When your baby is crying, fussy or uncomfortable during or between most feedings, you are likely trying everything possible to soothe him/her. Many women believe that something in their breastmilk is causing the baby to feel uncomfortable. This is usually not the case. More likely causes include hunger, gas, acid reflux, high foremilk vs. hindmilk ratio and possibly dairy intolerance.
When a baby is fussy or uncomfortable between feeds, especially in the early days after birth, you need to make sure that the baby is not crying because of hunger.
To rule out whether or not the baby is hungry after breastfeeding:
- Give the baby expressed breastmilk or formula, whatever you have available.
- Use a slow flow bottle nipple, supplemental feeding tube, or small cup
- Hold the baby fairly upright and the bottle fairly horizontal so the flow of the bottle will not be too easy for the baby.
- If the baby is comforted , continue to offer 1 to 2 ounces of expressed milk or formula at every feed until you are able to see the pediatrician.
If you find that the baby is gaining weight at an acceptable rate, he/she may be uncomfortable for another reason.
Reflux occurs when acidic fluid from the stomach travels up the esophagus. This happens because the esophageal sphincter (muscle that controls the opening between the esophagus and stomach) is not mature in young babies. Babies with acid reflux do not always spit up, but may be in discomfort because the gastric fluid irritates the esophageal lining.
Babies with acid reflux may show any of the following:
- Pulling off of the breast and crying (usually closer to the middle or end of feed)
- Crying between feeds.
- Feeding more frequently and taking in small volumes each time.
- Wanting to be held (especially upright) despite having been fed well.
- Crying when spitting up.
It can be difficult to differentiate between acid reflux and gas. Sometimes you can feel the gas when the baby is laying against you. The baby may cry when trying to pass stool.
There is no easy cure for gas. Over-the-counter gas drops have not been shown to be better than placebo in treating gas. Speak with your pediatrician to see what they recommend.
High Foremilk vs. Hindmilk ratio
The fat content of breastmilk varies depending on the amount of milk is stored at the time. When a breast has just enough or a low volume of milk, the difference between the fat content of the first milk released and later milk is small and all of the milk is considered hindmilk. When a breast is carrying a high volume, the milk that is released first is lower in fat and higher in sugar content (foremilk). As more milk is released, the fat content increases and the milk is creamier (hindmilk). This distinction is only important when a breast has a high volume of milk because the difference between the beginning milk and the later milk is great. When the breasts contain a high volume of milk and the baby feeds for a few minutes on each breast, not fully emptying either breast, he/she is getting more foremilk and less fatty milk. The foremilk may make the baby more gassy, and may cause the baby to want tot feed more frequently.
If you have high milk production and have been timing the baby on each breast, consider letting the baby finish the first breast completely and then offering the second side.
As previously stated, it is unusual for something in the breastmilk or from the mother’s diet to affect the behavior of the baby. One exception to this is dairy. A milk allergy or milk protein intolerance may manifest as a rash, frank blood or microscopic blood in the stool or fussiness.
If you think your baby is allergic to dairy, discuss this with your pediatrician and get the baby tested. In the case of milk allergy, you need to take all dairy out of your diet, check labels and avoid products with whey and casein.
If there is no true allergy but you want to see if changing your diet will improve the baby’s fussiness, try it for two weeks. If there is no improvement in the baby’s behavior, you can reintroduce the dairy. If there is improvement, you may want to reintroduce the dairy anyway and if the baby’s fussiness increases then you know that it was beneficial to change your diet, and not just a coincidence that the baby improved.
If you cut out any other foods because you think they may be causing the baby discomfort, I recommend re-introducing the food after a week or two, whether the baby’s behavior improved or not. If the fussiness doesn’t improve, then the food should be re-introduced. If the fussiness does improve, reintroduce the food anyway and if the fussiness worsens again, you have verified that it is a true intolerance and not just a coincidence. Most foods with a “bad reputation” for causing gas don’t actually cause any problems (ie. broccoli, garlic, tomato sauce). What we don’t want is mothers restricting these foods from their diets unnecessarily.