Making sense of feeding issues
- Learn causes and potential solutions for your baby’s colic.
- Spitting up versus vomiting—is there a difference?
- Get the facts on diarrhea, dehydration, constipation and concerns.
Few things are more frustrating and exhausting than an inconsolable baby—especially when he’s your own! Colic affects as many as 30% of babies and their families, but what is it?
- Colic begins at 2 to 4 weeks of life and can last through five months of age.
- Colic is characterized as excessive crying for no apparent reason and the baby is unable to be soothed.
While we don’t know what causes colic, recent research has shown that a probiotic—Lactobacillus reuteri (L. reuteri)—may help.
L. reuteri is found naturally in breastmilk and has been studied clinically in hundreds of infants and children. It has been clinically shown to cut crying time by half in colicky, breastfed babies after one week of use.
Interestingly, breastfed babies actually experience colic at similar rates to formula-fed babies. Therefore, symptoms of colic alone are no reason to stop breastfeeding. L. reuteri can easily be given to your breastfed baby through a dropper as a supplement without interfering with breastfeeding.
Babies who are experiencing excessive crying and colic and not exclusively breastfed can get L. reuteri from a new solution formula designed with their comfort in mind.
- L. reuteri—clinically shown to significantly reduce crying time.
- Special carbohydrate blend (only 30% lactose) to ease fussiness and gas.
Consult your doctor
Talk to your baby’s doctor if your baby has symptoms of colic.
Fussiness and gas
Fussiness and gas often go hand-in-hand in babies. As your baby’s digestive system is developing, he may experience pain associated with excessive gas. Inhaling air during feeding can also produce excess gas, which is why it is important to feed your baby with his head elevated above his abdomen, ensure your bottle is correctly positioned, and create a calm environment.
Food sensitivity can also result in fussiness. Moms of breastfed babies can try changing their diet. The American Academy of Pediatrics (AAP) recommends first cutting down on milk products or caffeine, and avoiding spicy or gassy foods, like onions or cabbage. If this doesn’t work, then resume your normal diet and consult your baby’s doctor.
Is your baby a “happy spitter”?
Your baby’s tummy is tiny at birth—the size of a marble—and grows to the size of an egg around day 10. Many babies eat a lot quickly, so spit-up is common, and often the result of overeating or air entering the stomach during feeding. “Happy spitters” spit up one to two mouthfuls during, or shortly after, each feeding and show no sign of discomfort.
As your baby’s stomach grows and her digestive system matures, the rate and frequency of spit-up will decrease. Your baby will likely outgrow spitting up around the time he can sit up, but it can continue through the first year in some babies.
Tips to help reduce spit-up:
- Don’t wait too long—feed your baby before he is too hungry to reduce the chance that he will eat too much or too quickly.
- Feedings should be calm and quiet. Watch for fullness cues.
- Burp your baby about 2 to 3 times (or about every five minutes) during each feeding. Burping your baby upright on your lap can help decrease pressure on his tummy.
- Tilt the bottle so formula or breastmilk, not air, fills the nipple. If your baby is breastfed, make sure your baby is properly latching on to the nipple to prevent the ingestion of air.
- Hold your baby in an upright position (his head should be higher than his abdomen) for 20 to 30 minutes after each feeding, avoiding vigorous play.
- Slightly elevating the head of the entire crib with stable blocks, which will help keep his head higher than his abdomen. Putting him to sleep on his back can help prevent choking if he spits up while sleeping.
Spit-up versus vomiting
The American Academy of Pediatrics (AAP) defines vomiting as “forceful throwing up of stomach contents through the mouth” compared to spit-up, which they define as “easy flow of stomach contents out of the mouth, frequently with a burp.” Vomiting can be a sign of a minor feeding concern or it could indicate a more serious issue.
Vomiting can be caused by a number of issues including food allergy and gastrointestinal reflux disease (GERD), but it is most often the result of a virus in babies. While most viruses resolve on their own in a couple of days, they can be serious if they involve vomiting and diarrhea, which can lead to dehydration.
When to call your doctor
- Vomiting occurs repeatedly or is unusually forceful.
- Green or yellowish color.
- Accompanies fever or diarrhea.
- Your baby seems to be choking when vomiting.
You pay close attention to your baby—and his stools. They may frequently change color, consistency, and odor—especially when you introduce solid foods. Generally, there is no need to be concerned, but when there is a sudden increase in frequency or looseness it could be diarrhea.
Diarrhea looks different in breastfed and formula-fed babies. Breastfed babies naturally have a looser stool that may appear runny or seedy with a yellow or greenish color. Breastfed babies frequently stool after each feeding during the first month of life.
Diarrhea in breastfed babies:
- Sudden increase in frequency of stools.
- Stool contains mucus, blood or a new foul odor.
Formula-fed babies have less frequent stools (1 to 8 per day in the first week and 1 to 4 per day in the first couple of months) with a yellow or green color (for whey protein-based formulas) and a paste-like consistency.
