Tummy Trouble The scoop on poop and other first-year digestion issues

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, MD, a specialist in pediatric gastroenterology. “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.”

Most babies have healthy, functional digestive systems—even those who experience an occasional bout with gas, diarrhea or tummy pain. But because common digestive issues like spitting up, reflux, diarrhea, gas, constipation and changes in bowel movements top the list of new parent concerns, they’re worth addressing.

From the first poop to the first birthday, Dr. Pisharody answers questions about first-year digestion issues.

What are the top digestive issues you see in babies?

Most babies who come to see me are brought in for fussiness or excessive crying. The vast majority of the time, the baby is otherwise fine.

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.

What’s the first step you take when a new patient comes in?

I ask the parent or caregiver a lot of questions about feeding: What’s going on in the home during feeds, when do feeds occur, and how do feeds relate to fussiness or other symptoms. I then look for red flags that tell us there could be a digestive problem.

Those red flags could be forceful vomiting (noticeably more forceful than normal spit up), particularly vomit that has a fluorescent yellow/green color or blood, any blood in the poop, or problems with the baby’s growth.

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?

Red Flags that Need Medical Attention

Contact your baby’s pediatrician if any of these symptoms are present. • Feeding aversion—an infant who seems disinterested or is opposed to feeding. • Baby is not gaining weight or growing. • Prolonged jaundice—lasting longer than two weeks. • Stools that lose the normal brown or yellowish color and become white or creamy could signal a problem with baby’s liver and bile ducts. • Belly distension, extreme or sudden fussiness, forceful and/ or bilious or bloody vomiting or bloody stools.

When in doubt, contact your provider with questions about your baby’s digestion. If you search for answers online, Pisharody recommends visiting www.gikids.org.

If a baby spits up dozens of times [without the above issues] and is happy and growing well, I don’t consider that a problem. On the other hand, a baby could spit up just a few times each day, but if those issues are present, there could be something going on.

Does a breastfeeding mom’s diet create gassiness in her baby?

Byproducts of foods that cause a mother to have gas can also occasionally cause gassiness in her infant, but 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 breastmilk. 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. Broccoli, beans, and yes, even chocolate are often OK in moderate portions.

Newborn poop is already so watery—how can parents tell if their baby has diarrhea?

When I examine diarrhea in newborns, I am looking for a significant change in frequency of bowel movements more than a change in consistency. If a baby who was having six watery bowel movements each day suddenly begins having 10 to 15, that’s probably diarrhea and worth a call to your pediatrician.

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 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 can be normal. We look for changes in each individual baby’s routine: If a baby is having 3 to 4 stools each day and then starts going a few days between stools, or if the stools suddenly become firm, that’s something to bring to your healthcare provider’s attention. Until solids are introduced to a baby’s diet, we want bowel movements to be fairly runny.

What is colic and how common is it?

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

What are signs that a baby is experiencing gas and how can caregivers help?

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 over-thecounter 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, 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. For older babies, laying them on their backs and gently bicycling the legs can help. v

Malia Jacobson is a health and family journalist.

Local Mom Tips

Our toddler had a lot of issues with constipation. Her doctor prescribed medication to soften her stool, but we didn’t want to rely on that. We made changes to her diet to include more fruit, fiber-rich foods, increased fluids, and dried prunes (we told her they were candy!). Victoria, East County

My youngest (now 4) had a bad milk protein allergy when she was a baby that resulted in frequent spit-ups and other issues. Since she was breastfed, I switched to a complete dairy-free diet from months 2 to 6. It was rough, but worth it. Tia, Point Loma

I took my infant twin girls to a chiropractor to help with a variety of issues, but I saw an immediate improvement in their digestion! As they’ve grown into toddlers, I now ask how they feel after eating different things. It helps me (and them) understand what makes them feel good, and what their bodies aren’t loving. Sandra, Rancho Santa Fe

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