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Friday, June 29, 2012

Possible Reasons for A Newborn’s Fussy Stomach

Newborns are born with immature digestive systems.  Breast milk is the absolute best thing for their immature system, but even under normal conditions, their bodies/bellies/guts/and little butts are learning how to digest (and poop out) food for the very first time, so some difficulty and a “learning curve” is normal and to be expected.

However, even Moms who are exclusively breastfeeding might observe digestive issues in her baby that she would consider greater than normal: frequent spitting up, watery, green and/or mucousy poop, gas, or discomfort which leads to frequent crying, reflux, etc.

There are two VERY COMMON (more common than not) issues that can cause these digestive problems, and even if you are aware of them, it can be difficult to tease out WHICH of these things is the true issue or if it could be both.


The first most common issue is oversupply which can be coupled with overactive letdown and typically a foremilk/hindmilk imbalance .  MOST Moms are made to nurse twins—evolutionarily it makes sense given the odds of twins and the fact that before formula, a baby who lost their mother during childbirth or who was separated from their mother for any length of time would need to be nursed by another mother also nursing her own baby.  It is literally more common than not to have SOME amount of oversupply; meaning that when the Mom’s milk comes fully in—usually between 5-10 days post-partum, they might find that they have much more than they need.

It is a common misconception that more milk is better.  In fact, it is best for your baby if you are making the exact right amount of milk and no more.

Oversupply causes a fussy stomach for several reasons:
One, the fast flow of the milk means that the baby is taking in extra air when he/she is nursing.  This extra air causes gas and discomfort. 
Two, the milk that comes out at the beginning of a feed (foremilk) is very different than the milk at the end of the feed (hindmilk).  The milk at the beginning is watery and sugary, almost like milk-juice.  This sweet milk gives baby energy and motivation to keep them nursing.  However, the milk which comes out when the breast is getting more empty is equally, if not more important.  The hindmilk is much thicker and fattier, the “cream”.   This thick milk sticks to the stomach and makes it easier to digest. 

The problem arises because oversupply means that often the baby gets full on the foremilk—they are already done nursing before they get to the “cream” which comes out of a more empty breast.  This foremilk is much higher in the sugar lactose, and lactose is much harder for a baby to digest.  This will cause watery, green poops, and stomach upset.

Additionally, babies whose Moms have oversupply will sometimes actually have LOW weight gain because they have so much trouble getting to the fatty milk. 

I think there is a further issue with oversupply which is rarely discussed—it is SUPPOSED to take WORK for the baby to extract milk from the breasts.  Babies who are used to a high supply do not have to work very hard to get milk out.  This can cause issues later when the supply regulates because the baby finds himself for the first time having to work hard to eat.  Many Moms at this point (3-5 months) will start to notice issues like bottle preference or fussiness at the breast. 

In my opinion it is GOOD for your baby to learn IMMEDIATELY that life isn’t easy and that you don’t get something for nothing.  You can think of this as the first way to build self-esteem and self-efficacy.  You are teaching your baby that working hard will reward them, a lesson that is never too early to teach in my opinion.  Babies whose Moms have a regulated supply have much more patience and determination, not only for nursing but I believe this translates into other areas of life as well.

Oversupply can also cause issues for the Mom:  nipple pain.  Because the milk is often flowing too fast for the baby, they will clamp down on the nipple to reduce the flow.  I can tell you from experience: OUCH.

Food Allergies and Sensitivities

Another very common issue is baby reacting to one or more foods in the Mom’s diet.  About half the time, the problem is dairy.  The next most likely culprit is wheat, after that, soy.  Some babies will have issues with caffeine, also, or you can have one like mine who basically reacts to EVERY food in existence. 

However, luckily, half the time, eliminating dairy in the Mom’s diet will solve the whole issue. 

Our society has a growing awareness of food sensitivities, and it is increasingly common to discover sensitivities to dairy, wheat, gluten, soy, etc.    Luckily it has never been easier to lie allergy-free.
Like oversupply, food sensitivities can cause watery poops, gassy stomach, frequent spitting up, and colic.

So if your baby has a fussy stomach and is exhibiting these symptoms, what is the problem?  Is it oversupply or food sensitivities?  It can be very difficult to tease apart the problem, but there are a few ways to tell.

Oversupply will often start causing symptoms from the first week or two.  Mom will often feel engorged, experience her milk leaking, letdowns when the baby isn’t hungry . . . the baby will often be satisfied with only one side.  If the Mom ever pumps and can get more than 4 ozs per side, that is a sure sign of oversupply.    Again, the nipple pain is also a very good sign.

