When I gave birth to my younger daughter, Annika, I thought, as a second-time nursing mom, I'd be more prepared for any breastfeeding curveballs she threw my way. I was wrong. Annika would arch her back during feedings, spit up, and have long crying fits afterwards. Her nose was also always stuffy. I worried that she was allergic to something I was eating, or that she had gastroesophageal reflux disease (GERD), a condition in which stomach acid flows back into the food pipe, or esophagus. Confused, and getting different advice from my pediatrician, lactation consultants, and breastfeeding friends, I gave Annika three different reflux medications and then stopped eating dairy for nearly two months. At the end of it, my daughter was no better, I missed my decaf lattes, and my whole family was still drenched in spit-up. If your baby is fussy and you're concerned that your diet has something to do with it, read on before you ditch your favorite foods.
A newborn's digestive system is immature, and often the valve at the top of the esophagus that keeps stomach acid down doesn't tighten as it should. As a result, most infants spit up, but the majority stop doing so by age 1. Some have gas and are fussy on top of spitting up, and it may be because they're swallowing too much air during feedings. As long as an infant who spits up and is fussy is gaining weight and has no serious complications, all he needs is a little TLC, says Leo A. Heitlinger, M.D., a pediatric gastroenterologist at St. Luke's University Health Network in Bethlehem, Pennsylvania.
Focus on Food
We hear so much about food allergies, it's understandable that moms may suspect that common allergens, such as cow's milk, soy, eggs, corn, peanuts, or wheat, in their breast milk could be causing irritability and spitting up. Some might stop eating whole food groups in an effort to ease their infant's symptoms. But the issue may be that your baby's digestive system is immature, not what you're eating. There's no definitive evidence that elimination diets are effective, says Jimi Francis, Ph.D., a nutritionist and lactation consultant on the board of the nonprofit Foundation for Maternal, Infant, and Lactation Knowledge. Removing certain food groups from your diet can be detrimental to your well-being and your baby's, which is why you should only attempt an elimination diet under a doctor's supervision. "Nursing mothers who eliminate too many foods from their diet run the risk of missing out on key nutrients, which can harm their health and milk supply," says Dr. Francis.
If you really think that eating gassy foods, such as broccoli or cabbage, is causing stomach upset in your baby, feel free to skip those particular veggies, says Jatinder Bhatia, M.D., chair of the committee on nutrition for the American Academy of Pediatrics. Keep in mind that it's very difficult to link a reaction to a specific food and it's unclear how much of a certain food a nursing mother would have to eat for it to give her baby gas through her breast milk.
While dietary restrictions aren't the answer for most babies' fussiness, there are things you can do to minimize spit-up and help your baby be more comfortable. Try burping her frequently during meals and avoid overfeeding her by watching for fullness cues, like turning her head away. After feedings, help her keep food down by propping her up for at least 30 minutes. And, of course, avoid bouncing games.
If your baby gags, pulls away from your breast, or arches her back at the beginning of a feeding, you may have a strong initial flow. "Your baby may have to drink quickly, which can lead to gas and spit-up from swallowing air," says Dr. Francis. If you suspect you have a fast milk flow, pump for a couple of minutes before feedings.
There are instances when the above fixes may not be enough and you should call your pediatrician. If your baby isn't gaining weight or is vomiting forcefully, he could have GERD, says Dr. Bhatia. If he has diarrhea, eczema, a rash, or blood in his stool, he may have an allergy and will need further testing. You may be asked to eliminate any allergens you consume regularly from your diet for 14 days. If your baby's symptoms disappear, you'll add foods back into your diet one at a time to see which triggers a reaction.
In my case, I finally realized that Annika just needed time to get better on her own. She had reflux, but by 6 months, when her digestive system was more mature, she was spitting up far less, no longer stuffed up or arching her back -- and one of the happiest babies I've ever known.
Originally published in the March 2013 issue of Parents magazine.
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