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.

These problems DO frequently co-occur!

Oversupply & Forceful Let-down

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.

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.

Chronic oversupply (lasting beyond the initial engorgement period) is often linked to tongue tie or lip tie or another physical factor....

If you think your main problem might be oversupply, see our suggestions:


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.

Elimination diet info


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.

Wheat vs Gluten Allergy vs. Sensitivity WHAT THE HECK IS THE DIFFERENCE??

Often when it comes to figuring out sensitivities, a common problem is wheat and/or gluten.  However, wheat sensitivity and allergy is different than gluten sensitivity.  Let’s try to figure this out now...

Wheat sensitivity is exactly as it sounds.  When you or your baby consume wheat, you get symptoms that suggest a reaction such as rashes, gas, funky stools and mucous.  It’s not life-threatening nor does a sensitivity show up in traditional allergy testing.  People that are sensitive to wheat should avoid wheat including products that say “may contain wheat.” 

A wheat allergy occurs when the immune system becomes sensitized and over-reacts to wheat.  The body’s immune system puts up a fight to attack the allergen and this shows up in a variety of symptoms including rashes, hives, nausea, vomiting, diarrhea, asthma, and anaphylaxis.  To test for an allergy to wheat, a skin-prick test or a blood test which measures IgE antibodies in the blood are most commonly used by allergists.  A wheat allergy is potentially life-threatening and needs to be managed by avoiding all sources of wheat and wheat contamination.  Some people may even require the use of an epi-pen or other medicines to mitigate against serious reactions.

A non-celiac gluten sensitivity occurs when people eat gluten products and have reactions similar to a wheat sensitivity but do not have the autoimmune response in the body that a person with Celiac Disease has when they eat gluten.   In addition, people with gluten sensitivity have to avoid more than just wheat.

If we think of these sensitivities in a hierarchy of consequences, a wheat allergy stands on its own because allergies are different than sensitivities and allergies can be life-threatening..  When it comes to sensitivity, the hierarchy will be wheat sensitivity, followed by gluten sensitivity, followed by Celiac Disease.  Celiac Disease is an autoimmune disease where the immune system attacks the body in response to eating gluten and it is THE reason for the gluten free lifestyle.  People with diagnosed Celiac Disease have great consequences on their health than those with wheat or gluten sensitivities.

Avoiding gluten is a bit more challenging than just avoiding wheat.  Unlike wheat, which is a top 8 allergen that must be identified on food labels, you will not find labeling on a food package that says “this product contains gluten.”  So when shopping, you really need to be familiar with what gluten is and where it could be found in food.  People that are sensitive to gluten must avoid wheat, barley, rye, spelt, triticale and other wheat and barley derivatives such as couscous, farina, farro, durum, barley malt.  There is a host of hidden ingredients that may indicate gluten and nearly 80% of processed food items contain gluten.  It is found in the most unexpected places including chocolate and other candy, dressings, soy sauce and other condiments, seasoning mixes and the list just goes on and on.  Here is a link for ingredients to be avoided when on a gluten free diet.  http://www.celiac.com/articles/182/1/Unsafe-Gluten-Free-Food-List-Unsafe-Ingredients/Page1.html

We often see on our board, “What grains are safe for someone avoiding gluten?  Gluten sensitive people can still eat rice, quinoa, corn, buckwheat, sorghum amaranth, millet.

Another common slip up is oats.   Read this: Oats are gluten free.  I repeat oats are gluten free.  That said, people avoiding gluten or wheat should be purchasing certified gluten free oats.  This is because oats are commonly contaminated by wheat and the only safe product for those avoiding wheat and gluten is certified gluten free oats.

So how do you avoid wheat and gluten and make wise shopping choices?  The easiest is to first choose foods that are already naturally free of these products including butcher meats, fruits, veggies, gluten free grains, beans, legumes, nuts, eggs and dairy.  These items are on the outside perimeter of your grocery store.  Remember, many processed foods contain gluten.  The second is to read all labels carefully.  If a product says “may contain wheat” avoid it for now.  Third, if you must want to find a suitable substitute for your favorite bread or pasta, choose a labeled gluten free food.  For a food to be labeled gluten free, the gluten content in the product must be below 20ppm.  This means it’s a safe product for those with Celiac Disease.   Fourth, avoid choosing items in bulk bins.  Flour flies!!  Bulk bins are a major source of contamination for other allergens.  Fifth, if you don’t recognize the ingredient or can’t remember all the potential sources of gluten, just avoid the product and make another choice. 

