gets circulated in mommy groups. Take any advice you
get with a large grain of salt, but the camaraderie is truly priceless.

2) Ask for help


Don’t be like I was at first and feel as though you need to carry this burden alone. Call on family and friends for help. If you’re lucky enough to have
family nearby, ask them to come over for a bit and watch the baby so you can nap or shower. You may worry that it’s too much to ask anyone else to be subjected to the torture that is your baby, but they will probably be happy to help in any way they can. Being with a colicky baby for an hour or two is a far cry (forgive the pun) from what you’ve been dealing with every single day. Honestly, they will manage
just fine with your little one. Just leave plenty of pumped milk or formula and enjoy a bath, shower or nap.

There were numerous times my mom came to my aid and I am so thankful. If you feel guilty leaving your crying baby in the hands of someone
else, that’s okay, I definitely did. Just remember that it’s okay to take a break for yourself…you need it! If you are able to take a nap, you’ll be much better equipped to handle the next several hours
of crying. If you do not have family or friends living nearby, consider whether or not it is in the budget to pay for some help. Perhaps a retired neighbor, or a responsible college student would be interested in making some extra money. It is only in hindsight that I learned that several of my neighbors would have been willing to help me, if only I’d asked.

A friend of mine had a colicky baby and hired a night nurse twice per week to ensure that every few days she and her husband would get an
actual night’s sleep. This was not in the budget for us at the time but if we ever have a colicky child in the future – we are finding room in the budget. It is a relatively short period of time that colic lasts (usually 3-4 months, but longer in some cases) and keeping one’s sanity is worth any extra money spent during that period of time.

3) Have built in breaks throughout your day:

My husband is a full-time physician and works very long hours, sometimes overnight or 24 hour shifts. We eventually worked out that he would take the baby for an hour when he got home so I could shower and have a bit of time to myself. If he was working an overnight call shift, usually I’d ask my mom to come help me for a bit in the morning.
I recommend establishing at least one break during the day…even more if you can. It is nice to have something to look forward to in the midst of this difficult time.

4) Focus on the future

Honestly, my husband was better at this than I was. He’s generally a very optimistic person while I tend to wallow. Not knowing when colic would end drove me crazy. Sometimes the idea of even one more hour of crying felt unbearable, never mind the prospect that it might last for several more months.

Deciding to schedule a future event to celebrate the end of colic will help you remember that this is only temporary and better days are
ahead.

We chose to have a nice family photo shoot, and our photographer was very flexible with dates, given our circumstances. We also booked a weekend family getaway. Although this did require
rescheduling, since we were still in the midst of colic, we were able to go at around 4.5 months and had a great time.

My husband and I also booked a trip to Mexico, just the two of us. Some time together without the baby was wonderful.

Be sure to keep your plans flexible, as anything can change.

5) Count your blessings


This was another hard one for me. It can be difficult to see beyond your own misery during colic, but try to remind yourself that this is temporary and you have a healthy, beautiful baby waiting for you on
the other side of colic.

Around the same time that I delivered my son, a colleague lost his child to a congenital illness after a very long stay in the NICU. That type of loss is incomprehensible to me.

Your baby is truly a blessing…yes, a crying, colicky blessing right now, but a blessing nonetheless.

Bonus tip (take it or leave it)Accept that it’s colic


This is much easier said than done, but it helped me tremendously. One day when I was talking with a friend whose baby also had colic, I told her that Everett had a milk protein allergy. If you’ve read my other post about colic, you know he doesn’t actually have a milk protein allergy but I was sure I had cracked the colic code. I lamented about
giving up my beloved cheese and half & half. First colicky baby and now no cheese? WHAT IS LIFE?

She said, “you need to accept that this is colic.” She was right. By this point, Everett was nearly 11 weeks old. We had tried EVERYTHING. When/if he ever took a nap, I was researching causes of colic
tirelessly. If this is you, consider whether or not you’re willing to accept that your baby has colic. If you’re not, that’s okay, but if you are –allow yourself the freedom to let it be.

Consider whether a nap or shower for you might be a better use of your precious time than more
internet research. I truly believe in physicians and medicine but I can now relate with the desperation parents feel to have answers.

Sometimes in medicine there isn’t an answer because we just don’t know YET.

