Your Baby's Digestive System
Isn't it wonderful how babies are such uninhibited little creatures? Adults have to mind their manners, refraining from uncouth behavior such as belching or passing gas in public, whereas babies let loose naturally. They can't help themselves -- eating is their favorite pastime and their digestive system is getting used to food.
Other than crying, these noises are some of the few sounds your newborn makes early in life, and they tell you a lot about what he wants. Surprisingly, spit-up can be equally revealing. So get your burp cloth ready, because you're about to decipher your baby's varying digestive needs.
Q. Why all the gas?
A. It comes from two sources: harmless bacteria breaking down undigested sugars in the large intestine, and swallowing air during crying and feeding.
Some breastfed babies may produce excessive gas when their mothers eat gas-forming vegetables, such as broccoli, cauliflower, cabbage, brussels sprouts, beans, and onions. (If you're eating these foods and notice your baby is gassy, you may want to limit them in your diet.)
Feeding babies too much fruit juice can also cause gas, as well as bloating, tummy pain, and diarrhea.
Easing Your Baby's Gas Pain
Q. Can I alleviate my baby's gas pain?
A. You can help prevent gas by feeding her before she cries, a signal that she's too hungry to wait any longer to eat. When you do feed her, use a leisurely pace, because rapid feeding increases her intake of air. If you are breastfeeding and your milk is letting down briskly, you may need to remove your baby for a moment and let the spray of milk slow down so she can manage the flow. If bottlefeeding, check the nipple opening to be sure it isn't too large or too small. Bottlefed babies usually swallow more air, especially when the bottle's nipple isn't full of milk.
But if, despite your efforts, your baby seems uncomfortable, gas may be the reason behind her fussiness. You can help trapped gas move by gently massaging baby's tummy in a clockwise motion while she lies on her back. Or hold your baby securely over your arm in a facedown position, known as the "gas hold" or "colic hold." Still no relief? Ask your pediatrician about trying the over-the-counter anti-gas medication simethicone, sold as Infants' Mylicon Drops, which may help move gas through the intestines.
Q. How often should I burp my baby?
A. For most babies, burping midway through the feeding and afterward will release any air bubbles. Try burping your baby during his natural pauses in feeding, such as when he slows down after finishing the first breast. While a few babies need to be burped more frequently, many parents make the mistake of disrupting feedings with unnecessary attempts at burping. This prolongs the feeding time, frustrating a hungry baby, which can increase air swallowing.
Trapped air can cause immediate discomfort, make a baby feel full before he has finished his feeding, or pass into the intestines, causing flatulence.
There are several good positions for burping your baby. Use the one that works best for you:
- Support your baby upright over a burp cloth on your shoulder and firmly pat his back.
- Sit him upright on your lap with your hand under his chin to support his chest and head. Lean him forward slightly while you rub and pat his back.
- Lay him across your lap on his abdomen, with his head slightly higher than the rest of his body, and firmly rub and pat his back.
If he doesn't burp after a few minutes, resume feeding him, and if he acts uncomfortable, try burping him again.
Spit-Up and Vomit
Q. Why does my infant sometimes spit up after feedings?
A. Feeding your baby is gratifying, but it also can be a messy experience, considering that as many as half of all healthy, fullterm newborns spit up daily.
The medical term for spitting up is gastroesophageal reflux, abbreviated as GER or simply reflux. With GER, stomach contents (including food, saliva, air, stomach acids, and other digestive juices) back up into the esophagus and sometimes out the mouth. (Some infants with GER may even vomit.) Reflux typically occurs after eating, when the lower esophageal sphincter (LES) muscle, which separates the esophagus from the stomach, is relaxed.
In infants, GER peaks at 4 months, equally affecting nearly 70 percent of breastfed and bottlefed babies. (Babies have small esophagi, which are vulnerable to increased abdominal pressure from crying, straining to have a bowel movement, or coughing.) In most instances, they outgrow the condition between 6 and 12 months of age, after they learn to sit up, begin eating solid foods, and spend more time in an upright position.
A more severe form of GER, called gastroesophageal reflux disease (GERD), affects about one in 300 infants. GERD occurs if frequent reflux of stomach acids causes injury to the lining of the esophagus. A baby with GERD is likely to spit up or throw up more than usual, choke or gag, arch away from the bottle or nipple, or be irritable during and after feedings. See "How is GERD treated?" section for more information on this condition.
A Whole Lot More Than Spit-Up
Unlike spitting up, vomiting can be a symptom of a wide variety of medical problems, ranging from a bacterial or viral infection, to a cow's milk allergy, an intestinal blockage, or a head injury. Repeated projectile vomiting that begins around 3 to 5 weeks may be due to a thickening of the muscle where the stomach empties into the small intestine. This condition -- known as pyloric stenosis -- requires immediate medical attention and minor surgery.