Oversupply is often linked to an overactive letdown…this has many tell-tale signs.  After a minute or a few minutes of nursing,  the baby might start fussing—come unlatched and cry, or be sputtering and choking on the milk.  Mom sometimes sees her milk spraying at this time.  This is a definite sign of oversupply.

Oversupply will more often cause GREEN watery poops, sometimes in huge diaper blowouts.  The green is evidence of the excess lactose in the milk. 

Baby will have issues from the first or second week and the symptoms would usually get BETTER over time, though some Moms unknowingly make the problem worse by pumping off extra milk. 

Supply is highest in the morning and lowest at night.  If you have oversupply you might notice the most spitting up and discomfort in the morning and early afternoon, while the spitting up is less frequent at night.  HOWEVER MOST babies have fussy evenings and want to nurse frequently in the evenings, so this can be a hard thing to gauge.

Oversupply, especially in the absence of excess pumping, will get better over time instead of worse, often resolving itself between 3-5 months.

Meanwhile, food sensitivities look a little different.

Most food sensitivity issues will not be present immediately.  If oversupply is not an additional problem and it is ONLY food sensitivities, Mom probably would not see many digestive problems in the first month.  However, between months one and two she would notice an increasing problem.  Weeks 6-8 is the most frequent time for food sensitivities to start causing major issues.

Food sensitivities will also cause watery poop, and it can be green.  However it is much more likely to be mucousy, and BLOOD in the poop is a very good sign that it’s a food sensitivity issue.  It is less likely to see diaper blowouts.   With my son I NEVER saw “seedy” poops until we eliminated all problem foods.  It was VERY watery.

With food sensitivities, you would notice more of a variety in babies’ symptoms from day to day.  Instead of spitting up equally after every feed, you would more likely have occasional large amounts of spit-up and not as much on other days/times.  You would notice the digestive issues being worse after you eat certain meals and less of a problem on other days.   However, if you are someone who eats a LOT of dairy, wheat, and/or soy with every meal, it can again be difficult to tell if the issue is food-based. 

Food sensitivities can also cause other issues such as a rash (most typically on the face), and/or a flushed red blotchy look to the skin after nursing.  It is much more likely than oversupply to cause weight gain issues, colic, or reflux.

Food sensitivities from week 8 will typically get WORSE over time (from months 2-5 or longer).  Some babies do gain the ability to process the sensitive food eventually, though, so after getting worse it can start to get better.

Hopefully this will help some Moms figure out which of these things (if not both) is causing the baby’s issue!   I will write about dealing with each of these problems in a separate post.

Thursday, June 28, 2012

Retroactive Wordless Wednesdays

I did have some great pics from these last months while I've been a lazy blogger, so I added them on the Wednesdays they apply to:

4/11/12: Cosleeping
5/2/12: First Sleep in His New Room
5/9/12: First Trimester Exhaustion
5/30/12: Cousin Play

Wednesday, June 27, 2012

Wordless Wednesday: Summer

Tuesday, June 26, 2012

Baby Signs

When I was in high school I babysat for a little girl from the age of 14 months.  Her parents had taught her a few simple baby signs, and it was so invaluable!  She could tell me when she was hungry, thirsty, or all done. . . it was only a few things but it made my job as a babysitter a million times easier!  I always said when I had kids, I would teach them baby signs, too.

Fast forward to last year--teaching your baby to sign has never been more popular and easy.  There are tons of resources and a million different versions of baby signs.  We decided to teach Jamey American Sign Language because it is a common and widely used language throughout the whole country--teaching Jamey the "real" sign means that we are teaching him a way to communicate, for life, with other people all over the country.

The research on teaching signing is very motivating--Over 140 participating families were randomly assigned to a signing or non-signing group and the following differences were noted (among other benefits):
-By age two, signing children on average have 50 more spoken words in their vocab than non-signing children
-By 3 years old, signing children were speaking at the level of average (non-signing) 4 year olds.
-At age 8, children who had learned to sign as babies had an average IQ of 114, which was 12 points higher than their non-signing peers at 102.  (This is a HUGE difference, and somewhat shocking to me!)

So how did we start out with signing?

