What to Expect the First Year (45 page)

If your baby's spitting is accompanied by prolonged gagging and coughing or associated with poor weight gain, if it seems severe, or if the vomit is brown or green in color or shoots out 2 or 3 feet (projectile vomiting), call the doctor. These could indicate a medical problem, such as an intestinal obstruction or pyloric stenosis (
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).

“When my 2-week-old spit up today after I breastfed her, there were some reddish streaks that looked like blood in with the curdled milk. Now I'm really worried.”

Any blood that seems to be coming from your newborn, particularly when you've found it in her spit-up, is bound to worry you. But before you panic, try to determine whose blood it actually is. If your nipples are cracked, even very slightly, it's probably your blood, which baby could be sucking in (and then spitting up) along with the milk each time she nurses.

If your nipples aren't obviously the cause (they may be, even if you can't see the tiny cracks), or if you're not breastfeeding, call your pediatrician to help you figure out the source of the blood in your baby's spit-up.

“My baby is crying a lot, and I'm wondering if he might be allergic to the milk in his formula. How can I tell?”

As eager as you might be to uncover a cause (and an easy cure) for your baby's crying, it's not likely the milk that's to blame. Milk allergy may be the most common food allergy in infants, but it's a lot less common than most people believe (only about 2 to 3 in 100 babies will develop a true allergy to milk). And when a baby is allergic to milk, other symptoms will accompany the crying.

A baby who is having a severe allergic response to milk will usually vomit frequently and have loose, watery stools, possibly tinged with blood. Less severe reactions may include occasional vomiting and loose, mucousy stools. Some babies who are allergic to milk
may also have eczema, hives, wheezing, and/or a nasal discharge or stuffiness when exposed to milk protein.

Unfortunately, there's no way to test for milk allergy, except through trial and error—but don't try anything (including a change of formula) without the doctor's advice. If there is no history of allergy in your family, and if your baby doesn't have any symptoms other than crying, the doctor will probably suggest that you treat the crying spells as ordinary colic (
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).

If there is a family history of allergies or your baby has symptoms of milk allergy other than crying, the doctor may recommend a trial change of formula, from regular cow's milk formula to hydrolysate (in which the protein is partly broken down or predigested). If the symptoms disappear, it's likely your baby is allergic to milk (though sometimes it can just be a coincidence), and you'll probably be told to keep him on the hydrolysate formula for now. Happily, milk allergies are eventually outgrown, so at some point the pediatrician may recommend a reintroduction of cow's milk formula, or after a year, whole milk. If symptoms don't return when you switch back, your baby either wasn't really allergic in the first place or has outgrown the allergy (at which point you can bring on the dairy products without worry).

A switch to soy formula usually isn't recommended when a true milk allergy is suspected, since a baby who's allergic to milk is often allergic to soy as well.

Very rarely the problem is an enzyme deficiency—an infant is born unable to produce lactase, the enzyme needed to digest the milk sugar lactose. Symptoms of congenital lactose intolerance include gas, diarrhea, bloated stomach, and failure to gain weight. A formula containing little or no lactose will usually resolve the problem.

If the problem is not traced to milk allergy or intolerance, it's probably best to stay with—or switch back to—a cow's milk formula, since it is the better breast milk substitute (though the doctor may suggest one for sensitive stomachs).

“I'm breastfeeding exclusively, and when I changed my baby's diaper today, I noticed some streaks of blood in his bowel movement. Does that mean he's allergic to my breast milk?”

Babies are virtually never allergic to their mother's milk, but in rare cases, a baby can be allergic to something in his mom's diet that ends up in her milk—often cow's milk proteins. And it sounds as if this might be the case with your very sensitive infant.

Symptoms of such an allergy, known as allergic colitis, may include blood in baby's stool, extreme fussiness, lack of (or minimal) weight gain, and vomiting and/or diarrhea. Your baby could have one or all of these symptoms. Researchers suspect that some babies may become sensitized to certain foods mother eats while baby is still in utero, causing allergies after birth.

Although cow's milk and other dairy products are common culprits in these reactions, they're not the only ones. Others include soy, nuts, wheat, and peanuts. A quick check with your baby's doctor will probably lead you to this course of action: To determine what in your diet is causing your baby's allergy, try eliminating a potential problem food for 2 to 3 weeks. Baby's
symptoms may ease during the first week after you've eliminated a food from your diet, but for a sure call, wait the full 2 to 3 weeks to confirm that you've found the culprit.

Occasionally, no correlation between foods and allergic symptoms is found. In that case, your baby might just have had a gastrointestinal virus that caused the streaks of blood in his stool. Or there might be small cracks or fissures in his anus that caused the bleeding. Another possibility: Baby may have swallowed your blood if your nipples are cracked—and that blood can exit in spit-up or poop (sometimes the blood can give poop a black tinge instead). Monitoring by your baby's doctor should solve the mystery.

“I expected 1, maybe 2, bowel movements a day from my breastfed baby. But she seems to have one in every diaper—sometimes as many as 10 a day. And they're very loose. Could she have diarrhea?”