Notify your baby's doctor if your infant vomits after two or three consecutive feedings; has blood- or yellow-stained vomit; has a swollen or tender abdomen; refuses to drink; or is vomiting along with having other symptoms.
The Facts About GER and GERD
Q. Are GER and GERD ever serious problems?
A. GER is a common, normal occurrence in infants. On the other hand, GERD is more rare. Although most infants with GERD regurgitate frequently, some have what is known as "silent reflux," in which stomach contents back up into the esophagus and cause painful irritation without reaching the mouth. GER and GERD occur more often among preemies, babies with developmental delays, infants born from a prolonged labor or traumatic delivery, and those with chronic lung disease or gastrointestinal birth defects.
If your infant cries excessively, doesn't eat well, or has difficulty sleeping, GERD may be the cause. During feedings, infants with GERD often appear irritable and uncomfortable, frequently arching while pulling away from the breast or bottle, presumably due to heartburn. Many infants with GERD stretch and turn their necks in an effort to lengthen the lower esophagus, a posture known as Sandifer's syndrome. And they may prefer to graze, taking only a small amount of milk at frequent intervals, because a distended tummy aggravates reflux.
Babies with GERD (often called "scrawny screamers") may also gain weight slowly, due to difficulty feeding or excessive loss of nutrients from frequent regurgitation. Other symptoms of GERD include coughing, wheezing, choking, and gagging. These respiratory symptoms are the result of acid irritation of the airways and inflammation in the lungs. Constant reflux increases the risk that stomach contents can enter the windpipe through inhalation, and can ultimately cause pneumonia. To further compound these potential complications, anemia can be yet another risk because of bleeding from the damaged esophagus.
There is no single test to confirm that a baby has GERD. The diagnosis is often made after an infant is referred to a pediatric gastroenterologist for severe reflux.
Q. How is GERD treated?
A. Typically, the lifestyle and feeding changes used to treat GER can help alleviate GERD. But if these methods don't work, your pediatrician may prescribe medications either to reduce reflux episodes by speeding stomach emptying or to protect the lining of the esophagus from acid damage by suppressing the production of stomach acids. Antacids, though, are generally not recommended for infants.
In addition, cow's milk may cause allergic reactions, such as vomiting or inconsolable crankiness in infants, which can mimic the symptoms of GERD. (Although milk allergies are rare, infants with eczema, chronic congestion, or a family history of allergies are more at risk.) To determine the true cause behind baby's ill health, pediatricians may first ask that formula-fed infants with severe reflux be switched to a protein hydrosolate formula, which doesn't contain cow's milk, for a week or two to see if symptoms improve. Similarly, the mother of a breastfed infant may be asked to eliminate cow's milk from her diet for a trial period.
If your baby's irritability is caused by reflux disease, the complications are rarely severe enough to warrant surgery.
Q. What can I do to decrease GER?
A. Several lifestyle and feeding changes may help minimize reflux:
- Keep your baby as upright as possible during feedings. Frequent, small feedings are often recommended to decrease reflux because there is less volume to regurgitate. Some babies with GER will even self-regulate, preferring to drink small amounts often. Others with reflux cry if their hunger isn't satisfied and insist on taking a full feeding.
- Avoid bouncing and jostling your baby after meals. Instead, keep her quiet and upright for about 20 minutes after feedings. If you don't have time to hold her upright, carry her in a front pack or prop her in a swing.
- Avoid tobacco smoke, which has been linked to reflux, because among many detrimental effects, it reduces muscle function in the LES and boosts acid secretion.
- Keep your baby's diaper loose to reduce pressure on the abdomen, and avoid changing his diaper right after he eats, as laying him on his back or bending him at the waist during a diaper change can provoke spitting.
- If using formula, check with your pediatrician about thickening baby's feedings by adding rice cereal to the formula (up to 1 tablespoon of dry rice cereal for each 1 to 2 ounces of milk). This increases the caloric content of feedings, allowing you to give your baby a lesser volume. The thickened formula, which may need to be fed through a cross-cut nipple (widening nipples isn't recommended for other formula), decreases episodes of reflux. Some formulas are available (such as Enfamil AR) with added rice cereal that thickens when it reaches the stomach.
- Although reflux is most likely to occur when a baby is on his back, this sleeping position is recommended to reduce the risk of SIDS. Elevating the head of the crib may help decrease reflux during sleep, as will putting your infant on his stomach after feedings when he's awake.
Marianne Neifert, MD, also known as Dr. Mom, is a clinical professor of pediatrics at the University of Colorado Health Sciences Center, in Denver, an author of four parenting books, a professional speaker, and a mother of five.
Originally published in American Baby magazine, August 2005. Updated 2010
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.