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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.


Anonymous said...

thanks for sharing..

albertjett said...

informative blog and interesting to read thanks to read.

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