It's hard being a mom to a baby who is fussy and cries a lot. It's even harder when you don't know whether your baby's behavior is due to his temperament or a potential health issue.
Trusting your mother's intuition is always a good idea, as is seeing your pediatrician any time that you are concerned about your baby's well-being. Your doctor can help figure out what's going on and provide solutions to ensure your little one stays healthy and happy.
One way to gauge whether there is something more behind your baby's discomfort is to observe how he acts when you feed him or shortly afterward. Notice if he gets upset when you try to nurse or offer a bottle, or whether he seems uninterested in eating even when you know he's hungry. You'll want to pay attention to these potential signs of trouble too.
All infants experience some degree of gastroesophageal reflux. It's what causes stomach contents to occasionally flow back into your baby's esophagus or mouth (in other words, baby spit-up). But some babies have more severe reflux problems. They may frequently spit up lots of liquid, forcefully vomit, choke or gag, arch away from the bottle or breast, seem irritable during or after feedings, or have trouble putting on weight.
Your little one's stomach may look bloated or feel hard or tense. He may pull up his legs or lock them out straight, clench his fists, and pass gas.
Signs of colic.3
If your infant won't stop crying even though he isn't hungry, tired, or in need of a diaper change, he could have colic. Colic tends to follow a pattern of threes: crying for more than three hours per day (usually in the evening), for more than three days per week, and for more than three weeks. Up to 25 percent of newborns suffer from these crying jags, which generally start a few weeks after birth. Colic often improves by the third or fourth month.
Tiny red bumps on your baby's face, scalp, hands or feet may be a sign of eczema. The bumps may itch, ooze and crust over, or feel like dry, scaly skin.
Raised red welts or hives on your infant's skin suggest that your baby is having an allergic reaction, possibly to something in his diet or to pet dander, a medication, plant pollen, or any number of things. Hives typically occur soon after exposure to an allergen.
A chronic cough, persistent runny nose, and raspy, wheezy breathing may indicate allergies.
Your baby's stool might look like little rabbit pellets or a hard ball. You also may notice some blood. Don't judge whether your baby is constipated by how frequently he has a bowel movement. Sometimes, healthy infants may go several days without one.
The stools of breastfed babies are typically runny and seedy. Stools of formula-fed infants tend to be a little thicker. If your baby has diarrhea, you will notice frequent watery, foul-smelling loose stools. Because infants who have diarrhea may become dehydrated, you should call your doctor.
What's going on?
Any number of things could be causing your baby's behaviors, which is why it's important to see your pediatrician. One condition to consider is cow's milk allergy. You might not be familiar with this health issue, yet it affects up to 240,000 babies in the United States and is a common childhood food allergy.9 Infants who have cow's milk allergy may react in many different ways to the protein found in cow's milk. Most babies experience mild-to-moderate allergic reactions like colic, reflux, diarrhea, constipation, gas, skin rashes and upper respiratory problems. A smaller number have more severe problems, such as breathing difficulties, rectal bleeding, hives or rashes, and anemia.10 The most serious allergic reaction, anaphylactic shock or anaphylaxis, causes a mix of potentially life-threatening health issues—low blood pressure, irregular heartbeat, distressed breathing, intense stomach pain, vomiting and hives—within minutes or hours of exposure to an allergen.11 Fortunately, this sort of allergic reaction is rare.
What is cow's milk allergy?
Babies with cow's milk allergy experience allergic reactions to certain proteins such as casein and whey that are naturally found in milk and other dairy products.12 Ordinarily, your baby's immune system keeps him healthy by fending off illness-causing germs.13 But sometimes, an infant's immune system mistakenly reacts to things that are not a health threat. For reasons that are not clear, the immune system of a baby with cow's milk allergy sees milk protein as an unwanted and harmful invader, similar to a disease-causing virus. For protection, your infant's immune system releases chemicals like histamines to fight off the cow's milk protein.14 This causes allergic reactions. Lactose intolerance, the inability to digest a natural sugar in milk called lactose, can cause tummy upset.15 However, this digestive problem is rare in infants. Unlike cow's milk allergy, lactose intolerance doesn't engage the immune system and cause allergic reactions like eczema, hives, breathing problems, or chronic runny noses and coughs.16
What should I do now?
Your pediatrician should evaluate your baby. If your doctor suspects your infant has cow's milk allergy, he or she may suggest eliminating cow's milk protein from your infant's diet. This isn't as daunting as it might sound. Breastfed babies can be exposed to cow's milk protein fragments passed in breast milk when their mothers consume dairy products. Breast milk still provides the best nutrition for your baby, so you shouldn't stop nursing. Depending on your doctor's recommendation, you may have to make some dietary changes such as eliminating dairy products.17
Formula-fed infants simply need to switch to a formula that is hypoallergenic, meaning it has been specially designed to not cause allergic reactions in infants with cow's milk allergy. The majority of babies with cow's milk allergy feel better after a switch to an extensively hydrolyzed, hypoallergenic formula. In fact, some allergic reactions like colic stop within 48 hours* after a formula change.18 The cow's milk protein in extensively hydrolyzed formulas has been broken down or hydrolyzed into small pieces, so they are less likely to cause allergic reactions in infants with cow's milk allergy.19 Rarely, a few infants with cow's milk allergy react severely to cow's milk protein. If this happens to your baby, you can feed him a hypoallergenic elemental formula made from amino acids, the compounds that form proteins.