Most breastfed infants seem bent on beating the world record for dirtying diapers. But not only is a prolific poop pattern not a bad sign in a breastfed newborn—it's a very good sign. Since the amount that's coming out is related to the amount going in, lots of movements a day in the first 6 weeks means your baby's getting plenty of nutrition from your breast milk.

In the early days, breastfed babies usually have—on average (and average being the operative word here)—one poopy diaper per day of life. In other words, on day 1 of her life, she'll poop once, and on day 2 she'll poop twice. Fortunately, this pattern doesn't usually continue past the fifth or so day of life. After day 5, the average breastfed newborn will poop about 5 times per day. What counts as a BM worth counting? Any poop bigger than the size of a quarter can be added to your tally (if you're keeping track, that is). Some babies—like yours—will poop more (sometimes even once per feeding), some less (though consistently infrequent poops in the first few weeks can mean a baby's not getting enough to eat). By 6 weeks the poop pattern of breastfed babies may start to change, and you may notice your baby skipping a day (or two … or even three) between BMs. Or not. Some babies will continue to poop up a storm, filling their diapers several times a day or more throughout the first year. It's not necessary to continue keeping count after 6 weeks as long as baby is happy and gaining weight. The number may vary from day to day, and that's perfectly normal, too.

Normal, also, for breastfed infants is a very soft, sometimes even watery, stool. But diarrhea—frequent stools that are liquidy, smelly, and may contain mucus, often accompanied by fever and/or weight loss—is less common among babies who dine on breast milk alone. If they do get it, they have fewer, smaller movements than bottlefed babies with diarrhea and recover more quickly, probably because of the infection-fighting properties of breast milk.

“My son's poops come with such force and such explosive sound, I'm beginning to think there's something's wrong with my breast milk.”

A breastfed newborn is rarely discreet when it comes to pooping. But the noisy barrage that fills the room as your little one fills his diaper is completely normal. While giggle inducing (for parents), and sometimes a bit embarrassing (in public), these explosive movements and the surprising variety of sounds that punctuates their passing are just a result of gas being forcefully expelled from an immature digestive system. Things should quiet down in a month or two.

“My baby passes gas all day long—very loudly. Could she be having tummy troubles?”

The digestive exclamations that frequently explode from a newborn's tiny bottom (otherwise known as farts) are, like those explosive poops, perfectly normal. Think of it like new plumbing, which it essentially is. Once your newborn's digestive system works out the kinks, the gas will pass more quietly and less frequently, if not less pungently.

“I'm wondering if my formula-fed baby is constipated. He's been averaging only one BM every 2 or 3 days.”

When it comes to constipation, frequency isn't what counts—consistency is. Formula-fed babies aren't considered constipated unless their poops are firmly formed or come out in hard pellets, or if they cause pain or bleeding (from a fissure or crack in the anus as a result of pushing a hard poop). If your baby's movements are soft and passed without a struggle (even if they arrive only once every 3 to 4 days), he's not constipated. No need to jump to constipation conclusions, either, if he grunts, groans, and strains when he poops. That's standard pooping practice for babies, even when passing soft poop, probably because
their anuses aren't strong or coordinated enough for easy elimination. Not to mention that young babies, who usually poop lying down, get no help from gravity.

If your baby really does seem to be constipated, check with the doctor for confirmation and a treatment plan, if necessary. Don't use any at-home remedies without medical advice.

For breastfed babies, constipation is rare, but infrequent poops in the early weeks can be a sign that an infant isn't getting enough to eat (
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.

“I know my baby's supposed to sleep on her back, but she seems so uncomfortable that way. Wouldn't she sleep better on her tummy, or at least on her side?”

There are no two ways about it: Back sleeping is a must for your baby's safety. Research has shown that compared with tummy sleepers, back sleepers have fewer fevers, fewer problems with nasal congestion, and fewer ear infections, and are no more likely than tummy sleepers to spit up during the night (or choke on their spit-up). But by far the most important reason why back sleeping is crucial: Placing babies to sleep on their backs sharply reduces the risk of crib death (Sudden Infant Death Syndrome, or SIDS).

Start your baby sleeping on her back (without any sleep positioners or wedges, both of which are considered unsafe) right away, so that she'll get used to and feel comfortable in that position from the beginning. Some babies fuss more on their backs at first—that may be because they feel less cozy and secure, since they can't cuddle up against the mattress. They may startle during sleep more on their backs, too, and that can lead to more frequent wake-ups (
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for more on startling). Swaddling your little one for sleep (or putting her in a sleep sack) will help ease startling and help make her more comfy—and content—on her back.

The incidence of SIDS is highest in the first 6 months, although the recommendation of “back to sleep” applies for the whole first year (and applies no matter who's putting baby to sleep, so make sure anyone who cares for your baby follows this recommendation). Once baby starts rolling over, however, she may decide that she prefers a tummy position for sleep—still, continue to put your baby down on her back and let her decide about flipping.

And don't forget the flip side of back to sleep: tummy to play.
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for more.