Julia's Elimination Journey

I’m no stranger to screaming babies. All four of my children are sensitive to common elements of the standard American diet.  So much of what brought me to the world of dietary elimination while breastfeeding and specifically the development of this Elimination group was my third baby, Elizabeth.  From birth, things were different.  Her latch was awful.  She screamed around the clock.  Even while sleeping, she would fuss and make awful faces.  Everyone assured me that she was fine.  She was gaining weight.  She was just fussy.  Having dealt with two previous “fussy” babies, I knew that this baby was different.  At seven weeks, things went from bad to worse.  Elizabeth contracted RSV and pneumonia.  She was hospitalized for a week.  The pneumonia was a double strain and required intense antibiotics that I was told might make her tummy “a little off” for a few days after we got home.  She was also unable to nurse for more than a few moments due to her labored breathing for over a week. 

We brought our baby home and expected things to go back to normal.  We hit a new normal of shrieking screaming, bad, BAD diapers when she would have a bowel movement, less sleep and further nursing problems.  I didn’t even know where to begin.  My pediatrician offered formula after I mentioned that my older kids seemed to have dairy issues.  One night, when Elizabeth was 15 weeks, I almost gave up.  I was having vasospasms.  She hadn’t pooped in three days and her last diaper was pure mucous.  My husband just cried with me.  He told me he’d support whatever I needed to do. 

I decided to try a full elimination diet.  I was already dairy and mostly soy free.  I went to our local health food market and talked to the nutritionist there.  We came up with a game plan based on Elizabeth’s very specific issues: Eczema, inflamed bowels and extreme colic.  Let me be clear here:  I had no other options.  This was extreme.  Nothing was working.  My baby was broken.  I started off with bone broth, steamed carrots, grass fed beef and free range chicken, steamed pears and apples. I took a high powered probiotic and gave Elizabeth one, as well. I added fruit juice sweetened gelatin after a week.  That was it.  It wasn’t overnight.  It wasn’t even over a week.  After two months of a very extreme diet, we had a somewhat normal diaper.  (I totally took a picture and sent it to my husband at work.)

I called it a success, but we weren’t done yet.  At seven months, our nursing issues came back with teething.  So did extreme mucous.   I knew I couldn’t eliminate anything else from my diet.  I had just added raw fruit and vegetables back in.  A fellow admin had just had her daughter’s lip and tongue ties revised.  I sent her a picture of Elizabeth’s mouth.  She was MAJORLY tied.  I made an appointment for the following week.  Post revision, she spit up twice.  And never again.  Our nursing issues ended and we had much better diapers. 

In the end, I learned that elimination isn’t a one size fits all shirt.  We had combined extreme issues with Elizabeth.  As a whole, our kids are allergic to diary and cannot digest eggs.  Our girls can’t handle wheat.  Elizabeth has an anaphylactic allergy to peanuts.  While nursing Elizabeth’s baby sister, I have to remain free of soy, dairy, corn, peanuts, wheat, eggs, and pecans.  We’ve done extensive testing.  We work with a fantastic team of doctors to maintain Elizabeth’s health and wellbeing and that of her siblings. 

This can be done.  It’s never easy.  It is seldom fun.  We’re all a team and here for each other.  Ask me anything, ladies!  

Does My Baby Have A Sensitivity?

Getting Started:
Elimination can easily go overboard when we expect immediate results. Many times, one bad day leads us to believe that WE are doing something to harm our babies through our breastmilk.  Babies, like their mommas, are entitled to feeling off and cranky.  Let’s explore some reasons to eliminate foods while breastfeeding.  

·         Consistent fussiness or colicky behavior:  This means several days – sometimes growth spurts or teething can really look like a major issue when they are a normal part of infancy.

·         Eczema:  While it can be managed or treated with creams or lotions, often times, eczema is a result of a food sensitivity. 

·         Blood/Mucous diapers:  Mucous is a sign of inflammation.  If it happens one day and not for another month – it’s not an issue.  If it’s an everyday thing, there is likely an issue that needs uncovered.  Blood is always alarming and I take it very seriously.

·         Reflux/spit up: You’d be surprised what a little elimination in your diet can do for your wardrobe, ladies. 

·         Sibling history:  You have had a baby with reactions to something in the past and suspect it may happen again.

