I'm fortunate to have many newborns in my practice as not only do I thoroughly enjoy working with parents ready to embark on a journey like no others, but it also helps satisfy the "baby fix" I have considering my youngest and last is now approaching 2 ½ years of age.  And while the experienced parents understand those first few months are not always moments of pure happiness, new parents often do not realize there may be some unexpected bumps along the way.  So as a brief guide for the parents-to-be and for others who just want to reminisce about the baby days, I share 3 reasons why the first few months may not always periods of harmony.  And please keep in mind, I am referring to overall healthy infants...those who are gaining appropriate weight and reaching appropriate developmental milestones.  Granted, there are other (and often more significant) reasons for a difficult first few months (and beyond) but for the purpose of this discussion, I'll keep it to the healthy infants.

1. Milk protein colitis/allergy: For a new parent, this is a surprising one.  How can breast milk (or milk-protein based formula for that matter) upset a newborn's tummy?  Well, many proteins (including ones from egg, soy, and nuts) can pass through breast milk.  And sometimes, a baby's digestive system is sensitive or allergic to one or more of these proteins in those first few months causing symptoms such as increased gassiness, irritability, spitting up and/or mucousy-greenish stools.  If suspicious, I will often check a baby's poop for trace amounts of heme (a product of blood) via a simple but crude test in the office.  Please also keep in mind this sensitivity/allergy may take a few weeks to develop and when it does, I usually initially recommend removing dairy, soy, and eggs from a mother's diet as we don't always know which is causing the problem.  For how long?  Well, that depends on the infant.  Some grow out of the allergy in a couple months, others may take the entire first year before they can handle these proteins.  But the good news is nearly all grow out of it.  And for formula fed babies, there are specially designed formulas (unfortunately, quite expensive) to handle this milk protein allergy.  And as an aside, as I am always asked about other foods that may cause some irritability in a breastfeeding infant, ones to keep in mind include nuts, peanuts, citrus, shellfish, and chocolate.  And the process to determine is something is causing a reaction...trial and error.

2. GERD (gastroesophageal reflux disease): As above, doesn't necessarily start on day 1 of life, but takes a bit of time to develop.  Typically, an infant who is symptomatic may or may not be actually spitting up as all it takes is for the reflux to move up the esophagus to cause the symptoms.  What kind of symptoms?  Well, yes, there can be spit-up, but what really looks like painful spit-up...arching, writhing around in pain, and maybe even an acid-like smelling breath.  Symptomatic babies usually feed a bit more frequently as the breast milk (or formula) helps coat the areas of irritation (particularly the esophagus).  Initially, I will recommend good burping techniques (which is actually something that should always be done) and head elevation for a good 15 minutes or so after each feed (good ol' gravity theory).  If formula fed, there are some thicker formulas for the babies with reflux (similar to the idea of adding a bit of rice cereal to a bottle).  If symptoms worsen or persist, I will often use anti-reflux medications in order to ease the pain.  Because the peak age of spitting up is around 4-6 months of age (typically closer to 6), I remind parents to be patient.  And yes, "happy spitter" is a very common term to describe a thriving baby not bothered by the spit up.  I usually try to avoid meds in this situation.

3. Colic: Affecting possibly ¼ of all infants, usually follows the "rule of three"...symptoms of extreme crying and irritability begin about 3 weeks of age, occurs at least 3 days a week, lasts about 3 hours each day (usually in latter part of the day), and typically resolves around 3 months of age (but not always).  If it fits this pattern and I feel confident the milk protein allergy and GERD issues have been addressed, then I usually turn to colic.  What causes colic?  No clear answer but I like to think it has something to do with an immature digestive system.

So what happened in my household?  Well, no reflux issues but my wife had to avoid any nut, peanut, and soy intake while breastfeeding each child...sacrifices, but ones worth making.  And, of course, something clearly worth acknowledging and applauding if you're the parent who doesn't have to make the sacrifices.

Dr. Jeremy