Once you make dietary changes and the allergic reactions are managed, your baby's disposition should greatly improve. Here's more good news: You aren't facing a lifetime of saying no to your child's pleas for ice cream, mac and cheese, and glasses of cold milk. More than 75 percent of children outgrow cow's milk allergy by the time they are five years old.20 As your baby gets older, your doctor may recommend that you start reintroducing your child to foods made with cow's milk. This should always be done carefully and under a doctor's supervision.21
*Studied before the addition of DHA, ARA, and LGG.
- AAP: http://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/GERD-Reflux.aspx; Mayo Clinic: http://www.mayoclinic.com/health/infant-acid-reflux/DS00787/METHOD=print; Children’s Hospital Boston: http://www.childrenshospital.org/views/august07/treating_acid_reflux_in_infants.html
- Mayo Clinic: http://www.mayoclinic.com/health/colic/ds00058/dsection=symptoms (under “symptoms/posture changes”); American Pregnancy Association: http://www.americanpregnancy.org/firstyearoflife/colic.html (3rd bullet under “key facts about colic”)
- American Academy of Family Physicians (AAFP): http://www.aafp.org/afp/2004/0815/p735.html (3rd graph); Mayo Clinic: http://www.mayoclinic.com/health/colic/DS00058/METHOD=print (last graph under “symptoms”); American Pregnancy Association: http://www.americanpregnancy.org/firstyearoflife/colic.html; http://www.ijponline.net/content/pdf/1824-7288-36-5.pdf (p. 3, under “a child fed cow’s milk”); Parents magazine: http://www.parents.com/baby/care/colic/colic-basics/; U.S. National Library of Medicine: http://www.nlm.nih.gov/medlineplus/ency/article/000978.htm; World Allergy Organization: http://www.worldallergy.org/public/allergic_diseases_center/foodallergy/
- U.S. National Library of Medicine: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001856/ (8th bullet under “Symptoms”); Nemours Foundation: http://kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=20047&article_set=21940; BabyCenter.com: http://www.babycenter.com/0_eczema_10872.bc
- Nemours Foundation: http://kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=20047&article_set=84042; U.S. National Library of Medicine: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001848/
- U.S. National Library of Medicine: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004990/; Nemours Foundation: http://kidshealth.org/parent/medical/allergies/milk_allergy.html; World Allergy Organization: http://www.worldallergy.org/public/allergic_diseases_center/foodallergy/
- American Academy of Pediatrics: http://www.healthychildren.org/English/ages-stages/baby/diapers-clothing/Pages/Infant-Constipation.aspx and http://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Constipation.aspx; Nemours Foundation: http://kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=128&article_set=46078
- AAP: http://www.healthychildren.org/English/tips-tools/Symptom-Checker/Pages/Diarrhea.aspx and http://www.healthychildren.org/English/health-issues/vaccine-preventable-diseases/Pages/Rotavirus.aspx; Nemours Foundation: http://kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=20029&article_set=46830 (1st graph under “Caring for your child”)
- US: http://www.cdc.gov/nchs/fastats/births.htm/ (3,999,386 births in 2010 (most recent data available); 6 percent of 3,999,386 = 239,936, which was rounded up to 240,000); 6 percent figure comes from: A parent’s guide to cow’s milk allergy: Could my baby have CMA? (p. 3); http://www.ijponline.net/content/36/1/5/ (under “introduction”); Virtual Pediatric Hospital: http://www.virtualpediatrichospital.org/patients/cqqa/milkallergy.shtml (3rd bullet under “what is milk allergy?”)
- PurAmino launch visual; World Journal of Pediatrics, p. 2: http://www.wjpch.com/UploadFile/003%20%2011-194.pdf
- World Allergy Organization: http://www.worldallergy.org/public/allergic_diseases_center/foodallergy/ (under “nose and lung reactions”); NIH: http://www.nlm.nih.gov/medlineplus/ency/article/000844.htm
- Mayo Clinic: http://www.mayoclinic.com/health/milk-allergy/DS01008/METHOD=print&DSECTION=all (under causes”)
- NIH: http://www.nlm.nih.gov/medlineplus/ency/article/000812.htm (under “causes”); American College of Allergy, Asthma & Immunology: http://www.acaai.org/allergist/allergies/Types/food-allergies/Pages/default.aspx (under “food allergy causes”) and http://www.acaai.org/allergist/allergies/Types/food-allergies/types/Pages/milk-allergy.aspx; University of Maryland Medical Center: http://www.umm.edu/ency/article/000821.htm
- NIH: http://www.nlm.nih.gov/medlineplus/ency/article/000812.htm (under “causes”)
- NIH: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001321/; UK Dairy Council: http://www.milk.co.uk/page.aspx?intPageID=60
- A parent’s guide: does your baby have CMA?; Children’s Hospital of Atlanta: http://www.choa.org/Menus/Documents/Wellness/teachingsheets/milkprofree.pdf
- A parent’s guide: Could my baby have CMA? http://www.ijponline.net/content/pdf/1824-7288-36-5.pdf (p. 5); http://www.ijponline.net/content/36/1/5/ (under “a breast-fed infant with suspected CMPA”)
- British Dietetic Association: http://www.bda.uk.com/foodfacts/CowsMilkAllergyChildren.pdf (p. 1)
- A parent’s guide: Could my baby have CMA? (p. 3, under “How common is CMA?”) http://www.ijponline.net/content/pdf/1824-7288-36-5.pdf
- A parent’s guide: does your baby have CMA?