It's All About the Children

One of the most reassuring things I can share with parents of newborns/young infants is their child is gaining beautiful weight...something often referred to as thriving.  And along with reaching appropriate developmental milestones, hearing their child is thriving removes much of the anxiety new parents have about whether things are going well or not.  But even thriving babies have their issues...particularly when they include those bouts of unexplained and prolonged crying. 

But every cry has its reason and it's my job to help parents figure out why, in fact, their infant is crying.  So in light of this, I thought it would be worthwhile to share some of the more common reasons why thriving infants cry (and again, the long bouts of crying).  So in no particular order...

1. Milk Protein Colitis/Allergy: This one often blindsides breastfeeding mothers...and it usually breaks my heart when I have to tell them they will need to reduce their dietary intake of milk-protein based products.  The usual presentation is a newborn will become increasingly fussy during the first month of his/her life with increased gas and more mucousy appearing stools (sometimes even blood is seen in the poops).  The problem is the infant is not yet ready to digest milk-proteins, and therefore, because they are passed through breast milk, breastfeeding mothers now have to reduce their own intake of milk-protein based products.  And because of an association with soy- and egg-protein as well, I will often instruct moms to reduce these as well.  Now for the formula feeding babies, a relatively simple switch to a hypoallergenic formula (which is based on a predigested protein) is all that needs to occur.  So when does it resolve? Usually over the first year of life and most children will not have any issues throughout life...including lactose intolerance (which is a different entity anyway) unless a significant family history of this exists.  I might also point out here a few other proteins and food groups that can pass through breast milk can also act as an early irritant to an infant's gut...nuts, peanuts, citrus, chocolate, shellfish.  But please don't just cut these food groups out from the start..."try them out before cutting them out".
2. Gastroesophageal Reflux Disease (GERD): Although more common in the premature babies, even the hulking infants can be affected by infantile GERD.  Now we've all seen the commercials for the GERD medications (H2 blockers, proton pump inhibitors) on television geared for adults.  Well, young infants can be plagued with this as well...the difference being, they usually outgrow the symptoms during the first few months of life.  These infants usually present with significant spit-up (more than the normal) as well as associated arching, crying, and writhing around in pain.   The symptoms usually present during or shortly after a feed (but even 1-2 hours later as well).  Now some of those excessive spitters may not be bothered by it ("happy spitters") and I just reassure parents that GERD reaches a peak about 4-6 months of age, before the spitting up begins to improve.  But for those who seem to be bothered by the spitting up, "reflux precautions" are implemented: head elevation after each feed...a good 20 minutes, good burping techniques, and slight head elevation while sleeping.  When these methods provide minimal relief, I then discuss the medications (same as mentioned above) as a possible solution in reducing the acid level in the spit-up, which often helps to reduce the pain associated with GERD.  But remember, these medications do not necessarily stop the spit-up...only time really helps here (unless symptoms are so severe that surgery is discussed). 
3. Colic: ...and when all else fails and the above reasons don't appear to explain the prolonged crying bouts, colic may be the reason. Unfortunately, there is no way to prove colic until it runs its course and there really aren't any interventions to implement anyway. It typically runs its course by about 3 months of age...a reason why I term it the 4^th trimester (not an original thought but something I feel that helps explain this best to parents). I simply share with parents that the gastrointestinal system needs a bit more time to develop.

So for new parents and parents-to-be, if you feel those cries are a bit too much, not only may there be a good explanation for them, there may be a solution as well.

Dr. Jeremy