As a physician assistant, this has changed my perspective greatly and as a mom, I understand what you’re going through.

If you’re able to accept that it’s just colic and it WILL pass – you might feel a little weight lifted from your shoulders…I did.

I hope these tips help. Hang in there. Better days are coming!

Top 8 Essentials for the Colicky Newborn

When I was pregnant with Everett, I researched a ton of products and read lots of must-have lists but one thing I never considered was the possibility of having a colicky baby.

Having experienced colic for a solid 4 months, I feel confident in providing my own “top list.” These 8 products were critical in helping our son get through his first 4 months of life.

While every baby is unique, perhaps some or all of these items will help you and your baby, too.

None of these items “cured” his colic but I did notice a reduction in duration of crying if I used them consistently.

  1. Breast or Bottle

Everett was exclusively breastfed until 9 weeks of age when his weight dropped from the 44th percentile to the 3rd. At that point, he was breast- and bottle-fed. With the help of an outstanding lactation consultant and the use of domperidone – I was able to continue breastfeeding (I’ll share that experience in a separate post).

Our son would not take to a pacifier but he did find comfort in nursing and did so constantly.


If he was not breastfeeding, he would typically be crying.

If your baby is soothed by a pacifier, I would not hesitate to use one! We tried the MAM pacifier and the WubbaNub but he rejected both – so we stuck with comfort nursing.

2. Blackout cellular shades 

(use sheets if you have to, anything to make the room DARK)

Mid-day nap. Very dark room courtesy of the blackout shades.

I found that keeping Everett in a dark room most of the day helped to minimize his crying time.

One of the theories about colic is that the central nervous system is immature. When a baby is born, he/she is taken from its comfortable womb – a place that is very loud, warm and dark in exchange for a cold, bright and relatively quiet space. It is hypothesized that the new environment is too stimulating for the immature nervous system to process. The baby is not yet capable of self soothing – so he/she cries.

In an attempt to recreate the womb, we purchased blackout cellular shades and my husband installed them on all of our bedroom windows.

It doesn’t really matter what you choose to put over your windows. Just keep the environment as dark as possible!

Above the doors, we put black construction paper when he slept in our room. It was a very high-end touch.
This is a little sitting room in our bedroom – we also put construction paper on the arched part of the window above the shade (remember, as dark as possible).

3. Sound machine

This is the Red Rooster Sound Machine.

Once your room is dark enough – it’s time to make it loud enough.

I can recall one night vividly when my husband and I played white noise on two laptops, an iPad and two cell phones. He finally fell asleep.

There are many to choose from and ours is one of the less expensive options. It is by a brand called Red Rooster.

Any will do but make sure it has a battery backup in the event of power outage. Trust me, you’ll appreciate this.

4. Swaddle

The Love To Dream Swaddle is THE swaddle for us.

I believe every baby should be swaddled as the boundaries of the swaddle are womb-like, making the baby feel more secure. Additionally, it can calm the startle reflex which can often wake a baby.

You may need to test out a few swaddles to find what works best for your baby.

We settled on the Love To Dream line of swaddles and LOVED them. Our son enjoyed chewing on his hands and keeping them close to his face, something other, more traditional swaddles didn’t allow. We used these until he outgrew all of their sizes (up to size large).

He now sleeps in a Zippadee-Zip sleeper! This is essentially the same concept as the Love To Dream swaddles, but provides more mobility.

5. Wireless headphones

Your headphones aren’t just for working out anymore!

Your baby is going to cry – and cry a lot.

Wireless headphones connected via bluetooth to your favorite Spotify playlist, podcast or audiobook provides a reprieve from the crying, while still allowing you to be present with your baby.

The “Peaceful Piano” playlist on Spotify is still among our favorites.

6. Yoga ball

When Everett was in his most inconsolable mood, bouncing on the yoga ball was my go-to. I’d either strap him into a wrap or carrier or just hold him in my lap and bounce.

My husband received this tip from a colleague who had a colicky baby years ago and the yoga ball worked quite well.

I also attribute my very rapid post-partum weight loss to this exercise. One perk of colic!

7. iPad with Netflix/Hulu

While you’re nursing/holding/rocking/bouncing your baby, you’re likely to get very bored. I found an iPad to be the most portable/lightweight option for entertaining myself.


