For me, eating is truly a wonderful past time. When I travel, I usually center my destinations on locations that I can obtain a new or exciting dish. If I need to wind down, there is always food involved. When I celebrate, something will likely need to be catered. And when things go wrong, sustenance is often found to be a part of the healing process. Unfortunately the journey to this love affair with food is not always an immediate one for most infants. The newborn infant can cause an incredible amount of stress in a new parent’s life due to their seeming unwillingness to cooperate with feeding. Whether this trouble stems from what they are eating, or perhaps how their eating is affecting their stomachs, it is a common problem all the same. So let’s take a moment to discuss this topic.
What to eat is a question that appears to be solved for us at first glance. Mom’s come equipped with a food factory built in. How convenient! Breastfeeding is always recommended as the primary source of calories for the first 6 months of life. Babies have a tailor-made food source that is unique to them, almost like having a personal fingerprint for your nutritional needs. Breastfed infants are shown in some studies to have lower incidence of asthma, ear infections, respiratory infections, obesity, diabetes and even cancer! And that’s not all folks! Moms also receives the added bonus of lower rates of depression, rheumatoid arthritis, heart disease and that special bonding time with their baby. Have I sold you yet? I don’t think anyone needs to be sold on this concept, we all understand that this is a good option. It can be inconvenient, and it can be difficult for some. I feel we sometimes oversell this to moms and gratuitous guilt is applied. But if you are able to do it for at least the first 6 months of life, this is certainly recommended. Discuss any medications that you are taking with your physician as to the possible effects on the baby, both prescribed and unprescribed. Caffeine is one ubiquitous medication that I would have you consume in moderation. Maintain good hydration and do not change your diet dramatically as there is little evidence that your affinity for dairy, grandma’s salsa or gummi bears has any effect whatsoever. Discuss this with your doctor. There are many diet suggestions found from various sources that I find counterproductive for the moms I see on a regular basis. No need to make life any more difficult during the first few months with your new little baby. It’s already pretty hard. But life doesn’t always cooperate with us. Despite their best efforts I have many mothers who present to my office who are unable to breastfeed. So, if you fall into this category, let’s discuss our formula options.
Formula is a difficult minefield to navigate at times. It’s both expensive and confusing. Do I want a formula that’s more gentle, or more smooth? Should I choose the formula that is for reflux or colic? Do I need the name brand, or can I choose the off-brand 10-gallon bucket at Costco? Formula manufacturers capitalize on this confusion with multiple products that offer a myriad of solutions to your fussy baby. Let me offer a few words of advice.
First things first, you should pick a formula that is right for your baby and stick with it. Too often I have a well-intentioned parent who presents with a child that is miserable with gas, constipation, and spit up. In a scrambling effort to solve this issue they have been playing formula roulette for the better portion of the child’s life. This may be a major contributing factor to the issue. An infant’s stomach is a sensitive thing and does not adjust quickly to changes in the diet. You may be able to have a wide variety of foods in your diet, but this is because you are accustomed to do so. A baby is developing this important environment that we call the microbiome. Also, the maturity of the infant’s digestion can vary depending on whether they made it to full term. The more premature an infant, the less ability they have to produce the enzymes needed to digest appropriately.
To choose a formula, it is important to know what is in a formula. This is a very insightful observation, I know. All formulas will contain both a protein component as well as a carbohydrate or sugar component. We tend to vilify this sugar component, which is lactose in most formulas. Both lactose and gluten I’m afraid are the unpopular outcasts at most people’s school of nutrition. Poor lactose and gluten, all alone at the loner table. You should be aware however that it is most commonly the protein component of formula that infants have a hard time with and not the sugar component. So, in an instance where the infant is struggling with their formula, it would be wise to address the protein content of the formula. A formula with more Whey protein will be closer to breastmilk and will treat the baby’s tummy better. If the issue persists, there are “Partially-hydrolyzed” formulas available. This essentially means that the manufacturer has broken the proteins up for the baby so it’s easier to digest. There are even formulas broken down to the elemental level, as to create as little need to digest as possible. Soy is a common solution that most parents come to. This is probably what I have most parents present to me as their silver bullet to the problem that is their child’s difficulty with feeding. However, there is little indication this will do any good. If a child is allergic or having troubles with milk proteins, they will almost certainly have the same issues with soy proteins. I would only recommend a soy-based formula for those parents that desire a vegan option. You should discuss all these issues with your pediatrician to choose the correct formula. Most infants will do just fine on regular formula. If they have issues, sit down and together decide a proper course. Having a good discussion and choosing to stick with one formula will save you both headache and money in the long run.
But what are these “issues” I speak of? Glad you asked. No discussion of feeding a baby would be complete without discussing spit-up and gas. Baby’s love to spit up. Parents are not always so enthusiastic. It’s a sort of magic trick in a way, you feed a baby 3 oz of milk and they manage to spit up 3 gallons all over you. No one knows how they do this. But before you become too concerned, it is important to note that spitting up is normal. In combination between poor muscle tone and simply a short distance from their little tummies to their mouths, they will spit-up. But for those with what seems to be a particularly leaky child, there are some interventions.
There is only so much room in a newborns stomach and we tend to overestimate this amount. In general, a baby who is happy and eats well but consistently makes their lunch reappear minutes after ingesting it may be getting more than they can hold. Decreasing both the amount and the duration between feeds has proven to significantly improve spit-up. If done properly there is no decrease in the total amount of feeds given but allows for proper transit of feeds. Frequent burping is also helpful. The positioning of burping is found to be most effective with the infant on their left side or on their tummy. This allows for most effective evacuation of gas without the entire feed coming out along with it. Gas, in general, is a very difficult thing to deal with. This is usually the reason your little one will grunt and get ornery with you throughout the day.
Again, many different sources will offer you the solution to this problem but there are those who are striving to make money on the desperate parent. I endorse having a good conversation with your pediatrician before using any medications or other interventions. I do recommend the use of infant probiotics, there is some evidence that shows this may be beneficial for not only gas but to encourage a more regular pooping schedule. And when it comes to babies, we’re all about a good pooping schedule.
I can offer this one reassuring truth; this will all resolve as they get older. Once a child develops a regular schedule, a good microbiome, and stronger muscle tone they will stop spitting up and will become less irritable with gas. Work on what I have discussed here by finding appropriate nutrition and sticking with it. Avoid the temptation of comparing your babies progress with others, your baby is unique and has their own path to take. You got this.
By Dr. Adam Wahlstrom
Dr. Adam Wahlstrom began his post high school education at Brigham Young University where he received a Bachelors of Arts Degree in Humanities and Art History. He served a two year full time Mission for his church in the Phillipines. He then went on to Medial School at Arizona College of Medicine in Phoenix Arizona. After completing his degree in Arizona he went on to complete a Pediatric Residency with Oklahoma State University at the Children’s Hospital in Tulsa, Oklahoma. There he focused on Pediatric Nutrition and completed research on current Pediatric Obesity Guidelines as well as being actively involved in OSU’s nutrition clinic. He is the father of four children and he is currently practicing medicine as a board certified pediatrician in St. George Utah.