And here are some reasons NOT to eliminate:

·         Baby is not sleeping through the night:  Some babies do.  Some babies don’t.  It’s not a food sensitivity if your baby is having normal night waking.

·         Occasional spit up:  Again, sometimes, this just happens.

·         Baby wants to nurse frequently:  This is very normal infant behavior. Growth spurts, developmental leaps or comfort nursing are a huge deal for infants. Also, I don’t like to eat on a schedule and some days I’m hungrier than others.

·         Occasional mucous in an older, previously unbothered baby:  Usually a result of teething or maybe a little post nasal drip.

Believe it or not, there are some other issues that could LOOK very much like food issues.  Before you start living on unicorn tears, double check the following:

·         Do you have oversupply?  Oversupply can cause all KINDS of funky diapers.  Lime green, frothy poops are a hallmark of oversupply.  Oh, and a VERY fussy baby.

·         Has your baby been evaluated for a lip and/or tongue tie?  Unfortunately, so many health care providers are only familiar with an anterior tongue tie.  Spit up, mucous and green poop can all be signs.  Poor weight gain is a big one, too. 

·         Are you taking supply boosting herbs, such as fenugreek?  They are notorious belly achers!  

We really strive to make elimination diets user friendly.  Make sure to check out our “First Steps to Elimination Survival!”

First Steps to a Successful Elimination Diet and Breastfeeding

Breastfeeding is natural.  It’s beautiful.  It’s also hard work.  Add in suspected food sensitivities and you’ve got double the work and often times, none of the pizza!

Here are a few tips to get you started and make it a bit more streamlined:

·         START SMALL:  We usually advise dairy and soy elimination first.  By far and away, these are the MOST common offenders.  They can take a while to clear out, so we like to start there for that reason, also.

·         KEEP A FOOD JOURNAL:  I can’t stress the importance of this enough.  We like to start small with eliminations here – but a food journal can be so helpful if we need to dive deeper into elimination land! Be exacting.  Brands, times, everything!  Make sure to add any vitamins or drinks, also. 

·         CHECK EVERYTHING:  Vitamins.  Gum.  Candy. Bread. Soap.  Lotion.  It’s everywhere, friends.  If your baby is sensitive to it, you’ll find it even more places than you imagined. 

·         PINTEREST AND GOOGLE ARE YOUR NEW BFFS:  Need a recipe that’s dairy free?  Need a substitution for eggs?  Fire up those search engines!

·         IF YOU THINK YOUR BABY IS SENSITIVE, DON’T PARTIALLY ELIMINATE IT:  Here’s why  -it takes twice as long to figure out.  If you think your baby can’t handle dairy, don’t play around.  Just eliminate it.  You can always trial it in baked goods later!

·         DON’T GET CAUGHT UP:  Slow and steady will win this race.  You may have to eliminate a ton of food.  You may have to eliminate one food.  But don’t jump in headfirst.  Your baby deserves a sane mother! 

·         IF YOU NEED HELP, ASK:  We’ve been there.  We’ve done that.  We’re still alive.  We’re here for you! 

·         IS IT WORSE?  IS IT THE SAME? IS IT BETTER?  This goes with the food journal – keep track of perceived reactions and what they are.  It’ will help down the road.

·         STAY STRONG!  It’s really not worth the pizza.  

Help! My Baby Isn’t Gaining Weight

It’s a story that has been told time after time. A mom leaves her pediatrician’s office in tears. “My baby isn’t gaining weight, they told me I have to use formula” is often the phrase we hear. Moms are often upset, sad, angry, and confused. “I thought everything was fine!” “she acts so happy” “he’s hitting all the milestones!” 

So what is a mom to do if she is told by her pediatrician her baby isn’t gaining weight?

This shows an example of a baby
who has stopped gaining weight

Step 1: Evaluate your baby’s weight gain from birth to current.

The first thing to do is look at a detailed weight history. Look at the scales and other factors when all weights were taken. Was baby naked? Was it a different scale? Remember that birth weight can sometimes be inflated, it is best to go from the lowest recorded weight when looking at weight gain.

Is your pediatrician using a correct growth chart? Often times a pediatrician will use an incorrect growth chart when assessing a baby’s weight. Remember that the WHO growth chart is to be used for breastfed babies. Sometimes a pediatrician will say there is a problem when there is none just because of this factor.