8. Himalayan Salt Rock Lamp

When/if your baby DOES actually fall asleep at night, you’ll want to keep the sleeping conditions ideal. When it is time for your baby to wake up for a dream feed or his regularly scheduled diaper change/feed, it is best to keep the lighting minimal. I found that a salt rock lamp was the perfect solution. Placed on my bedside table, it was within easy reach to turn on, didn’t wake up my sleeping husband and provided just enough light to change his diaper and nurse him.

I hope these essentials help you and your baby.

What products helped your colicky baby?

Breastfeeding & Domperidone: my experience with low milk supply.

If you’ve come to this blog post, you’re likely experiencing issues with breastfeeding and if you’re researching domperidone or low milk supply, you’re also likely at your wit’s end.  To you I say, “I’m so sorry, and no matter what, it will be okay.”  

I found myself in this position at 9 weeks postpartum when my pediatrician confirmed my suspicion that my son wasn’t gaining enough weight.  Everett had fallen from the 41st percentile at birth to the 3rd percentile at 9 weeks of age.  Dropping percentiles isn’t always a huge deal and pediatricians use a curve to evaluate growth – but my son had fallen off of his curve.  

I was so excited that breastfeeding had apparently been going so well for the first few weeks of his life.  He achieved his birth weight at 5 days postpartum (10 days to 2 weeks is normal) and had an excellent latch.  Breastfeeding had also been a great source of bonding in the midst of severe colic and my postpartum depression.  

 Be thankful formula is available.  Back in the day, these babies would have required women in the village to feed them or cow’s milk which isn’t nutritionally optimal for an infant,” my pediatrician said.  He was right, but I didn’t feel thankful at all; I was devastated and hanging on by a thread as it was.  I was not ready to give up on breastfeeding, and anyone who knows me well will tell you that I rarely accept no as an answer.  

Panic set in as I left the pediatrician’s office.  I immediately called the lactation consultant (IBCLC) whom I’d met in the hospital after delivering my son.  Yes, I do realize the irony of a lactation consultant needing the help of another lactation consultant, but I was clearly not in a rational state of mind to be helping myself. Also, I’m very new in my own lactation consultant training. I have not yet obtained my IBCLC designation (I am a CLC) but it is in the process! We will call my IBCLC “V” for anonymity.  V is a highly experienced lactation consultant, and she was honestly a godsend.  

Disclaimer: If you are considering domperidone and you have not yet seen a lactation consultant, stop reading this right now!  This is step number one and it is absolutely critical.  The vast majority of breastfeeding issues can be resolved without the use of domperidone.

Disclaimer #2: I in no way condone or recommend the use of domperidone to anyone who is not my patient. This blog post is exclusively intended to be informational in nature and should not be interpreted as medical advice.

V observed Everett nursing and weighed him pre- and post-feed.  She assessed his latch (excellent) and monitored for signs that he was swallowing.  He transferred less than 1 ounce in nearly 30 minutes, which was not great!  He was evaluated for tongue/lip/cheek ties and had none.  The issue did not lie anywhere with Everett.

I was sent home with a hospital grade pump and spent the weekend power pumping (10 minutes on, 10 minutes off) for one hour, every three hours, in addition to nursing and supplementing Everett’s feeds with frozen pumped milk.  I began taking supplements such as fenugreek, blessed thistle, nettle and fennel.  I ate loads of oatmeal, chocked full of flax seed and drank plenty of water.  None of this seemed to have any effect on milk output, at least not noticeably so.

After one week of power pumping, nursing and supplements, my supply seemed to be dwindling even more.  Around this time, I had my thyroid and prolactin levels tested to ensure there was no underlying thyroid disease causing my sudden drop in milk supply.  My prolactin was low for a breastfeeding mother at 10 weeks postpartum.  Of note, prolactin levels are finicky and can be difficult to use diagnostically, but it nonetheless seemed low for an exclusively breastfeeding mother.  

I was running out of frozen milk, so we began incorporating formula into Everett’s bottles.  The first time I watched my husband feed Everett a bottle I sobbed so hard I couldn’t breathe.  I realize now how irrational this was and how much added stress I put on myself.  In the moment, coupled with colic and PPD it truly felt like the end of the world.

