Gastrointestinal Problems in Newborn

What might gastrointestinal problems indicate in a newborn?

A newborn's ability to eat and digest food is essential to growth and development. Most babies are able to absorb nutrients and have normal bowel movements after being fed. Difficulty in any of these areas can be a temporary adjustment or a sign of a more serious problem. The following symptoms may indicate the baby is having gastrointestinal problems:

• Vomiting. Spitting up and dribbling milk with burps or after feedings is fairly common in newborns. This is because the sphincter muscle between the stomach and the esophagus (the tube from the mouth to stomach) is not as strong as it will eventually become as the baby matures. Forceful or projectile vomiting, however, or spitting up large amounts of milk after most feedings, can indicate a problem. In formula-fed babies, vomiting may occur after overfeeding, or because of an intolerance to formula. In breastfed or formula-fed babies, a physical condition that prevents normal digestion may cause vomiting. Consult your baby's health care provider immediately if your baby is vomiting forcefully or frequently, (especially if this lasts longer than 24 hours), vomiting green bile or blood, becomes lethargic, or has any other signs of distress.

• Reflux. Some babies may constantly spit up all or most of every feeding, or gag and choke during feedings. This may be caused by reflux. Reflux occurs when stomach contents back up into the esophagus (the tube that connects the mouth to the stomach). The esophagus can become raw and irritated by the stomach contents. When the stomach contents back up into the esophagus, they may be vomited and aspirated (breathed) into the lungs. You may also be able to hear and feel "rattling" in the baby's chest and back. Tips that may help babies with reflux include:

  • Play with, bathe, and/or change baby's diapers before feeding.

  • Be sure the baby's diaper is not too tight.

  • Feed the baby smaller amounts, but feed more often. Smaller meals can promote digestion and prevent stomach contents from refluxing into the esophagus.

  • Feed slowly, holding your baby upright throughout the feeding and directly after.

  • Burp your baby often during the feedings.

  • Handle your baby gently after the feeding.

  • Hold your baby in an upright position for about 30 minutes after feeding.

  Consult your baby's health care provider if he or she is fussier than usual, the vomiting seems worse, or your baby has problems breathing during or after feedings, choking spells, or refuses feedings.

• Diarrhea. The first bowel movement of a newborn is called meconium. This is a sticky, greenish-black substance that forms in the intestines during fetal development. The baby may have several meconium bowel movements before this substance is completely gone from the baby's system. After the first few days, normal bowel movements become yellow and formed in formula-fed babies and may occur once or twice a day, sometimes more often. Breastfed babies tend to have soft, seedy, yellow-green bowel movements several times a day, as often as every few hours with feedings. Babies with diarrhea have watery, very loose bowel movements that occur very frequently. A baby may or may not have signs of cramping with the diarrhea. Watery bowel movements and diarrhea in a newborn can quickly lead to severe dehydration and should be treated immediately. Consult your baby's health care provider if there is a change in your baby's bowel movements or your baby develops diarrhea.

• Colic. Colic is a problem that affects some babies during the first three to four months of life. It can be very stressful and frustrating to parents. Doctors have defined colic as prolonged or excessive crying in an infant who is otherwise well. The crying can be very loud and can last for several hours a day. Colic often starts by 3 weeks of age, is at its worst around 6 weeks, and gradually gets better by about 3 months of age. It is not clear what causes colic. Some of the reasons babies may have colic include the following:

  • Adjusting to one another. Colic may relate to the adjustments that a new baby and his or her parents have to make to each other. Babies obviously cannot talk. Until they learn to talk, one way they communicate with adults is by crying. Parents have to learn to interpret the reasons their baby is crying, and then determine what to do to make the baby more comfortable. Is the baby hungry? Wet? Cold? Hot? Tired? Bored? A baby will cry for these reasons as well as for other problems, and parents must try to determine what is causing their baby stress, often by trial and error. New parents, especially, may have trouble reading their baby's cues. The baby may continue to cry simply because his/her needs have not yet been met.

  • Temperament and adjusting to the world. Newborns must also make adjustments to the world around them. Not all babies have the same temperament. Some adjust to lights, loud noises, and all the other stimulation around them without difficulty, while others are not able to adapt as easily. Just like adults, some babies are easygoing, and some are impatient. Crying may be one way for a baby to vent feelings as he or she is getting adjusted to the world.

  • Oversensitive to gas. Another possible reason for excessive crying in babies might be that they are oversensitive to gas in the intestine. The normal amount of gas that is produced as food is digested may be more uncomfortable for some babies than others. If a baby with colic seems to pass more gas than other babies do, it is probably due to swallowing more air while crying for prolonged periods of time.

  • Milk allergy. It is rare for colic to be caused by a true milk allergy. However, some babies may be more sensitive to cow's milk-based formulas. Your baby's health care provider may recommend changing formulas to a soy-based rather than cow's milk-based formula to see if this helps relieve the symptoms of colic.

Dealing with colic

Learning how to interpret your baby's cry can be helpful in dealing with colic. It does take some time for parents and babies to become accustomed to each other. Remember, babies will cry for a certain length of time every day even under normal circumstances.

Other suggestions include the following:

• Make sure your baby is not hungry, but do not force feed if he or she is not interested in the bottle or breast.

• Change your baby's position. Sit him or her up if lying down. Let your baby face forward if you are carrying or holding him or her facing your chest. Babies like to see different views of the world.

• Give your baby interesting things to look at: different shapes, colors, textures, and sizes. Talk to your baby. Sing softly to your baby.

• Rock your baby.

• Walk your baby.

• Place your baby in an infant swing on a slow setting.

• Let your baby lie on his or her belly on your lap, and rub his or her back. If your baby falls asleep, be sure to put your baby on his or her back in the baby bed. Never leave your baby unattended on a bed, sofa, or other soft surface.

• Consider going for a ride in the car. The motion of the car often soothes babies.

• Try using something in your child's room that makes a repetitive sound, like a wind-up alarm clock or heartbeat audio tape.

• Hold and cuddle your baby. Babies cannot be spoiled by too much attention. However, they can have problems later in life if they are ignored and their needs are not met as infants.

Let an adult family member or friend (or a responsible babysitter) care for your baby from time to time so that you can take a break. Taking care of yourself and lowering your stress level may help your baby as well.