Identifying Common Infant Feeding Conditions

Reflux in babies is caused by an immature digestive system and symptoms usually resolve in the first 12 months. The contents of a baby’s stomach is regurgitated back up their oesophagus (food pipe) or into the mouth. This is called gastro oesophageal reflux or GOR.

It is very common in newborns, often referred to as ‘spitting up’ or ‘posseting’, and is usually instant and effortless. The contents are sometimes swallowed back into the stomach instead of coming out the mouth.

The most common symptom of reflux, and the easiest to spot, is if your baby is regurgitating milk, especially after feeds. Other symptoms can include:

• Difficulty eating or swallowing
• Irritability; especially before, during or after feeding
• Frequent hiccups
• Tender breasts and/or breast enlargement
• Difficulty gaining weight.

Up to 1 in 3 infants suffer from regurgitation or mild reflux.

Reflux is normally not a sign of a serious health issue, and you can continue to feed your baby normally, but it is always a good idea to get medical advice from a doctor if you are concerned or if you think your child is in pain.

Silent reflux, also known as laryngopharyngeal reflux (LPR), occurs when stomach contents are brought back up into the voice box, the back of the throat or the nasal passages. This type of reflux doesn’t usually cause the baby to vomit or posset, which makes it more difficult to detect.

Silent reflux has some of the same symptoms as gastro oesophageal reflux, and they can both be present at the same time. Other signs of silent reflux can include:

• Difficulty breathing; such as wheezing or laboured breathing
• Sudden crying during or after a feed, without any other obvious reason
• Gagging or coughing
• Weight reduction in those overweight or obese
• Grimacing when they’re eating.

Reflux in infants is very common, and usually nothing to be concerned about. It will usually go away on its own by the time your child is a toddler, but if your child is experiencing unusual symptoms; such as blood in his/her vomit, you should see a doctor or take them to the hospital. They may need treatment if they are diagnosed with gastro oesophageal reflux disease (GORD).

To decrease your child’s discomfort, you can try feeding them in an upright position – and try not to bounce them around after a feed.

Correct the frequency and volume of feeds if necessary, to avoid over feeding.

Yes, you may continue breastfeeding your baby. There is no evidence to suggest that changing from breastfeeding to bottles will have any effect on the reflux.

You should consult your doctor and ask their advice before deciding to use a feed thickener, but it may help to reduce the signs of reflux. A feed thickener, or thickened formula, can help to reduce vomiting.. Thickener can be added to either formula or expressed breast milk.

Constipation in babies is quite rare, affecting around 15% babies in the first year of life, and should be checked by a doctor.

The causes of constipation in babies includes:

• Formula that is made up incorrectly (too much formula powder for the amount of water).
• Changing to a different formula.
• Not enough fluids over a day – bottle-fed infants will require more water between formula feeds.
• The introduction of new foods to the diet.
• Delaying toileting – sometimes the baby seems to delay going to the toilet because they are expecting pain, and this can make the problem worse.

Many parents think that their baby is experiencing constipation when the frequency of pooing changes. Your baby’s poos should be a smooth, soft sausage like consistency. Some babies can go once a feed, others once every few days – some may only go once a week.

Breastfed babies are rarely constipated because break milk is easier to digest than formula. Furthermore, a large amount of time between bowel movements is not necessarily an indication of constipation.

The most important sign of constipation in babies is that their poo is separate hard lumps (like nuts) and hard to pass or sausage-shaped but lumpy.

Other symptoms of constipation can include:

• Your baby is crying and looks uncomfortable when having a bowel movement.
• Poos are large in diameter.
• They’re not eating as much or their belly feels hard.

The best way to treat constipation is to follow the medical advice from your doctor or healthcare professional.

Additional suggestions may help, including:

• If your baby is fed with formula, check that the formula has been made up correctly. Make sure you are following the instructions, using the scoop that has been provided and not packing the scoop too tightly. You should also add the water first, before adding the formula.
• If your baby is breastfed, you may need to feed them more often.
• If your baby is eating solid foods, you may need to offer extra water with and between meals. You may also want to offer them more fruits and vegetables.
• You can try giving your baby a gentle tummy massage or a warm bath.
• You should NOT give prune juice to a baby that is less than six months of age – it’s not recommended to treat infant constipation.
• Encourage regular toilet times for your child.

If symptoms persist consult with your doctor or healthcare professional for further advice.

In rare cases, constipation can be a sign of an underlying health issue. You should see a doctor, or seek medical advice if your baby:

• Is less than six weeks old.
• Has blood in their poo.
• Seems to be in a lot of pain.