Diarrhea in formula-fed infants:
- Sudden increase in watery or very loose stools.
- Stool contains mucus, blood or a new foul odor.
Other symptoms in both breastfed and formula-fed infants include decreased appetite, increased fussiness, and fever.
Diarrhea can be a symptom of food allergy or a reaction to a medication, virus, bacteria, food-borne illness or related to excess juice consumption. Remember to continue to feed through your baby’s diarrhea with breastmilk or their current formula, unless otherwise directed by his doctor. If your baby is less than 6 months and has vomiting and/or diarrhea, consult your doctor. For children 6 months and older, consult your doctor and offer an oral electrolyte hydration solution at the onset of diarrhea and vomiting, along with your baby’s normal food and beverage intake.
Take dehydration seriously
Dehydration is a serious concern associated with vomiting and diarrhea. Frequent vomiting or diarrhea, or vomiting and/or diarrhea with fever, increases the risk of dehydration. With vomiting, your baby can lose important electrolytes, like sodium, Potassium, and chloride, which play an important role in their nervous system and regulating their body’s fluid balance.
The AAP recommends alerting your baby’s doctor if any of the following symptoms develop:
Mild to moderate dehydration:
- Plays less than usual.
- Urinates less frequently (for infants, fewer than six wet diapers per day).
- If dehydration is caused by diarrhea, stools will be loose. If caused by vomiting or fever, there will be fewer stools.
- Parched, dry mouth.
- Fewer tears when crying.
- Sunken soft spot of the head in an infant or toddler.
Severe dehydration (in addition to the symptoms and signals already listed):
- Very fussy.
- Excessively sleepy.
- Sunken eyes.
- Cool, discolored hands and feet.
- Wrinkled skin.
- Urinates only one to two times per day.
Good to know
Consult your doctor immediately if you suspect your child is dehydrated, if there is vomiting or fever, or if diarrhea continues beyond 24 hours.
Blood or mucus in your baby’s stool
Around 90% of the time, bloody stools are indicative of anal fissures—small tears caused by large or hard stools. Blood in the stool is usually bright red, but dark tar-colored blood is often indicative of a stomach bleed. Always check with your baby’s doctor if you notice blood in the stool.
Mucus is not uncommon in a newborn’s stool, particularly in the first few weeks of life in a breastfed baby. If mucus is present with a green stool, it may indicate an infection caused by a virus. However, mucus can also be indicative of other health concerns, so call your baby’s doctor if it is present and your child is having other symptoms—like fever and/or diarrhea.
As your baby grows, he will stool less frequently, and you may become concerned about constipation. Breastfed babies should stool very frequently in the first month of life, then may quickly move to a phase where they go a few days with no dirty diapers. Also, stooling often becomes less frequent in all babies when solid food is introduced.
In a newborn, firm stools less than once per day that are hard to pass generally indicate constipation. Stools which are large, hard, dry and associated with pain, should be cause for concern.
Skin rashes—could my baby have an allergy?
Your baby’s skin is very sensitive and can be greatly affected by his environment and what he eats. Food allergies are on the rise and skin rashes are often one of the first symptoms.
Eczema and atopic dermatitis
Atopic dermatitis is a type of eczema and is the most common chronic skin disease in children. It is commonly related to cow’s milk protein allergy, but may also be the result of heat, an immune system disorder, medication or an infection.
- Itchy bumps, blisters or very dry skin.
- Skin appears red to brownish-gray and may leak fluid, which may crust over when your baby scratches.
- Often found on the cheeks, forehead or scalp, but may also be found around the elbow joint, wrists, or behind the knees and ears.
Hives and angioedema
Hives look like raised white or red bumps or welts, and can occur anywhere on the body and often itch. Hives may be the result of an allergic reaction, but could also be caused by heat.
Angioedema is associated with hives with extra swelling typically around the face, but also may be found on hands, feet or genitals.
Contact your baby’s doctor if you believe your baby is having an allergic reaction and/or atopic dermatitis, hives or angioedema.
Diaper rash typically appears as redness or small bumps in your baby’s diaper area. It is most often caused by leaving a wet or dirty diaper on for too long. Mild diaper rash will typically resolve on its own in 3 to 4 days with proper care.
- Clean your baby’s bottom with a soft, damp cloth after every dirty diaper. Avoid diaper wipes which may increase irritation. Pat—don’t rub your baby’s sensitive area.
- Change your baby’s diaper frequently.
- Expose his bottom to air as much as possible.
- Apply a thick layer of a protective ointment or cream designed for diaper rashes to the affected area.
Call the doctor if the rash:
- Doesn’t resolve within 48 to 72 hours.
- Appears with blisters or pus-filled sores.
- Occurs when your baby is on antibiotics—it could be a yeast infection.
- Is accompanied by fever or pain.
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