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Breastfeeding the Fussy Baby Features
Updated December 2015
Sue Cardus and mothers of La Leche League GB
Photos: Suzie Blake

 

Fussy baby?

“The newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts and security in the knowledge of her presence. Breastfeeding satisfies all three.” — Dr. Grantly Dick-Read

This simple recipe for keeping a baby happy works for the majority of breastfeeding families. But a few babies remain unhappy and despite their parents’ efforts to meet their needs. It can be worrying if you have a fussy baby, that is if your baby is unsettled, uncomfortable, distressed or in pain. If he is being sick, experiencing diarrhea or has other symptoms, this may add to your concerns.

Identifying possible causes

Babies can be unsettled for many reasons and it can sometimes take time and effort to work out the cause. You may worry that your baby’s symptoms are caused by something either of you has eaten. While it’s true that food allergy or intolerance could be the cause it is wise to consider other possibilities first. When your baby’s behavior shows that something is not right a La Leche League Leader can help you keep searching until you find a solution that makes both of you feel better.

Hunger—or other cause?

fussy babyDelaying or scheduling feeds will make most babies unhappy. Responding to your baby’s fussiness by breastfeeding (offering both breasts if needed) and/or carrying him will ensure that he is comforted and not hungry. It is normal for a baby to want to nurse around 8–12 times each 24 hours. The table below outlines some other reasons for babies being unsettled or unhappy, and there are some ideas, and suggestions of where to find out more if you have a fussy baby.

Comfort techniques

If your baby is distressed he will need you all the more while you try to work out what the problem is. If he isn’t comforted by breastfeeding you may find carrying him in a sling or soft carrier helps. Research shows that babies who are carried more tend to cry much less. And even if your baby doesn’t settle, he will at least know that someone cares enough to be with him while he’s unhappy. Sometimes the colic hold can relieve abdominal discomfort. Mothering an unhappy baby is not easy. Try to minimize outside demands so you can concentrate on your baby’s needs. Enlist your partner’s support in taking care of you both—sometimes the difference of dad can be just what is needed.

Finding out more

Talking to an LLL Leader can help you determine the most likely cause of your baby’s unhappiness and she will be able to suggest things to try. You can obtain information leaflets from an LLL Leader or from the LLLI store or check out what’s available from LLL in your own particular country.

The good news is that many mothers have solved, or at least reduced, their baby’s problems with small changes to breastfeeding management or diet.

It is well worth the detective work involved when you have a happy, healthy infant in your arms again.

Symptoms

Possible Causes

Fussy at breast or breast refusal Latching on problems
Low milk production
Overactive letdown
Oversupply problems
Reflux
Thrush in baby’s mouth
Using creams or ointments on your nipples.
In an older baby, it may coincide with your baby teething, or the start of your period or pregnancy
Latches on to the breast but soon pulls away, arching back; shows distress Intolerance of something in mother’s diet
Overactive letdown
Reflux
Unsettled after feeds A rigid routine
High-need baby
Latch-on problems
Low milk production
Oversupply
Reflux
Thrush in baby’s mouth
Slow weight gain A rigid routine
Low milk production
Reflux
Thrush
Colic and inconsolable crying for long periods Intolerance of something in mother’s diet
Oversupply
Young babies often have a fussy period in the evening.
Waking at night Many babies continue to wake in the night for a lot longer than you might expect.
Green stool, diarrhea Low milk production
Oversupply
Temporary tummy upset.
Frequent sickness, vomiting, projectile vomiting Allergy
Pyloric stenosis
Reflux
Consult doctor, especially if your baby is not gaining weight well.
Eczema, dermatitis, dry skin rashes Reactions to baby products such as bubble bath, skin cream or washing detergent.
Redness of skin often in nappy area or round mouth or on cheeks Allergy
Thrush
You may be told that this is a ‘milk rash,’ but keep an eye on it—it may be part of a bigger problem.
Constantly blocked or runny nose, lots of mucus Allergy
Common cold
Hay fever
Sensitivity to animal hair
Wheezing, coughing, unusual breathing Allergy
Chest infection
Hay fever
Sensitivity to animal hair
Consult your doctor
Ear infections May be caused by a cold or by allergy.
Blood in stool Various causes, consult your doctor.

Pinpointing the problem

Perhaps your baby’s symptoms are caused by one of the things listed. If these brief descriptions are not enough, seek further information by talking to an LLL Leader or to an IBCLC, who can help you find breastfeeding solutions.

Not enough breast milk

fussy-baby-settling-at-the-breastYour baby could be fussy because he is not getting enough milk. In this case he may not show steady weight gain. As weekly weight gain can vary, average your baby’s weight gain over several weeks. Check he is well attached at the breast, and offer both breasts at least 8–12 times every 24 hours. Keep an eye on diapers too. After the first four days, expect at least 6–8 wet and 3–5 dirty diapers in 24 hours. These should be yellow, loose unformed stools at least an inch in diameter (the size of a British sterling 2p coin). From about six weeks, some babies have less frequent but abundant stools.

