Gastrointestinal Problems

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 happen 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. Talk with your baby's healthcare provider immediately if your baby is vomiting forcefully or often, 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 happens 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:

  • 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.

  Talk your baby's healthcare 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 happen 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 happen very often. 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. Talk with your baby's healthcare 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 3 to 4 months of life. It can be very stressful and frustrating to parents. Healthcare providers 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. Many people think that colic is caused by belly cramps or gas, but no one really knows for sure. Treatment for gas or changing formulas has not been shown to decrease crying in a colicky baby. Talk to your child’s healthcare provider if you think there is a gastrointestinal problem making your baby fussy. Some of the reasons babies may have colic include the following:

  • Temperament and adjusting to the world. Newborns must 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. 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. Although some people think that gas may be to blame for colic, there is little evidence that this is the case. In fact, treating gas has no effect on colic in babies. The normal amount of gas that is made 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. Some adjustment in the nursing mother's diet can be tried, such as avoiding milk products, caffeine, and gas-producing foods. 

  • 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 healthcare 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.