From about 6 months, we started out with demonstrating simple signs to Jamey, such as milk, nurse, more, and all done.  It was a long time before he was able to do the signs back to us.  Starting to wave is usually the first "sign" that they are ready to start to use more signs.  Jamey started to wave around 10.5 months.  After this, the first signs he would do were all hand signs only:

Milk, Light, Hi/Bye (waving), More (4 signs total)

Then at some point a little before he turned a year old, a new connection was forged in his brain and he started learning how do signs referencing his own body:

Mom, Dad, Nurse, All Done (8 signs total)

Then, around 12/13 months, some language center in his brain turned on.  He started to nurse a lot more and at the same time, wanted to know the word and sign for everything he saw.  All of a sudden his favorite books were picture dictionaries.  This was an absolute explosion in his signing vocabulary, and I honestly think he was only limited by OUR knowledge and ability to teach him.

At 13 months, he could sign all of the above signs, plus:

Potty, Diaper, Hot, and Yay (clapping) (12 signs total)

At this point we got a little more serious about teaching ourselves so that we were able to teach him, and by 14.5 months he had added all of the following:

Water, Drink, Food, Orange
Cat, Dog, Bird, Pig
Hat, Shirt, Shoe
Yes, Moon, Teeth, Please, Bath
(28 signs total)

Only two weeks later (15 months) he'd added:

Grandpa, Grandma
Cow, Bear
Want, Hurts, Sleep
Sun, Boy, Working, Car, Book
Additionally he had invented a way to turn words into a question by shrugging/looking around while making a sign.  We did not teach him this but he came up with it naturally after learning "where"
(42 signs total)

By 16.5 months, he'd added:

No, Thank you, Sad
Rain, Fire, Grapes
Turtle, Lion
Additionally he had made up a sign to request to watch "Blues Clues"
He had also made up a sign to ask us to practice qigong!
(52 signs total)

By 18 months:

Mouse, Frog, Butterfly, Fish
Apple, Library, Outside, Firefighter
Baby, Man
(63 signs total)

Now he's 19 months.  And he's learned even more, which I haven't written down yet and probably won't remember, but let's try:

James (a sign I made up for his name)
Pee, Poop
Truck, Airplane, Boat
Tiger, Spider
Aunt, Uncle, Cousin
(77 signs total)
Honestly there are definitely some I am forgetting.  I have to be honest that my kid is a delayed talker, however, kids who have learned as MANY signs as he has often have delays because they are not dependent on language to communicate.  With this said, he has a HUGE comprehensive vocabulary and has understood pretty much everything we say for many months.

Additionally (and interestingly), the first intervention for kids who are brought to speech therapists with language delays is to begin to teach signing.  There can be a variety of physical issues that can interfere with language, but signing means that even a non-speaking child can begin to build the language centers in their brains at this critical age, which is actually much more important.

Many people have commented on Jamey.  He is obviously very smart, but more than that, he is a confident and independent person.  He has very good self esteem and can participate actively in conversations with all kinds of people.  Most of our friends and family have enjoyed learning some signs, too.

And to be honest I LOVE it.  I have always been interested in language and I think I enjoy learning the signs almost as much as Jamey does.  Plus a lot of the signs are so intuitive, or relate to each other and the signing alphabet in fun and interesting ways . . . the benefits are not limited to the child but extend to everyone the child is in contact with!

So we'll continue to build our family vocabulary.  Little Julien will be luckier than Jamey because he will be less limited at an early age by our ignorance and will be able to learn more signs at will.  Additionally I've heard that older siblings really enjoy passing their signing knowledge onto their little siblings!  I can't wait.

Tuesday, June 12, 2012

Adventures in Diaper-Free Potty Training, Take Two

I am once again attempting to write about our Adventures in Elimination Communication . . .

I had heard of EC when I was pregnant with Jamey, but couldn’t quite wrap my head around it—I wasn’t sure how to go about it—I was a brand new parent with a million other worries/distractions.  It didn’t work for me . . . but it WOULD HAVE worked for Jamey—he HATED to be wet even as a brand newborn and would definitely have responded well to early EC.  After learning even more about it, and seeing how Jamey went from hating his diaper being wet and loving to be changed to not caring at all and hating being changed.

For those who aren’t familiar, Elimination Communication is a term for less diaper-centered and more communication-centered approach to dealing with the inevitable pees and poos of infanthood.  In our culture where most people use diapers for 2-3 years, people often aren’t aware that even a very young infant: -has the ability to control their bowel/bladder, -prefers not to soil themselves if they don’t have to.  What this means is that EC describes a system in which the baby either does not wear a diaper or the parent is changing the wet diaper immediately, and the parent is cueing the baby to pee or poop over a toilet or potty, potentially from birth or a few months old. 

Ideally, what happens here is that the baby remains aware of and in control of their bladders/bowels, and instead of getting attached to a diaper as the “right” place to go to the bathroom, they learn from the beginning that they can use the potty instead.  Some Moms describe babies,  ECed from birth, who when they learned to crawl started crawling to their potty when they had to pee.  So potentially a baby who is EC’d from birth could be totally “potty-trained” by the time they start walking—12-18 months.