Oversupply or forceful flow

When a mother is producing too much milk, her baby may often bring up milk, be very windy and want to nurse a lot. He may suffer with colic, and be fussy at the breast, arching away when the milk starts flowing. Rather than the typical yellow poop of a breastfed baby, his may be green and frothy—occasionally or all the time. With oversupply, a baby is likely to be gaining weight very fast, as much as 400g (14 oz) in a week. A baby coping with an oversupply of milk may mistakenly be diagnosed with lactose intolerance or reflux—but the problem can be overcome by attention to positioning and attachment, and by ensuring that he takes a full feed from one breast before switching to the other.

Thrush in baby’s mouth

A baby may have thrush in his mouth. Mothers can also have painful nipple thrush. The main symptoms are fussy nursing because of a sore mouth and sore, itchy, burning nipples. A baby may also have nappy rash. Thrush can cause gas and slow weight gain because a baby doesn’t nurse as well as normal. When a mother or baby takes antibiotics, their risk of thrush increases.

Reflux disease

A baby with gastroesophageal reflux (GER) has a weakness in the tissue around the opening between the esophagus and the stomach, allowing the stomach contents to move back up into his throat. Symptoms include vomiting, colicky crying, and sudden waking at night. Because babies with reflux often associate food with pain, refusal to nurse and slow weight gain are common. Reflux is more common and severe in babies who are not breastfed.  For more information and suggestions on how to reduce a baby’s discomfort until his digestive system matures, see What is Reflux? and  Reflux in Newborns.

Pyloric stenosis

This is a narrowing of the muscular wall of the tube between the stomach and small intestine. The symptoms of pyloric stenosis generally appear between two and eight weeks with frequent spitting up, or projectile vomiting. As this can occur frequently, a baby probably won’t be gaining weight well either. If projectile vomiting occurs every day consult your doctor, as your baby may need medication or even simple surgery to resolve the problem.

Diarrhea due to a stomach upset

A baby or toddler with diarrhea due to illness has 12–16 watery, smelly stools per day, which have no substance. A baby may also have other signs of illness, including fever or vomiting. Even after the illness is over, a baby or toddler who is otherwise well can have continuing diarrhea, with loose stools, while his gut heals. If your baby has diarrhea it is important to continue breastfeeding, offering frequent, small feeds.

Lactose intolerance

Lactose intolerance is the inability to digest lactose (milk sugar), not an allergy to milk, though it can have similar symptoms. Lactose intolerance occurs when someone doesn’t make enough lactase, the enzyme that breaks down lactose in the intestine. Although it can occur in adults, lactose intolerance is very rare in young children. This makes sense as breast milk, the food on which they depend, is extremely rich in lactose.

In populations in which lactose intolerance is common, the ability to produce lactase generally declines gradually and symptoms increase gradually over many years. This sort of lactose intolerance does not occur before weaning age, which is considered to be between two and a half and four years.

Congenital disorders

In extremely rare cases, a baby is born with a congenital metabolic disorder such as galactosemia, which affects the ability to digest and use lactose. Symptoms in a baby are obvious in the first few days as lactose in the mother’s milk increases. These may include dehydration, severe jaundice, illness, persistent vomiting and very poor weight gain. Medical tests may be needed to identify the cause of the problem so appropriate treatment can be given. See more on breastfeeding a baby with a congenital disorder.

Allergy and food intolerance

If you have ruled out most of the obvious causes and your baby is still colicky, unhappy or experiencing dry and itchy skin, you may start to wonder whether your breastfed baby could be reacting to something in his diet or environment or if he is exclusively breastfed, something in your diet.

Starting solids and adding nutritional supplements, fruit juice or other baby drinks to your baby’s diet may trigger allergy symptoms. Once you start offering solids, keep an eye out for any food he might be reacting to and avoid it for a while. Sometimes, a baby will react to a food his mother eats or a supplement she takes—cows’ milk protein is one of the most common allergens. See Breastfeeding and Allergies and Allergies.

Seek support

When you find yourself coping with a baby who is unhappy, your local La Leche League group can be a great place to get practical and moral support. You may well find others there who have had similar experiences. An LLL Leader will be able to access more detailed information on specific conditions, if needed.

Resources

3 Common Breastfeeding Challenges

Cry It Out

Sore Nipples When Breastfeeding

Sweet Sleep

The Fussy Breastfed Baby

The Unhappy Breastfed Baby

There’s a New Baby in Your Life: How Do You…?

The Womanly Art of Breastfeeding

Tongue-tie & the Breastfed Baby

Why Babies’ Tears Make Us Cry And Why They Matter

 

 

 


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