Is your baby staying on their growth curve? This is important. Some pediatricians feel a baby should “catch up” and get to the 50% even if they are born in the 5%.  This simply does not happen typically. A baby should stay in the same % range and follow a growth curve. A baby in the 5% who stays in the 5% is fine. A baby who starts in the 50% and drops to the 5% suddenly is a concern.

Has anything changed between the last visit and now? An illness? A change in behavior?  Did mom go back to work?

Evaluate how often your baby is nursing. Is your baby under 6 months nursing at least 8 times a day? Are you offering both breasts each time you nurse? Before 6 months a baby should be nursing at a minimum 8 times a day and be offered both breasts each time.  While a baby may not take both breasts, they should both be offered.  A baby struggling with weight gain needs to be nursing more: 10 – 12 times at least.

A breastfed baby should gain 5 – 8oz per week in the first 4 months of life. From 4 – 6 months a baby should gain 3 – 5oz, and from 6 – 12 months 2 – 4oz per week. http://kellymom.com/bf/normal/weight-gain/ Gaining outside of this range would be a cause for concern and further investigation.

So, you have determined there is an issue. Your baby is not gaining weight appropriately for their age. They are falling off their growth curve. What do you do?

Step 2: Meet with an IBCLC

Most pediatricians are NOT trained in lactation. In fact some may have never taken a single class. While a pediatrician is great to help you with general health questions, for breastfeeding concerns you need to be working with an IBCLC. You can locate one near you using this website: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432

A good IBCLC will do a variety of things. They will watch you nurse,  assess latch and transfer, and do a weighted feed. They also should check for a lip or tongue tie and if they are concerned refer you to a specialist for further help.

What is a lip or tongue tie? This site from Breastfeeding USA explains it nicely: https://breastfeedingusa.org/content/article/tell-me-about-tongue-ties Ties are often the reason for poor weight gain in a baby. They can cause poor milk transfer which means that even if you are nursing enough your baby may not be transferring milk well. Many times mom think if a baby doesn’t gain it must be the milk, but often times that is simply not the case. This is especially true with a baby who shows a sudden drop in weight gain around 4 -6  months.  At this point supply regulates so baby has to work harder for the milk. It also means that your supply has regulated to what your baby is taking, and if there is a tie they are not transferring efficiently. If your LC doesn’t check for a tie or you still have concerns of a tie, get a second opinion. Signs of a tie could include poor weight gain, clicking whe nursing, a shallow latch, extreme nipple pain, cracked bleeding nipples, and a lip stick shaped nipple. This facebook group is an excellent resource: https://www.facebook.com/groups/tonguetiebabies/ The procedure to correct a tie is quick and minor and can be done in a matter of minutes in a doctor office.

But what can I do in the meantime?

Step 3 – NURSE NURSE NURSE

Sometimes you may not be able to meet with an IBCLC right away. There could be a waiting period of a few days. The same is true of a specialist to check for ties. In the meantime, there are a few things you can do to help your baby get more milk.

1 – Nurse. Nurse every 2 – 3 hours in the day and at least every 3 hours overnight. Sometimes babies who don’t gain well are sleepy to conserve energy. They need to be woken to eat. Make sure to offer both breasts each time you nurse.

2- Pump. Pump after every nursing session.  If your baby isn’t gaining well and an IBCLC suggests you need to supplement, you can do so with your own pumped milk. Remember: Pumping .5 – 2 oz combined after nursing is totally normal. If your baby is older and you haven’t pumped recently you can expect to get less. Make sure your pump is working correctly and your flanges fit right. Over time your body will produce more to feed the pump.

3 – Do breast compressions while you are nursing or pumping. Breast compressions help get the most milk out. If your baby can’t latch and transfer well, it helps make it easier for them.

The take away here is that poor weight gain is a serious issue. Sometimes it is quickly resolved with more nursing sessions and offering both breasts each time. Other times the issue is related to transfer, latch, or in rare cases true low milk supply.  In very extreme cases a baby may have a medical disorder that prevents them from gaining weight. Often moms who have a baby gaining slowly are told “Its normal” or given advice to just “take X supplement”. While the advice means well, it does not help identify the underlying issue. If your baby is not gaining appropriately for their age you need to be working with your doctor and IBCLC to come up with a plan to help your baby gain. Weight gain in infants is crucial for brain development. It is a serious concern and needs to be addressed with medical professionals.