Why Is Your Baby Fussing?
Have you ever wished your baby came with an instruction manual? I know when my first child was a baby, I sure did! Some things are easy to figure out -- like that a diaper needs changing when wet or full -- but some things are much harder to figure out, like when your baby is crying. When my daughter came to us, she was definitely a textbook “high needs” and “fussy” baby. So I’ve learned a lot about high-needs babies during my journey parenting her, her somewhat more settled brother, and finally in my role as a Breastfeeding USA Counselor.
It is a natural response for parents to be troubled by unsettled behavior in their babies. I know my head started spinning with questions, grasping at causes and effects, desperately wanting to try to make it better again: Why was she crying? Was it something I ate or drank? Was there anything I could do or give her to make it better? When will she stop? Her little legs would curl up and her hands were closed in tight fists as she cried. This was where advice and folklore collided as it seemed everyone, from my baby’s doctor to my neighbor, felt the need to share their “colic remedies” with me. Some suggestions I tried, while others did not personally resonate with me (the vibrating baby-belts and mattress pads, for example). I probably heard hundreds of ideas. So, what do you do what you’ve fed her, changed her diaper, checked that she’s not too hot or cold, burped her, swaddled her, rocked her, sung to her and she’s still fussy?
What are some basic things to know about fussiness in breastfed babies?
The first thing I wish was in the "fussy baby instruction manual" is information on normal baby behavior and digestion. Babies are born with immature digestive systems and can be very off-put by their own normally-functioning digestion. A gurgle here and a bubble there can be an upsetting experience for some babies. To some extent, a bit of “fussiness” is normal as the GI tract matures during the early months of baby’s life outside the womb. Generally, sources state normal uncomplicated “fussiness” or “colic” peaks at about 8 weeks and slowly resolves by about 16 weeks. It is considered normal for newborns to cry or “fuss” on and off for up to two hours per day. Waiting it out may therefore be one of the best remedies.
Another important thing to know is that in very young babies, while parents are still learning baby’s cues, fussing and hunger can sometimes be confused. Sometimes babies can behave very “colicky” if they are hungry or are going through a growth spurt and just want to comfort nurse but are instead really having to work for the milk. It’s also normal for your baby to tend to “cluster-up” feedings in the evening hours. Look to your baby’s weight gain pattern for reassurance. After your colostrum begins to transition to mature milk, full-term babies under 4 months of age should be gaining roughly 5-7oz per week. If your colicky baby is gaining weight more slowly or much, much more quickly than that, it’s a good idea to reach out to a Breastfeeding USA Counselor to see if breastfeeding needs a closer look and of course, consult with your baby’s doctor.
What are some things I can do to reduce fussiness, gas, or colic in my breastfed baby?
- Respond to Cues Early
Simply picking your baby up and responding to him is the best way to soothe a fussy little one. Early responses from caregivers can often prevent baby from escalating into major crying.
- Latch well
A deep latch will result in more milk transfer with less air swallowed. In the early months while baby lacks good head control, a semi-reclined position like Laid Back Breastfeeding can use gravity to help deepen a latch and make feeding more comfortable for both of you. If your let down reflex is fast, using “laid back” feeding positions can also help your baby manage a fast flow of milk.
- Skin to Skin
Skin to Skin contact isn’t something that is only helpful in the first few hours after birth - benefits for babies extend throughout the first year. If your baby is too frustrated to latch on, try some skin to skin first to soothe her and then try latching when she is calm.
A simple cloth wrap or sling is a powerful tool to help soothe fussy babies. This technique harnesses the combined powers of warm skin to skin, holding, and additionally adds the calming motion of walking or swaying, which your baby remembers from their time spent in the womb. A fussy baby soothing trifecta!
- Massage & Movement
Results of studies on infant massage as a colic-soother are mixed, but many parents have found it helpful. A favorite one is called the “I Love You” tummy massage. Another movement that is helpful is to lay your baby down on her back and gently move her legs in a “bicycle” motion.
- Set the Mood
Low lighting at night and a quiet, peaceful environment help set the mood for calm. Blue light and background noise from TVs or smartphones can disrupt baby’s still-developing circadian rhythms which can make babies harder to settle. Sometimes playing relaxing music or taking a warm bath with your baby can help relax both of you. Just be sure to have help getting in and out of the tub safely!
While the research results are still mixed, there is a sizeable body of research suggesting that probiotics can be a helpful therapy to relieve a lot of infant digestive complaints. If your baby is under 6 months old, you might consider taking therapeutic doses of probiotics yourself. Some research does hint that there is transfer of mother’s GI bacteria to the baby via breastmilk. Plus, breastmilk is rich in prebiotics that help feed and sustain the beneficial GI organisms.
Again, research conclusions are mixed on ‘manipulative therapies’ but many parents have found that seeking the care of a trained pediatric bodyworker (someone certified in chiropractic care, CST, osteopathic manipulation, or physical therapy) has been of benefit for their baby’s colic. This can be especially helpful for babies that may be fussy for physical reasons like torticollis or who may have undergone a delivery that involved forceps or vacuum extraction.
