This simple recipe for keeping a baby happy works for the majority of breastfeeding families. But a few babies remain unhappy despite their parents’ efforts to meet their needs.
It can be worrying if your baby is unsettled, uncomfortable, distressed or in pain. If he is being sick, experiencing diarrhoea or has other symptoms, this may add to your concerns. 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 behaviour shows that something is not right it’s important to keep searching until you find a solution that makes both of you feel better.
Hunger – or some other source?
Comfort techniques
Not enough breastmilk
Oversupply or forceful flow
Thrush in a baby’s mouth
Reflux disease
Pyloric stenosis
Diarrhoea due to a stomach upset
Lactose intolerance
Congenital disorders
Allergy and food intolerance
Hunger – or some other cause?
Delaying 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.
Comfort techniques for unhappy babies
If your baby 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.
Care for an unhappy baby isn’t 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 can be just what is needed.
See I think my baby’s got colic for more information..
The colic hold:
The ‘colic hold’ can be useful for comforting an unhappy baby
Not enough breastmilk
Your 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 nappies too. After the first four days, expect at least 6–8 wet and 3–5 dirty nappies in 24 hours. These should be yellow, loose unformed poos at least the size of a 2p coin. From about six weeks, some babies have less frequent but abundant poos.
See Is My Baby Getting Enough Milk? for more information.
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 poos 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 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.
See Too much milk and oversupply for more information.
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 windiness and slow weight gain because a baby doesn’t nurse as well as usual. When a mother or baby takes antibiotics, their risk of thrush increases.
See Thrush for more information.
Reflux disease
A baby with gastro-oesophageal reflux (GOR) has a weakness in the tissue around the opening between the oesophagus 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.
See Reflux for more information.
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 2 and 6 weeks with increasing frequency of possetting, or projectile vomiting, along with poor weight gain.
If projectile vomiting occurs every day consult your doctor, as your baby may need medication or even surgery to resolve the problem.
Diarrhoea due to a stomach upset
A baby or toddler with diarrhoea due to illness has 12–16 watery, smelly poos 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 diarrhoea, with loose poos, while his gut heals.
If your baby has diarrhoea 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 an individual 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 breastmilk, 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 2 and 4 years.
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. Cow’s milk protein is one of the most common allergens.
See Allergies and Food Intolerances for more information.
Congenital disorders
In extremely rare cases, a baby is born with a congenital metabolic disorder such as ‘galactosaemia’ 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.
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.
Written by Sue Cardus and mothers of LLLGB. Photos courtesy of Sue Upstone and Justine Fieth.
Further Reading
The Womanly Art of Breastfeeding, 2010, Pinter & Martin Ltd
My Baby Needs More Milk
Is My Baby Getting Enough Milk?
Too Much Milk and Oversupply
You can buy this in A4 printed form from the LLLGB Book Shop.
Copyright LLLGB 2015