Troubleshooting Tummy Trouble

Tiny Tummy Trouble

The scoop on poop and other first-year digestive drama

By Malia Jacobson

Babies, especially newborns, spend most of their waking hours feeding and pooping. So, it’s understandable that digestive issues are a top concern for new parents, says Uma K. Pisharody, M.D., a specialist in pediatric gastroenterology with Swedish Medical Center. “New babies mostly eat, poop and sleep, so anything that makes them fussier than normal often leads to an assumption that there’s a problem with the baby’s digestion.”

Happily, most babies have healthy, functional digestive systems — even those who experience an occasional bout of gas, diarrhea or tummy pain. But because common digestive issues such as spitting up, reflux, diarrhea, gas, constipation and changes in bowel movements top the list of concerns for new parents, they’re well worth clearing up.

From the first poop to the first birthday, Dr. Pisharody answers your questions about first-year digestive dramas.

What are the top digestive issues you see in babies? The top issues I see and treat in babies are feeding problems, difficulty gaining weight, vomiting, changes in bowel movements, like diarrhea or constipation, and reflux. Conditions like digestive tract birth defects or bowel obstructions are much less common.

When it comes to spitting up, what’s normal? How much is too much? There is actually no “normal” or “abnormal” amount of baby spit-up, as each and every baby is different, and it’s best not to compare babies to each other. What I look for first and foremost is whether or not there is any forceful vomiting. Second, does the spit-up contain bile or blood? And third, is the baby gaining weight?

If a baby spits up dozens of times per day but the spit-up isn’t forceful, doesn’t contain blood or bile, and the baby is happy and growing well, I don’t consider that a problem. On the other hand, a baby could spit up hardly a few times each day, but if those issues are present, there could be something going on.

Does a breastfeeding parent’s diet create gassiness in her baby? While by-products of some foods that make a mother gassier can also occasionally cause gassiness in her infant, this type of gas typically shouldn’t cause severe pain. The gas produced within a mother’s own digestive tract after she eats certain foods doesn’t get passed through her breast milk to her baby. I tell mothers that it’s wise not to eat too much of any one food, but to eat a varied and healthful diet while breastfeeding.

A newborn’s poop is already so watery — how can a parent tell if their baby has diarrhea? When I examine diarrhea in newborns, I am looking specifically for a significant change in frequency of bowel movements more than a change in consistency. If a baby who was having about six watery bowel movements each day suddenly begins having 10 to 15, that’s probably diarrhea and worth a call to your pediatrician.

But with constipation, we look for changes not only in frequency, but also in consistency. A baby should pass the first black, sticky stool, called meconium, within 24 hours of birth. From there, a baby’s bowel

continued from page 43 movements will vary in frequency from many per day (for example, after each feeding) to as long as one every two weeks for breastfed infants; the latter is not typical, but certainly can be normal. So we look for changes in each individual baby’s routine: If a baby is having three to four stools each day and then starts going a few days between stools, or if the stools suddenly become more firm, that’s something to bring to your health-care provider’s attention. Until solids are introduced to a baby’s diet, we want bowel movements to be fairly runny, not hard or firm.

What’s a common myth about baby tummy trouble? One big misunderstanding is that all babies with reflux are experiencing acid reflux in the same way adults do. Reflux in babies is different from the acid reflux experienced by adults. When infant reflux is treated with medication to reduce acid, the medication may end up harming a baby’s digestive process in the long run, instead of helping, since natural digestive acid is essential for normal, healthy digestion.

Another myth is that mucous in the stool is always a sign of a problem. In fact, mucous in stools can be normal for babies, particularly those who are breastfed. The amount of mucous depends on the baby’s specific microbiome, or types of bacteria present in the digestive tract.

What is colic and how common is it? Colic is inconsolable crying that starts around 1 to 4 weeks of age. Around one in four babies have it. It’s thought to result from immaturity of the nervous system, rather than digestive problems or gas, as many parents assume.

What are signs that a baby is experiencing gas and how can caregivers help? Any adult can tell you that gas can certainly be uncomfortable. One way to tell that your baby’s discomfort is from gas is that the pain seems to be relieved by burping or passing gas.

I haven’t found OTC [over-the-counter] gas drops to be particularly helpful, but I don’t have a problem with them, if parents want to use them or find them helpful. For babies, gas in the digestive tract is usually caused by swallowed air. Along with regular burping after feeds, I recommend working with a lactation consultant to improve a baby’s latch during breastfeeding to reduce air swallowed during feeding.

Gentle abdominal massage can help a baby who is experiencing gas pains. For a new baby, you can place the baby tummy down on your lap, with the infant’s knees tucked in towards the chest, and gently massage the abdomen with your hands. This has the added benefit of lifting the baby’s bottom up, so gas rises upward and can more easily pass. This can help the baby pass a gas bubble. For older babies, laying them on their back and gently bicycling the legs can help.

When should a caregiver seek help for a digestive problem? What are signs that something is wrong? Feeding aversion — when an infant seems disinterested or actively opposed to feeding — is a red flag that needs medical attention.

When a baby is not gaining weight or growing, that’s something to bring to your healthcare provider’s attention right away.

Prolonged jaundice — or jaundice lasting longer than two weeks — is a reason to see your pediatrician.

We also worry about stools that lose their normal brown or yellowish color and become white or creamy, since that might signal a problem with the baby’s liver and bile ducts.

Belly distension, extreme or sudden fussiness, forceful and/or bilious or bloody vomiting, or bloody stools are other reasons to contact your health-care provider.

When in doubt, contact your provider with questions about your baby’s digestion. If you do head online to search for answers, Dr. Pisharody recommends the GIKids website (gikids.org). ■ Malia Jacobson is a health and family journalist.

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