- Double Check Your Baby’s Vitamins
Many parents are surprised to discover their health care providers recommending vitamin drops for their nursing babies. Vitamin D is one vitamin that your breastfed baby may need. However, some products that your doctor may have recommended contain seriously tummy-upsetting and questionable artificial colors and preservatives! Vitamin D drops that contain only two ingredients - usually just highly purified coconut oil or MCT oil and 400 IUs of vitamin D - are available should one be needed, and can be found online or at health food stores and are less likely to upset baby’s stomach.
If your baby’s doctor is suggesting your healthy full-term breastfed baby needs additional vitamins or minerals like A, C, or iron, you can ask your baby’s doctor for a blood test demonstrating necessity and find a low-additive brand of vitamin or mineral should it be warranted.
- Double Check Your Herbal Supplements
Many mothers use herbs like fenugreek for milk supply support. Sometimes, however, these herbs can cause increased fussiness in a breastfed baby. It may be worthwhile, while you are troubleshooting your baby’s fussiness, to stop the herbs for a week and see if symptoms in your baby improve.
What about gas drops and gripe waters?
While there are many products available marketed to solve infant "colic" and "gas" it’s important to consider the impact on your young baby’s delicate and unsealed GI tract of introducing something other than human breastmilk, because it does carry risks.
- Simethicone Drops
Simethicone is just an anti-foaming agent. It doesn't really do anything other than reduce the surface tension of any bubbles so they pop more easily. It doesn’t stop gas, it simply makes a bubbly substance pass more quickly out of the digestive system. So, in other words, unless your baby actually has outright bubbles in their intestines it doesn’t do much. In clinical trials, simethicone drops have not been shown to be more effective than placebo. Additionally, many commercial simethicone products contain preservatives and artificial flavors which can themselves upset your baby’s stomach.
- Gripe Waters
There are hundreds of “gripe waters” on the market containing various herbs, sugars, extracts, and sometimes things like alcohol, baking soda (sodium bicarbonate), or activated charcoal (which is sometimes administered in emergency rooms when a baby has ingested a poison!!). Things to consider:
- Is the herb even safe? Believe it or not, there are many unsafe herbs used in gripe waters that are available on the market. A kind of anise is one example.
- What risk am I running with respect to pathogen introduction? These products are not sterile and because infant digestive tracts are still developing, babies are susceptible to infections. There have been product recalls for things like parasites (cryptosporidium) or bacteria (botulism) in gripe water products.
- Is this ingredient even going to help or could it harm? One international publication concluded: “Sodium bicarbonate in gripe water has no role as hyperacidity is not a cause for colic. Moreover, if given continuously and in large doses, it may cause alkalosis and milk alkali syndrome.”
What about manually relieving gas?
The use of a rectal thermometer to gently, manually stimulate your baby’s rectum is sometimes suggested to stimulate bowel movements and/or release gas. While this may be something that has been commonly suggested, it’s surprising to know that there is not much research on the safety or effectiveness of doing so!
When is it more than normal “fussiness”?
If your baby is upset and crying more than 3 hours per day, at least 3 times per week, for 3 weeks in a row, and the tips above don’t seem to be helping all that much, it may be worthwhile to investigate whether there could be a medical cause of your baby’s discomfort. I wish someone would have told me that the “rule of three” was a reasonable gauge of whether we were experiencing normal “fussiness” or whether something more could be going on! A few places to start sleuthing solutions to your baby’s discomfort are:
- Lip or Tongue Tie
We don’t have very good statistics on how common lip or tongue tie may be, but current published estimates are that around 4-11% of infants have a small, overly-restrictive membrane of skin under their tongues. There may also be an overly thick or short membrane of skin under their upper lip. In cases where these membranes are restrictive enough to impact the function of the upper lip and/or the tongue a baby’s attachment to the breast and swallowing may be impacted. This can mean a lot of swallowing of air, poor latching, and general ‘reflux’ like symptoms for the baby. Sometimes mothers may perceive these swallowing issues as an “oversupply” of milk, but often the cause is found to be latch-related rather than milk production related.
- Food Intolerance
Most breastfeeding mothers do not have to restrict their diets to eliminate particular foods and can enjoy even spicy foods, caffeine, and so-called “gassy” vegetables without upsetting their babies. However, if your baby is uncomfortable according to the “rule of three” and has other symptoms like excessive gas, chronic diaper rash, poor weight gain, or if your baby’s doctor is considering prescribing a reflux medication for your baby, it may be worthwhile exploring whether something you are eating is bothering your baby. The most likely food your baby may be reacting to in your diet is cow’s milk. However, any of the other "top 8 allergens" could be culprits: soy, eggs, nuts (tree-nuts or peanuts), wheat, or fish/shellfish. The ABM Protocol for Allergic Proctocolitis in the Exclusively Breastfed Infant is another resource to look at if you suspect you may be dealing with a food intolerance.
I am happy to report that after much sleuthing my first "fussy baby" and I did eventually get to the underlying cause of what was bothering her: a cow’s milk intolerance AND a tongue tie! But, I didn’t figure them both out during her first year of life, and it was a very rough, sleepless time period for our family. In my role as a Breastfeeding USA Counselor, I like to share resources with parents who may be dealing with a fussy baby of their own, because I understand it can be very stressful on the whole family when the newest member (or members!) of the family are unhappy. In addition to the information above, some of my favorite resources are The Fussy Baby Network that offers phone support nationwide and also Dr. Sears’ The Fussy Baby Book, which is older, but provides some worthwhile information and a much-needed pep talk for families living with a fussy member of the household.
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