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Baby feeding problems – frequently asked questions

Q&A Header Q&A with Dr. Sarah Jarvis

SUMMARY

It’s not uncommon for babies to experience feeding problems during the early weeks and months of life. We hosted a live Facebook Q&A session with Dr Sarah Jarvis to discuss feeding problems and their solutions. You can read her expert advice below.

The advice Sarah gave was based on her medical knowledge at the time of publishing (August 2017). If you’re concerned about your baby’s feeding habits or health, speak to your healthcare professional.

How do I know if my baby has reflux?

Reflux is when babies spit or bring up milk during or after feeding - it is very common and usually passes by the time they are one year old. If your baby is otherwise well and has no other symptoms, it's nothing to worry about. Other signs of reflux include feeding difficulties (such as refusing feeds), persistent hiccups or coughing, excessive crying, or crying while feeding or ear infections. Please do see your GP to discuss you baby’s symptoms.

If it is reflux, the good news is that there will be things you can try and your GP will be able to tell you more if this is the case. More serious signs that you should immediately see a doctor would include more forceful vomiting, frequent greenish bile-stained vomiting, retching, not putting on weight as he should, swallowing difficulties, blood in the vomit or the poos or if he appears unwell.

My 3-week-old baby is straining to poo – is this normal?

First of all, we’d recommend making an appointment to see your GP or health visitor as soon as you can as they will be able to advise you and give you some helpful tips. Everything to a baby is weird and wonderful, and the world is brand new, even the sensation of pooing which we all take for granted. To do this, your baby has to learn for the first time to contract and relax certain muscles at the same time - no small feat to do for the first few weeks of life. To help with constipation, you could try massaging your baby’s belly while pooing or putting a warm (not hot) water bottle on their tummy to help them relax. If the crying is high pitched and your baby is inconsolable, speak to your GP or health visitor.

I’m struggling to wind my baby and she seems really uncomfortable – how can I help?

Consoling an unhappy baby is never pleasant, but the good news is there are plenty of things you can try. Number one is feeding positions, as sometimes it can cause your baby to gulp down air or the milk to flow faster than they are able to swallow. Try holding your baby more upright to almost have him/her sit on your lap in a ‘saddle position’, rather than horizontally. Or, another position is lying down with your baby to feed which can help the milk flow more slowly, helping your baby ‘gulp’ less and swallow less air.

Secondly, even at night time make sure you are winding as you would in the daytime, and some babies will need winding during a feed, whereas others are happy to gulp down the lot and then do it at the end. Finally, if you’re bottle feeding you should also make sure the teat of the bottle isn't clogged, and you could speak to your midwife or health visitor about the possibility of changing to a faster-flow teat.

I’m worried my 14-week-old baby isn’t having enough milk – how much does he need?

Unfortunately, there is no way to control how much babies eat and drink and when they wish to do it - they really do vary from meal-to-meal, as well as day-to-day and month-to-month. Some babies need more calories than others, or less, depending on their growth and other factors. Let your baby's cues guide you but do follow the basic guideline. Most babies of this age will need around 150 – 200ml per kilo of their weight per day. This is not a hard and fast rule as every baby is different, and varies in how much and how often they want to feed and drink.

Newborns tend to feed little and often, and will usually give you signs that they want to feed or have had enough.

Do keep an eye on your baby’s weight. If there is a sudden drop in weight, they aren’t putting on weight normally, seem unwell or are not thriving, please speak with your GP or health visitor.

My 6-week-old always vomits after feeding, what should I do?

I’m sorry to hear your little one is struggling with this – it’s hard to watch, I know. It could reassure you to know reflux is very common and usually passes by the time they are one year old. If your baby is otherwise well and has no other symptoms, it's nothing to worry about. Other signs of reflux include feeding difficulties (such as refusing feeds), persistent hiccups or coughing, excessive crying, or crying while feeding and frequent ear infections.
If it is reflux, the good news is that there will be things you can try and your GP or health visitor will be able to tell you more if this is the case. More serious signs that you should immediately see a doctor would include more forceful vomiting, retching, not putting on weight as he should, swallowing difficulties, frequent greenish bile-stained vomiting, blood in the vomit or the poos or if he appears unwell.

My 12-week-old baby has stomach cramps whenever he is bottle fed, and screams in pain when he passes wind – is it colic?

This doesn’t sound pleasant for either of you, and I really sympathise! Without seeing your baby, I can’t say whether or not it’s colic, so please arrange to see your GP or health visitor as soon as you can. They will need to ask you about your baby’s symptoms before making a diagnosis.
In the meantime, I’d suggest you try massaging your baby’s belly while they’re pooing or putting a warm (not hot) water bottle on their tummy to help them relax.
In a very few cases (only about 3-5% of babies), tummy pain and diarrhoea can be caused by cows’ milk allergy. recognising the signs of milk allergy and intolerance in babies Your baby would also have red skin, eczema, redness around the bottom, blood in the poos, being off their food and looking pale.

My 5-week-old falls asleep while breastfeeding, but then brings up a lot of milk after most feeds, is there anything I can do?

Have you tried a different feeding position? If you try feeding lying down with your baby it helps slow the flow of milk which may help here. There are other things you can try too: try feeding off one breast as your baby maybe getting all the milk they needs from one - if they seem like they want more, offer the same breast initially as sometimes they just want to suckle rather than feed again. Also, if you're experiencing a forceful flow, express onto a towel to start, then once you're getting the steady drips, start the feed with your baby - the foremilk is more plentiful, but the milk that comes after is even richer in the nutrients they need.
Try to relax (I know, easier said than done)! And, make sure you keep doing the all-important winding at the end. It's worth speaking to your GP or health visitor anyway, as they'll be able to give you other tips and potentially demonstrate some techniques you can use. And, of course, if it becomes too difficult or your baby becomes unwell, then also speak to your GP.

How do I know when my newborn has had enough milk?

Newborns tend to feed little and often, and will usually give you signs that they want to feed or have had enough.

Babies have an excellent self-regulation system that makes them eat when they’re hungry and refuse when they’re not. Signs that they’ve had enough are (the obvious one) turning away from the breast or bottle a few times during feeding, spitting up milk, being fussy as their tummy is full, and passing a lot of gas. Don’t worry if they bring up a bit of milk after a feed – when they’re starting out, they may drink too much without realising they’re full, then bring up the excess as ‘overflow’. If they’re otherwise entirely well and putting on weight, this isn’t a concern.

Weight gain is not a useful sign of overfeeding, as babies grow so much and at different rates. Your doctor should be able to advise if your baby is overeating or at risk of overeating, otherwise it should be fine to feed them when they show signs of wanting it. However, sometimes babies may seem to be wanting a feed but actually just need a cuddle, or are cold, or hot, or – you get the picture.

It’s always worth a chat with your health visitor or GP if you’re concerned that your little one is showing any other signs of a feeding problem.

Is colic brought on by lack of sleep during the day?

Unfortunately, the causes of colic are not fully understood. However, suspected causes include swallowing excess air during feeding, having an immature digestive system or even responding to temporary gut sensitivity to proteins or sugars naturally found in breast or formula milk.

While lack of sleep is no fun for anyone, it’s not generally included among them. Colic can seem to get worse at certain times, particularly the late afternoon. So if you’re seeing symptoms of colic (defined as repeated episodes of excessive and inconsolable crying in an otherwise healthy and thriving baby) pop up around the same time every day, I can see why you might associate it with short nap times.

If you haven’t taken your baby to their GP already, it’s a good idea to make an appointment and get a diagnosis. If it is colic, they will be able to offer further advice.

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