breastfeeding issues
Feeding

Newborn feeding issues

Newborns can be susceptible to a number of different feeding issues, and sometimes it’s hard to tell what’s normal and what could actually be a problem. Here is a rundown of some of the newborn feeding issues you may encounter along the way.

Nutrition directly impacts your baby’s growth and development, so it’s natural to have concerns about whether or not he’s eating a balanced diet. If you’re concerned about your baby’s feeding issues, here is some advice on how to treat the following feeding problems you may experience.

Reflux and GERD

Reflux is a type of vomiting where your baby brings up the contents of her stomach. It’s very common and doesn’t usually hurt your baby. Reflux mostly gets better by itself with time.

Causes
Your baby can bring up food when the valve-like mechanism (lower oesophogeal sphincter) between her oesophagus and tummy momentarily relaxes. This allows tummy contents to come back up. It’s a type of vomiting and is sometimes called ‘posseting’.

We don’t know exactly what causes gastro-oesophageal reflux. It might rarely be associated with a hernia, which is when the bowel bulges upwards through the diaphragm (hiatus hernia).

Symptoms
The symptoms of gastro-oesophageal reflux usually develop within the first month after birth. Your baby might begin to vomit milk – this can happen all the time during, between and after feeds. Most children with reflux will grow out of it by the time they become toddlers.

This is probably because they’re spending more time in an upright position by this age. They’re also eating more solid foods. A small number continue to have symptoms after the toddler period.

In some babies, vomiting of the acid contents of the tummy into the oesophagus will very occasionally lead to complications. In this case, your baby might have gastro-oesophageal reflux disease (GORD).The symptoms associated with GORD might include pain and discomfort of the oesophagus. This might cause irritability and crying. Children might also arch their backs.

Sometimes your baby’s sleep might be upset or your baby might show poor weight gain. You should also look out for a chronic cough and wheeze, which might be associated with GORD.

You should see your doctor if your child:

  • has bile (green fluid) or blood in her vomit
  • finds it difficult to swallow
  • has a fever
  • is irritable and difficult to settle a lot of the time
  • won’t eat
  • is losing weight or not gaining any weight according to basic guidelines.

Tests
Usually, no tests for reflux are necessary. In a small number of children, particularly those who have complications of reflux, doctors might recommend pH monitoring (checking the level of acid) to see whether there’s too much acid from the stomach in the oesophagus. This is done by placing a tiny probe in the baby’s oesophagus for 24 hours.

Sometimes the doctor might want to have a look at the lining of the oesophagus. This test is called an endoscopy and is done under anaesthetic.

Treatment
If your baby’s reflux is mild, and his weight gain is okay, you might try nursing him in a more upright position to ease the problem.

Propping your child up in a cot or placing her on her tummy for an hour after feeds can also help. Sleeping on the tummy has been linked to Sudden Infant Death Syndrome (SIDS), though, so you shouldn’t leave your baby alone in this position.

If your child seems to be in pain after vomiting, or isn’t gaining enough weight, your doctor might prescribe an acid suppressant. The doctor might also recommend thickening formula or using pre-thickened formula for formula-fed babies, or thickening breastmilk with rice cereal or a thickening agent for breastfed babies.

Your doctor can advise you on the most appropriate treatment for your baby. It’s always advisable to consult your doctor if your baby is vomiting a lot with feeding.

Thrush and breastfeeding

If you suddenly get sore, pink nipples after you’ve been feeding without problems for a while, you may have an infection known as thrush. Ask your health visitor or another breastfeeding supporter to check that your baby is attached effectively. Make an appointment with your GP.

You and your baby will need treatment. You can easily give thrush to each other, so if your baby has it in their mouth you will still need some cream for your nipples or an oral thrush tablet to stop it spreading to you. You may want to ask your pharmacist for information. Some anti-fungal creams can be bought over-the-counter from a pharmacy.

Seek further information and help from your health visitor or GP if your baby continues to have symptoms.

Breastfeeding and tongue-tie

Some babies are born with a tight piece of skin between the underside of their tongue and the floor of their mouth. This is known as tongue-tie and it can affect feeding by making it hard for your baby to attach effectively at your breast.

Tongue-tie is easily treated. If you have any concerns, talk to your midwife, health visitor or GP.

feeding issues

Wind

Newborns might have wind because they swallow air when feeding. She may also gulp air down when she cries, and even as she’s breathing. It can make her feel full before she’s had enough milk. It can also make her feel very uncomfortable. They get rid of wind by burping or passing wind from their bottom. Some babies may be unsettled during and after a feed until they’ve been burped.

How do I know when my baby has wind?
If your baby has wind, she may stop sucking on her bottle and cry, or resist going on your other breast. She may squirm and grimace, particularly if you try to lay her down after a feed. Some babies have a lot of wind and need burping after every feed. Other babies hardly ever have wind.

Do breastfed babies get wind?
Breastfed babies tend to get fewer problems with wind than bottle-fed babies. This is because they can control the flow of milk better so suck at a slower pace, swallowing less air with the milk. Breastfed babies are also more likely to have smaller and more frequent feeds, and be fed in an upright position, which can reduce wind. However, breastfed babies will still need to be burped often, especially if they are fast feeders, or if your milk flows particularly quickly.
How can I help my bottle-fed baby to avoid wind?
The flow of milk from a bottle can make babies take in gulps of air between swallows. You can help reduce wind by giving your baby her bottle while keeping her as upright as possible. Also make sure that the bottle is tilted enough for the milk to completely cover the teat hole.
How do I burp my baby?