You should look for trustworthy health information if your baby is constipated, and only make changes to your child’s diet after seeking the advice of a doctor or child health nurse.

Iron is present in breast milk in low amounts. Iron supplementation may be necessary after birth and is safe in breastfeeding mothers, as iron passes very poorly into the breast milk. When prescribed by a Healthcare Professional, iron preparations are not known to cause problems during breastfeeding, however always check with your Healthcare Professional before taking iron supplements.

Colic is frequent excessive and inconsolable crying where babies find it difficult to soothe. Colic normally occurs between the ages of 2 weeks to 16 weeks old.

The cause of colic is still unknown which can be frustrating for parents.

Medication is not normally recommended for colic because there isn’t any medication that has proven to be beneficial. Certain drugs may make your baby more sleepy, which can be dangerous.

You should consult a doctor before making any changes to your diet or your baby’s diet, including the use of ‘gripe water’, which is sometimes suggested to ease the symptoms of colic.

If your baby suffers from lactose intolerance or has an allergy to milk, it may help to consult your doctor about removing this from their diet.

Colic affects around 20% of babies.

It is a good idea to check with a doctor to make sure there is no underlying medical reason that may be causing the crying, but once you’ve ruled that out, you should know that there is no instant cure.

Here are some things you can do to try and soothe your colic baby include:

• Respond to your crying baby as quickly as you can.
• Hold your baby when they are crying, and make sure that they are comfortable and warm.
• Stay calm and speak softly and gently.
• Try to develop a daily pattern of feeding and sleeping.
• Check that your baby doesn’t need a nappy change.
• Try offering them a dummy.
• Perform calming activities like swaddling them in a blanket, dimming the lights or giving them a warm bath.

It is important to note that sometimes nothing will soothe the symptoms of colic, and you yourself might need to take a break from time to time.

Certain symptoms may suggest that your baby may need medical attention. You should call your doctor immediately if you notice that your baby:

• Is only eating half of their usual feeds
• Has a fever
• Has persistent vomiting or is vomiting green fluid
• Has a very high-pitched cry
• Is blotchy or very pale
• Has breathing problems such as wheezing, grunting or panting
• Isn’t passing much urine
• Has a seizure
• Has a rash of any sort

A cow’s milk protein allergy is caused by the presence of antibodies in the immune system. These antibodies react to the protein (allergen) and release a chemical called histamine, that results in allergic reactions.

It is important to note that being allergic to cow’s milk is not the same as having lactose intolerance.

Lactose intolerance does not cause rashes or anaphylaxis, and does not require the person to cut milk out of their diet completely.

Lactose intolerance is not life threatening but a cows’ milk protein allergy can be if the symptoms are severe in nature.

The symptoms of a cows’ milk protein allergy can range from minor symptoms to severe allergic reactions or anaphylaxis. The symptoms may appear within minutes, or they may take several days to appear. The severity of the symptoms may also depend on the amount of cows’ milk that has been consumed.

Some of the mild reactions to a cows’ milk protein allergy can include:

• Hives (urticaria)
• An itchy, red or crusty rash on the skin (dermatitis or eczema)
• Swelling of the lips, face or eyes
• Vomiting
• Stomach pain or diarrhoea
• Wheezing or episodes of asthma
• Symptoms of a serious allergic reaction include:
• Noisy breathing or difficulty talking
• Swelling of the tongue or throat
• Persistent dizziness or loss of consciousness
• Paleness of floppiness in babies

If your child is having a severe allergic reaction (anaphylaxis), always call triple zero (000) to call an ambulance and get immediate medical attention.

A doctor may recommend that you keep a food diary to record your symptoms and how quickly they appear. This record can aid in a diagnosis. Symptoms that appear rapidly after consuming cows’ milk products are easier to diagnose than symptoms that occur after a few hours or days.

If more information is required for a diagnosis, the doctor may refer you to an allergy specialist. An allergy test such as a skin prick test or a blood test might be used to confirm the cows’ milk protein allergy. Another method is to trial an elimination diet (removing cows’ milk from the diet) followed by reintroducing it under strict medical supervision.

Lactose is a type of carbohydrate or sugar found in milk and milk products. Lactose intolerance is a digestive problem where the body is unable to digest lactose due to the absence or deficiency of lactase, an enzyme that breaks down lactose for easy absorption. Symptoms include diarrhoea, wind or unsettled behaviour.

