Feeding Problems in the Early Years of Life

Feeding Problems in the Early Years of Life

When you’re a new mom or dad, it can be a huge challenge to parent a baby who’s always cranky. Friends may say your baby is “colicky” or suffer from “reflux” What’s going on and how can you make it through this?

COLIC

Colic is common, poorly understood & frustrating feeding problem and cause considerable stress for parents & health professionals.

Colic is the word derived from the Greek word meaning ‘colon’ and it implies that the baby cries because of stomach pain. Colic affects 10-40% of all babies. It is present equally in boys and girls and equally in both breastfed as well as formula fed babies. Crying seem inconsolably for hours at a time for no apparent reason and tends to occur in the late afternoon and early evening.

  • Symptoms appear typically around 2 weeks of age, lasts until 4 months of age
  • Symptoms usually peaks at 6 weeks of age
  • Spontaneous resolution by 3-6 months of age (3 months: 60% of babies, 4 months in 90% of babies)
  • Starts in premature babies 2 weeks after the due date
  • Higher incidence in C-section babies

Characteristics

  • Inconsolable crying – for hours at a time, fussing & irritability in otherwise healthy baby
  • Cry longer and louder for at least 3 days of the week and last about a minimum of 3 hours a day
  • Present with excessive & persistent crying
  • Difficult to comfort
  • Screaming
  • Drawing up of the legs/knees after feeds
  • Tension of the body
  • Fist clenching
  • Arching of the back
  • Flushing of the face

Cause:

Nobody really knows and the cause of colic remains a very controversial subject. What we do know is that it is related to an immature digestive system. Researchers have been trying to find out why babies cry for no apparent reason and some of the explanations include:

  • Pain caused by build up of wind in the baby’s stomach. This may happen if they
  • Overfeeding – swallow air when they cry, feed or suck.
  • An intolerance to lactose
  • A cows’ milk protein allergy/intolerance
  • Imbalance in intestinal microflora (good and bad bacteria)
  • Maternal smoking

Whatever the reason, the most important thing to remember is that the crying is not anybody’s fault. You could be the most attentive, sensitive parent in the world and still have a colicky baby. You can be assured that colic usually resolve by itself within 4 months.

Is there anything I can do to help my baby?

There are many different things you can try to soothe your baby’s crying and discomfort. Every baby is different and respond differently to treatment, so if it doesn’t work today it may work tomorrow.

1. Keep a diary of your baby’s behaviour.

Record your baby’s activities, sleeping, eating, crying, fussing for at least 4-7 days in a row. This will give you a good impression of your baby’s behaviour and possible triggers.

2. Positioning

Hold your baby to your chest in the upright position or gently rock him in your arms. The closeness and body warmth will be comforting and soothing.

3. Getting rid of the wind

When babies cry they gulp air which can make them windy. Try burping him by supporting his tummy against your shoulder and help dislodge any trapped wind. Massaging the tummy in a circular motion or a warm bath also help to relieve discomfort.

4. Making-up feeds

Be careful when making feeds up, don’t shake the bottle to vigorously as this trap air bubbles. Ensure that the bottle is not in a horizontal position during feeding because it could cause your baby to swallow air.

5. Teat size

An anti-colic teat or slow flow teat/bottle is a useful option to try.

6. Type of milk

Breastfeeding: 

If a baby is breastfed, correct latching to the breast is important to prevent swallowing

air bubbles.

Make sure that a breast is emptied before moving onto the next breast, since the hind

milk contains much less lactose than the fore-milk and by swopping breasts to quickly

your baby will end up filling themselves with fore-milk which could worsen the colic.

Eating rich or spicy foods, dairy products or gas forming foods have all been

associated with possible reactions in babies. If you think your baby’s crying is linked

to something you’re eating a dietitian would be able to assist you with an elimination

diet in order to identify the possible culprit foods as well as on a suitable vitamin/

mineral supplement to avoid any nutritional deficiencies.

Formula feeding: 

If your baby is unable to digest lactose (milk sugar) in a formula or is intolerant to cows’ milk protein then it may be beneficial to change their milk formula either to an lactose-free formula or an extensively hydrolysed infant formula. Your dietitian would be able to advise you on the most suitable formula.

7. Frequency of feeds

It could benefit your baby by reducing the volume of feeds and increasing the frequency of feeding to help ease digestion.E.g. instead of having 6 feeds of 150ml at a time change it to 8 feeds of 115ml at a time.

8. Probiotics

There is a possibility that the colic symptoms could be due to an imbalance between the friendly bacteria and the unfriendly bacteria in your babies’ digestive system.  Thus by supplementing the so-called friendly bacteria it may help to restore the imbalance and resolve their symptoms.