  • Put a cloth over your shoulder. Put baby over your shoulder with your arm from that side supporting her bottom. Once baby is upright and outstretched, gently rub her back with your other hand.
  • It’s not unusual for your baby to vomit up some milk during burping.
  • Very windy babies might need to be burped during a feed before switching breasts.
  • Sit your baby upright on your lap, letting him lean forward with his tummy against your hand or arm. The pressure of your hand or arm against his tummy might help bring up wind. Rub his back gently with your other hand.
  • Place baby face down on your lap or your forearm so he’s looking sideways and is supported by your knee or hand. Rub his back gently with your other hand.

Are there any medicines that can help with wind?
If your baby has severe wind, talk to your health visitor or doctor. They may suggest an anti-gas medicine that contains simeticone. This can help trapped wind to join up into bigger bubbles that are easier for your baby to burp up. Most babies outgrow the need to be winded. As they get bigger, and become more mobile, they can move around to find a comfortable position for themselves.

If your baby is unsettled
If your baby is unsettled at the breast and doesn’t seem satisfied by feeds, it may be that they’re not attached to the breast correctly. It can also be helpful to ask a breastfeeding supporter to work with you to improve positioning and attachment of your baby.

Expert advice

Clare Boyle, breastfeeding consultant and midwife, gives some expert advice on latching on and positioning your baby.

Latching on issues
The latch on is how your baby attaches to the breast. When the baby is latched onto the breast correctly and sucking, there shouldn’t be any pain or discomfort, just a gentle tugging sensation.

This fact may come as a surprise to you because unfortunately the cultural myth still persists that nipples have to ‘toughen up’ during the first weeks of breastfeeding but this is completely wrong! If the baby is latching on properly then it should just feel comfortable. A good latch will also help the baby have a satisfying and fulfilling feed and also stimulate the breasts to keep making milk.

In short; getting the latch right is the key to successful breastfeeding!

In order to get a good latch the baby needs to take a big wide mouthful of nipple and areola into his or her mouth; the nipple needs to right at the back of the baby’s mouth. To facilitate a
good latch and encourage baby to open his or her mouth wide, you can stroke the baby’s top lip with your nipple; this will elicit a wide open mouth (gape reflex) and then you can quickly bring baby onto the breast. Once baby is latched on, the upper and lower lips should be folded outwards and more of the lower part of the areola should be in the mouth than the upper areola. But most importantly, it should not hurt!

Here are a few latching positions: each has its benefits and with practice you will find which you like best:

Cradle hold
Cradle the baby in your arms and snuggle him or her up close to you, stroke the baby’s top lip with your nipple and wait for a wide open mouth (as wide as a yawn) and then bring the baby onto the breast. Then wait and see how it feels. If it is painful, after about 30 seconds take baby off and try again, You may need to do it a few times to get it right.

Cross cradle hold
Another method is to use a breastfeeding cushion and lay baby facing towards your breasts. Bring your arm along the baby’s back and support the neck and shoulders. With your other hand, hold your breast with your fingers away from the areola and then gently stroke the baby’s top lip with your nipple and watch for the wide open mouth. Then bring baby onto the breast. Wait and see how it feels: If it is painful, after about 30 seconds or so take baby off and try again.

Laid back nursing position
Another method is for you to lie back in a semi-reclining position and place baby tummy down onto your torso with his head on your breast. You will see baby ‘head bob’ up and down (like a woodpecker!) and work his way over to your nipple. You can help baby locate the nipple by moving your breast so he can access it easily. The baby will head bob over to the nipple and latch on himself.
Then you just put your arm around baby to cradle him; you may need a pillow under your arm to support it. This is a very comfortable position to feed your baby and requires very little ‘expertise’ from mum.

Side lying position
You need to lie on your side with your head resting on your lower arm or a pillow. Baby is on his/her side facing the lower breast and snuggled in close. With your other hand along the baby’s back, neck and shoulders wait for baby to open the mouth wide and bring baby into the breast. Often the baby will self-latch in this position with little help from mum. Ensure that you are on a firm mattress and baby is not on a pillow and that the duvet is not up over the baby. If you are having any problems with latching on – don’t stress over it.

Sometimes there are other issues going on that need to be looked at so just find an IBCLC to come and help you as soon as possible

http://www.breastfeedingconsultant.ie

More like this:

Ask Tracey

Midwife Tracey Donegan answers your questions about pregnancy and birth

Q When should I have my first pregnancy scan? And how many scans should I get throughout my pregnancy?

A
Your first scan is known as your dating scan and is routine in all hospitals. Most mums will have this scan at their booking visit, which can be anywhere between 12-18 weeks. The earlier the scan the more accurate it will be. If you have experienced recurrent miscarriages some hospitals will scan you earlier. Contact your antenatal clinic for more information. In Ireland, most women will have two scans in a healthy pregnancy – a dating scan and an anomaly scan at around 20 weeks. However, some units provide a dating scan only. Private scans are also available in most cities and many parents use these services for additional reassurance and to find out the sex of their baby.

YOU MIGHT ALSO LIKE
MUST READ

Ask Tracey

Midwife Tracey Donegan answers your questions about pregnancy and birth

Q When should I have my first pregnancy scan? And how many scans should I get throughout my pregnancy?

A
Your first scan is known as your dating scan and is routine in all hospitals. Most mums will have this scan at their booking visit, which can be anywhere between 12-18 weeks. The earlier the scan the more accurate it will be. If you have experienced recurrent miscarriages some hospitals will scan you earlier. Contact your antenatal clinic for more information. In Ireland, most women will have two scans in a healthy pregnancy – a dating scan and an anomaly scan at around 20 weeks. However, some units provide a dating scan only. Private scans are also available in most cities and many parents use these services for additional reassurance and to find out the sex of their baby.