There are two types of lactose intolerance in babies:

• Primary lactose intolerance – this means the baby has a congenital lactase deficiency, and is a very rare condition. The baby would be diagnosed from birth, and would have to be put on a diet completely free from lactose.
• Secondary lactose intolerance occurs when the lining of the intestine has been damaged due to a bout of gastro, and will usually resolve itself.

If your baby is lactose intolerant, they may have the following symptoms:

• Stomach pain and swelling or bloating
• Irritability or failure to settle at feeding times
• Diarrhoea (loose stools)
• A sore, red bottom
• Failure to gain weight.

If you think your child might be lactose intolerant and you’re not sure of the cause, it’s a good idea to see a doctor. There are a couple of methods that might be used to diagnose lactose intolerance, including:

• Elimination diet – this involves removing lactose from the diet, monitoring the symptoms, and then reintroducing it to see if the symptoms reappear.
• Hydrogen breath test – this might be used by the doctor to test whether lactase enzymes are being used to digest lactose properly.

Temporary lactose intolerance in babies is normally caused by an infection of the digestive system called gastroenteritis. It can also be caused by intolerance to certain foods or other infections.

Lactose intolerance can also be present when babies are not yet able to produce enough of the enzyme lactase (required to digest lactose). This ability will increase with age.

It is always best to see a doctor or get medical advice before making any changes to your child’s diet. For formula fed babies, a lactose free formula maybe recommended.

There is usually no need to give up milk products entirely, especially because they are such a good source of nutrients, but you may want to check with a doctor about whether your baby is suffering from lactose overload. This happens when a baby is consuming more milk than they can digest.

Some foods contain surprising amounts of lactose – such as skim milk powder or custard – so you should read food labels carefully and seek trustworthy health information if you have been put on a low lactose diet by your doctor.

Lactose intolerance in infants is not uncommon, especially if they are very young. The production of the lactase enzyme will increase with age.

It is normal for babies to have occasional loose stools, and breastfed babies normally have looser stools than formula fed babies. It is also normal for babies to be going to the toilet quite frequently.

It is diarrhoea if their poo is consistently very watery or leaking out of their nappy.

There are a number of things that can cause diarrhoea in babies. This is because their stomachs are still getting used to digesting things, even small changes can trigger diarrhoea.

The causes for breastfed babies and formula fed babies might be different, but most of them will be temporary and will go away on their own.

In breastfed babies:

• Changes to the mother’s diet – because babies have sensitive tummies, a change to the breast milk can upset their stomach and result in diarrhoea.
• Medications – any medications that the mother is taking (like antibiotics, or sometimes even nutritional supplements) can make changes to the breast milk and affect a baby’s digestion.

In formula fed babies:

• Changing formulas – sometimes adding ingredients to the formula or using a different formula can upset your baby’s stomach.
• Milk allergy or lactose intolerance – both of these, though different, can cause diarrhoea in babies. If your child shows other symptoms, such as vomiting or a skin rash, you should take them to a doctor to see if an allergy is causing the problem.

In breastfed and formula fed babies:

• Stomach bug – if your baby gets a stomach bug (gastroenteritis) this may be the cause of their diarrhoea. This illness can also cause vomiting and a slight fever, but usually goes away within a day or two.
• Changes in your baby’s diet – after you introduce your baby to solid foods, they may need some time to adjust to this change. While their digestive system is adapting, they might have some diarrhoea.

If your baby has diarrhoea, the main treatment is to keep them at home and make sure they’re drinking plenty of fluids including water, oral rehydration solution, breastmilk or formula. This will help to prevent dehydration.

You shouldn’t give your baby medication or antibiotics to treat diarrhoea without speaking to a doctor first. Antibiotics are not normally used to treat diarrhoea.

Diarrhoea can become more serious if it starts to cause your baby to become dehydrated. Signs of dehydration include:

• Dark yellow urine
• Fewer wet nappies
• Dry lips
• Dry mouth
• Dry skin
• Not shedding tears when they cry
• Sunken eyes

If your baby has any of the symptoms of dehydration as a result of diarrhoea, you should contact a doctor immediately.

You should call a doctor immediately if your baby’s poo is white or red.

White poo could signal a liver problem, while red poo could indicate that there is internal bleeding. You should also call a doctor if your baby has vomiting and diarrhoea and is less than 6 months old.

If your baby has other other symptoms along with diarrhoea, you should seek the medical advice of a doctor. These include:

• Excessive or forceful vomiting
• Skin rash
• Fever