Eventually, he was almost exclusively bottlefed, nursing only for comfort. I also briefly used a supplemental nursing system (SNS) which was quite cumbersome and impractical for my own use.  As each day passed, I panicked more at the thought of our breastfeeding journey already being over.  My son was only 10 weeks old, and I had planned to nurse him until one year of age.  He was becoming fussier at the breast, and I was losing my one good way to console and bond with my colicky baby.  The thought that he would soon lose interest in nursing altogether was unbearable.

Around this time, V and I had been texting back and forth as we had been for several weeks.  She mentioned domperidone and metoclopramide, and I vaguely recalled learning about them in lactation training.  She recommended I research Dr. Jack Newman, a Canadian physician who works exclusively in breastfeeding medicine.      

As I mentioned in the top of the blog, I exhaustively researched the literature that does exist.  I did not take the risks lightly and considered the innumerable benefits to be gained by continuing with breastfeeding.  

Procuring domperidone can be challenging.  Many physicians are not familiar with the medication and do not prescribe it. If they do, it must be ordered from a pharmacy outside of the US or from a compounding pharmacy, which can be expensive.  It is important to discuss the risks and benefits with your own physician if you are considering domperidone.  

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I followed Dr. Newman’s protocol and saw an increase in my milk supply within two days.  By one week, I was almost exclusively breastfeeding again, supplementing with only 6 ounces of formula per day and milk pumped overnight.  

For 10 months I woke up every three hours at night to pump, and I nursed Everett throughout the day.  I gradually began weaning off of the medication and dropping nighttime pumping sessions simply because I was exhausted and wanted to sleep.  I am still very proud of my experience with breastfeeding and feel grateful to have made it as far as I did.  

Here’s some information that I gathered about domperidone in my own research.  This constitutes medical education, not advice.  Please seek guidance of a qualified healthcare professional for any specific medical questions.

Some basics:

What is domperidone?

Domperidone is a medication that leads to increased stomach motility, so it empties more quickly. Because of this effect, it is prescribed in various countries to treat several conditions, including nausea/vomiting (not in pregnancy), acid reflux and gastroparesis, a condition in which the stomach empties much more slowly than it should. It is also used to treat certain gastrointestinal side effects of drugs used to treat Parkinson’s disease. Domperidone works by blocking dopamine receptors outside of the brain (it does not cross the blood-brain barrier).

Domperidone is also used “off-label” in some countries to stimulate lactation, by indirectly increasing the secretion of prolactin, the hormone responsible for milk production that is produced by the pituitary gland.  The medication is not FDA approved for any of the above uses and must be obtained by prescription from pharmacies outside of the United States or from a compounding pharmacy in the US.

Is there another medication like this?

I emphasized that domperidone works exclusively on the dopamine receptors located peripherally (outside of the brain) versus centrally (within the brain) because this is an important feature when comparing domperidone to metoclopramide, a medication available in the US that also blocks dopamine receptors, but does cross over into the brain.  Medications like metoclopramide that block dopamine receptors within the brain can also increase prolactin levels, however there is a risk of some specific unwanted side effects – things like tremor, slurred speech, muscle spasms, rigidity, jerky movements and restlessness.  The likelihood of experiencing these side effects increases with duration of use, particularly greater than 3 months.

Because domperidone is not able to enter the brain and is not associated with any of these particular side effects, it was a more attractive medication to me.

Why isn’t domperidone available in the US?

The FDA does not approve the use of domperidone in the US for any indication because of concerns of cardiac arrhythmias (abnormal heart rhythms).

Why did I take domperidone anyway?

I exhaustively reviewed the literature (or lack thereof) for several weeks during my own breastfeeding struggles and personally believe that the studies showing a link between the use of domperidone and cardiac arrhythmias are not applicable to the general population.  The average age of the patient in the study was 72, and the majority had underlying cardiac risk factors such as high blood pressure, congestive heart failure or cardiovascular disease.  I am a young, healthy woman with no cardiac risk factors, and I take no other medications that are associated with abnormal heart rhythms (QT-prolonging drugs, for anyone who cares).

I do not have history of long qt syndrome and I take no other medications associated with qt prolongation.