9. Digestive enzymes

Enzymes can be given before feeds to help with digestion.

If your baby is unable to digest lactose their body most probably lack the  enzyme lactase that usually digest lactose. A failure to break down lactose by enzymes causes the milk sugar (lactose) to end up in the large intestine where it starts to ferment and produces gas, eventually leads to discomfort and some cases diarrhoea.

REFLUX AND REGURGITATION

It is estimated that 15-30% of normal babies experience problems with mild to moderate regurgitation (spitting-up) and

gastro-oesophageal reflux. It is not common immediately after birth, but normally appears within or during the first week or months of life. About ½ of all babies regurgitate at least once a day up until 2 months of age. Babies with a reflux problem may regurgitate as many as 20-30 times per day. Interestingly  this condition is more common in boys. Reflux usually  resolve with time – 20% of cases  resolve within 1 year of life.

Babies regurgitate small quantities of milk into the mouth due to the inappropriate opening of the lower oesophageal sphincter (LES) – releasing stomach content into oesophagus.

There is two  types of reflux present in babies

Simple gastro-oesophageal reflux (posseting)

Gastro-oesophageal reflux disease

Gastro-oesophageal reflux disease is more severe and in the long term can cause oesophagitis that makes feeding painful, causing a baby to refuse feeds and eventually could lead to growth failure.

Cause:

In many cases the regurgitation is due to an immature digestive     system, with problems disappearing by the age of 6 months.

It is exacerbated by gastric distension from air swallowed with feeds.

Cows’ milk protein allergy or intolerance are sometimes responsible for reflux, however 30-40% cases do not respond to this type of therapy.

How to Help your Baby with Acid Reflux:

Positioning

Vertical feeding position facilitates the digestive process and gravity helps foods going down into the tummy. So, the upright position,  either for you breastfeeding and for your baby if bottle feeding is the best. Try to let him keeping a standing position for the following  15 – 30 minutes, not laying him down and neither letting him moving too much. Consequently, it is better to avoid feeding right before bedtime.

Adjust your baby sleeping position, raising the head of the crib so that his head is elevated of around 30°. Lying flat may aggravate reflux. A sustained position, also during sleep, is important against the reflux because it helps reducing both reflux episodes and aspiration risks.

Choose properly your baby’s car seats, because in some of them your baby could hunch and slouch over, receiving added pressure on his tummy.

2. Feeding environment

Feed your baby in a calm environment. Feeding time should be a relaxed time, so that everything can go for its best. Feed your baby before he or she becomes frantic. Yourself try to be peaceful during feeding. Avoid to jostle or jiggle your baby while the food is settling. Formula fed babies may require longer periods since formula is digested slower than breastmilk.

3. Frequency of feeds

Try smaller and more frequent feedings. When and how much a baby is fed can also be important: smaller meals, taken more frequently through out the day are easier to be digested than larger meals e.g. 3 hourly feeds instead of 4 hourly.

4. Getting rid of the wind 

Let him/her burp often. Frequent burps during and after each feeding helps keeping air out of the stomach. To not put pressure on your baby tummy, avoid burping your baby over your shoulder but let him sit upright, supporting the head with your hand.

5. Teat size 

Make sure that the hole is free and of the right size. A larger hole will allow the milk flowing too fast, while a smaller-one will allow your baby gulping air. You can check the nipple right size holding the bottle upside down: just few drops of milk will fall out.

You may let your baby sucking on a pacifier or dummy. Pacifiers can increase saliva production that, with your alkalinity, can help neutralise some acids in the reflux.

6. Don’t shake feed too much – traps air bubbles.

6. Avoid tight clothing, particularly around your baby’s tummy. Tight clothes can increase pressure on the lower oesophageal sphincter, worsening the reflux. Prefer, instead, loose fitting and elastic waists.

7. Type of milk

Breastfeeding:

There are some foods that can pass through your milk, making reflux worse. If you are breastfeeding, you may try to eliminate these foods from your diet and, later on, challenging your diet to see which food is the offender. Dairy products, caffeine, fatty foods, spicy foods, citrus fruits are the most common culprits.

Formula feeding: 

Breastfeeding is definitely best for a baby: it is more hypoallergenic and easier to digest.  If breastfeeding is not chosen or not possible by the mother, formula changes can help some babies, eventually avoiding those that are milk based, that can make reflux worse.  Discuss alternatives with your dietitian.

Milk formula changes:

Pre-thickened infant formula

Hydrolysed formula (Hypo-allergenic)

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