So with that intro, back to us .  .  . 

Anyway, I never really did it much with Jamey—I would experiment for a week or two, leaving him laying on cloth diapers or loosely wrapped around him, and changing him often and trying to cue him—but like I said, I was a little too distracted mastering breast-feeding, baby-proofing, and adjusting to first time motherhood, so I never quite had the dedication to stick with it seriously for any period of time.

But then I got pregnant.  And nauseous, and tired . . . and the diaper changes that used to take all my energy/stamina/patience were now screaming/wrestling matches between Jamey and I.   He would throw a fit like I was TORTURING HIM every time I changed his diaper.  I resorted to yelling, pinching his legs, pinning him down . . . it’s not a choice when there is poop in his butt!

So when I hit the second trimester, started vomited with more predictability and less horsepower . . . and stopped being so tired that my body felt incased in concrete . . . I thought, "Well, let’s take the 2nd trimester and see if an EC/diaper free approach would actually work if I stuck with it.  And if I can get the boy potty-trained before I have another baby. . . awesome."

So we took off the diapers and I got over pee and poo.   I learned that baby pee doesn’t smell too bad . . . that baby poop barely gets his butt dirty when he’s pooping on the floor instead of a diaper.  I learned that it’s easier to wipe up a puddle of pee off the ground than change a diaper.  I learned that poop doesn’t even get the rug dirty unless he/someone steps on it before I can grab it.  And I learned that he instinctively DOESN’T step in pee or poo when he knows it’s somewhere, so that has rarely happened . . . and within a week I saw more control—he started to pee and poo in certain places at certain times, and NOT go in other situations.  For instance in 5 weeks of being completely diaper free, he has never peed or pood ON me or James or anyone else—never while anyone was holding him, or he was sitting in their lap or playing close together.  He has never peed on his books or toys.   Meanwhile he has peed standing at the screen door like 10 times.

And, throughout all this, though, my kid would not sit on the potty.  Or the toilet—he would not try to pee, he would not pee on cue, and for a while he would even STOP peeing when I managed to get the potty bowl in between his urine stream and the ground.  But I persisted. 

And finally,after a month of peeing and pooing with abandon, Jamey finally decided to pee on a bush one day when I suggested it.  Since then (maybe for a week or a bit longer), I've been taking him outside to pee on the bush regularly, reducing our "accidents"—pees on the floor—to 1-2 a day.  Finally a couple days ago he actually sat on his little potty and peed on request, and since then has been doing it more and more. 

So at this point he has total control over peeing—just like that, once he got the “trick” of trying, he can do it nearly every time . . . except that he still forgets to hold it, so if I don't take him often enough, he will eventually have an accident.  He also doesn't usually tell me when he has to go, though he has, on his own, peed and pood in the potty increasingly over the last few days/weeks. 

The actual toilet is still too distracting--focus and motivation seem to be key for him.  It works well (as long as he's not too hungry/tired) to say: "Please go pee-pee and then we can do X fun thing!"  But he is really into cars/vehicles right now so when he's outside trying to pee on the bush, if an interesting truck or something drives by he might totally "lose it".

Anyway, I think I might start trying to get him to go on the toilet more often, using the flush (and maybe a sticker/sticker chart) as motivation.  I think if I can get him attached to either flushing/handwashing or the stickers, and he realizes he just needs to pee in the toilet first to get these things, that might be the proper motivation to do it (until he gets bored with those things after a few weeks). 

I’m actually really pleased with how things are progressing—it is so gratifying to see that he has learned to “try”—and I really feel like a lot of the work left is just building skills and honing his habits so that he wants/expects/automatically goes to, try the potty at certain times every day.  Honestly a lot of this is honing OUR skills—remembering to take him every hour or so, and esp after meals and stuff . . .

It’s funny though, I started out this diaper-free thing thinking if it didn’t “work”, ie, result in “potty-training”, by the time I got too huge to deal with it, I would “give up”, ie “go back to diapers”. But at this point I really do buy into the idea that it’s just an easier, more straightforward way to deal with pee and poop.  Like, I’m to the point now that I don’t think I would go back to using diapers even if he just kept going to the bathroom on my floor.  But I also see it working—I see that there is real progress—he learns, he grows.  So now the idea of using diapers seems like backpedaling, and ironically, extra work!

Anyway, I’m very glad to report progress—hopefully I will report more soon!   ;-)
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