Tummy Troubles…. please shed some light
Digestive discomfort or what looks like pain/ tummy troubles in your little one can be described by many parents as distressing and confusing. It puts you into a fight or flight mode and as humans we naturally try to solve the problem of what is going on.
I’m sure if you goggle crying healthy newborn the term colic will come up. It can be defined as frequent, prolonged and intense crying or fussiness 3 hours a day in an otherwise healthy baby. Colic is actually just a symptom as is really common in newborns from around 2-3 weeks old. There are many reasons as to why babies cry and appear to be in pain especially when they are passing wind or doing a poo. Some babies will wake themselves up from a sleep and appear to be arching their back or pulling their legs up. These symptoms will usually resolve on their own by around 3-4 month.
As a mum of two who went through this I know how hard it is to comfort a baby like this. So as a well versed breastfeeding counsellor and mum, I’d like to share some reasons around these tummy troubles and offer some guidance to support or reassure you.
Immature digestion
Babies are born with an immature gut flora and underdeveloped nervous system. There are an abundance of nerves in gut which are highly sensitive and relay messages to our brain about what is going on in there. One theory with a baby’s gut is that because it has hundreds of underdeveloped nerves in it, it can perceive a normal sensation like wind or movement or reflux as very painful and uncomfortable. This pain although very real for the baby is not a true sign of illness or injury and as their nervous and digestive system starts to mature - the sensations they are not coping with will slowly normalise to how we feel digestion.
Strategies
Time, comfort like rocking, humming and skin-to-skin. Keeping their legs up in a froggy position and burping them frequently will all help.
Air in their large intestine
It has been will documented that when a baby takes in air during a feed, we can see it about 6-8 hours later in their large intestine. This wind could be from: a poor attachment at the breast; a baby who is popping on and off at the breast during a feed; a baby who is struggling to cope with the fast flow of milk at the start of a feed or even from a tongue tie. Whatever way the air came in will help you lessen the amount of wind your baby has.
Strategies: Getting a good attachment: this might mean seeking some support and guidance for positioning at the breast. Many mothers find that their baby attaches better when they are in a semi-reclined position (their body is on a 45 degree angle) and their baby is snug chest to chest with them. Naturally at this angle a baby’s jaw and tongue will move forward and down, giving them more of a grip on the breast tissue and deepening their latch. Some mothers who find their breasts to be very full and hard also have trouble attaching their baby comfortably to their breast. Here, strategies like reverse-pressure softening to push back the breastmilk up into the breast can really help to soften the tissue around the areola, making it much easier for a baby to get a deep latch.
These attachment strategies are also really helpful if your baby has a slight tongue tie. Of course it is suggested to get a proper formal assessment if your baby is not gaining weight and transferring milk from the breast properly- however many babies who do have a tie are still able to breastfeed well at the breast with simple strategies like the few above.
Another supportive way to alleviate wind before it gets to the large intestine and starts to cause discomfort in your little one is to try buying your baby between offering each breast- or if you have a really fast flow and your baby always pulls off within the first few minutes of the feed, you could try pulling them off for 30 seconds or so and keeping them on your chest which your flow softens and then popping them back on. A really simple way of burping is to lay them on their back for a few minutes followed by raising them onto your chest or shoulder for a few minutes of being upright… and then repeat the process. I swear by this burping strategy! Because babies have very weak abdominal muscles, it can be challenging to get the burp up however by putting your baby on heir back and then upright you are actively helping the air bubbles come up from their tummy and through their oesophagus.
Once your baby does have air in the intestine it will be too late to burp them, however by doing little bicycle legs and/or keeping them skin to skin with their feet in a ‘froggy M’ position, you can actively help them pass the wind or poo more easily.
Reflux
Because babies have a liquid diet and their sphincter from their tummy to their oesophagus is not yet strong enough to close, they tend to have milk travel back up the gullet, and may vomit. This is common and can be really scary to see at first. If the reflux is mild your baby will be gaining weight and wont be bothered by the vomiting. However in some cases- and this is rare- a baby can have a more serious condition called gastro-oesophageal reflux disease. In this instance, babies can be really uncomfortable and appear to be in a lot of pain when they are throwing up. Babies with reflux like to be kept upright and seem to be in pain when lying down. If it is serious you will notice that your baby is not putting on weight and doesn’t have 5 heavily wet nappies in 24 hours. If your baby is upset by the vomits and they are frequent it is really important to seek guidance from a paediatrician so you can get a proper diagnosis.
Strategies
Babies who struggle to keep their feed down and who are happy, gaining weight and healthy may benefit from the following strategies. Most bubs will keep their milk down if they are held upright after a feed for 20-30 minutes. If it is night time, many mothers find it helpful to keep their baby on their own/their partners chest while they are semi-reclined in bed. This is tough in the middle of the night but will prevent your little one from waking up with milk all over them.
Some upright positions when breastfeeding help reflux babies cope with the flow and keep the milk down. Here, you can try positioning your baby sitting facing your breast while straddling your leg (a footstool can help bring your baby level with your breast) or even use a baby carrier to hold your baby at your breast (you can adjust the straps to keep your baby at the level of your nipples)
Other things that can help are keeping the nappies looser around the belly, having a cloth over your shoulder for the vomits, offering smaller more frequent feeds, offer comfort sucking or a dummy if they are distressed but full and need to suck, when your little one is awake, place them on their tummy on a slope, with their head higher than their feet, a rocker or bouncer (without bouncing it) or a pram/stroller, propped up with a triangular pillow are helpful too.