One of the unfortunate facts about babies is that sometimes, they do cry. Of course, they can't talk yet, and even verbal toddlers are unable to fully manage their emotions. However, babies do give lots of cues and body language that we can tune into, and after a little while, as parents we can often recognise the different kinds of cry that we hear. Some babies do just seem happier than others, and there can be lots of reasons for this. Fostering good attachment can help, and babywearing can be a part of that along with other benefits too. You can read previous blogs on those by following the hyperlinks.
Let's explore some reasons why your baby might be unhappy:
It's funny as an adult when you think that babies often need help going to sleep. You may well find that a feed, a car ride, a walk in the sling or buggy gets them snoozing, but at other times they seem reluctant to give in to temptation! Sometimes this is because we have missed their early warning cues, such as yawning, rubbing eyes, rooting, looking away, grimacing, jerky movements and so on. It's particularly easy to miss these things when out and about or with distractions around like visitors. What happens then, is that the baby's stress response starts to kick in, causing a release of the hormones adrenaline and cortisol, both of which make it harder to calm down and relax into sleep. So, it's not that your baby is trying not to go to sleep, it's that their body is not allowing them because they are too stressed from being tired! Makes sense right?! If you find it happening often, then it may help to take some time to watch out for those tired cues, and start getting baby relaxed and sleepy when you see them. When they are overtired, doing your best to soothe them will eventually work.
OK, so I know that your baby only fed 90 minutes ago, but that doesn't mean that they can't be hungry again. Please don't listen to great auntie Ethel telling you that in her day babies only fed every 4 hours and that's all! A newborn baby is expected to feed a minimum of 8-12 times in 24 hours, and it won't always be evenly spaced out either. Then, add a growth spurt into the mix and it could be more. So, follow your baby's cues: rooting, turning their head, sucking their hands, opening their mouth can all indicate that they want a feed. If you're bottle feeding, UNICEF recommends responsive, paced feeding, to give your baby control of how much they're eating, instead of old-fashioned schedules. This might mean smaller, more frequent feeds than you expect. If in doubt, offer a feed. A baby who isn't hungry will make it clear that it's not what they want, and don't try to force it.
Overfull or windy
On the other hand, your baby might be upset because they are too full, or windy. With bottles, whether formula or expressed milk, we need to be careful not to force a baby to take more than they need. Keeping the baby in an upright position, with the bottle horizontal so the milk does not pour into the mouth will help. Guzzling the milk too quickly can mean that baby takes in a lot of air, and can become uncomfortable with wind. Have a look at the paced feeding video linked above.
At the breast, you can't overfeed a baby, but if the latch isn't quite right, or the baby has any issues like tongue tie, they can still end up in difficulty. A fast let down can cause baby to take in excess air and become uncomfortable too. Laid back or side-lying positions for breastfeeding can help.
For all babies that seem windy, keeping them upright as much as you can (using a sling for example), checking feeding technique and using some baby massage techniques on the tummy can be helpful.
I've put the subtitle here in inverted commas because clinical constipation is actually very rare in babies, particularly before they are introduced to solid foods. A truly constipated baby would have small, hard poo like rabbit droppings, and would need medical treatment fairly urgently. However, it's a term that I hear a lot of parents use to describe their baby seeming to have difficulty with poos. Most of the time, it's normal. Babies have immature systems, and it takes them a while to work out how to do it easily. In a breastfed baby, up to around 6 weeks we would expect at least 2 dirty nappies a day, usually yellow and seedy-looking. After that point, there can be quite a dramatic decrease (this is due to the change in breast milk composition at the point), and anything up to 10 or even 14 days between poos can be normal. As long as the baby generally seems ok, and the poo looks normal when it does come (probably in poonami form!) there isn't anything to worry about. Massaging the tummy regularly can help if you do feel that your baby is struggling a bit, as well as the measures for wind above.
Sometimes babies have allergies, usually related to food. The most common allergy is Cow's Milk Protein Allergy. In exclusively breastfed babies, the incidence of CMPA is only around 0.5 - 1%, and in formula fed babies, it's around 5 - 7%. CMPA is NOT lactose intolerance, which is extremely rare in babies! Human milk has the highest amount of lactose of any mammal (about 8%), and babies who cannot tolerate lactose become seriously ill very quickly.
Potential symptoms of allergy include:
- persistent runny nose and/or eyes
- excessive vomiting
- reflux (see below)
- colic (see below)
- mucus or blood in stools
However, not all symptoms will present in every baby. Some of these may actually be due to ineffective feeding technique, and it is important that feeding is always assessed before anything else happens. For food-related allergies, a breastfeeding mum will need to completely eliminate the allergen from her diet, and the family may need support from a dietitian. Always refer to a medical professional if you suspect your baby has an allergy.
Reflux is another term that seems to be ubiquitous when it comes to babies, and it's important to know what is really meant.
Gastro-oesophageal reflux (GOR), is the normal bringing up of milk after feeding. It occurs in around 40% of babies under 1 year old, and nearly all of them will grow out of it by their first birthday. It's thought that it may have a protective effect for the baby, coating their oesophagus and preventing overfeeding. If your baby is otherwise happy, gaining weight as expected, and the milk is not a weird colour like green or red when it comes back, then it's not a problem, other than the extra laundry that it might cause. It can often be improved by tweaking the feeding technique, minimising time in squashed sitting positions like in the car seat, and keeping baby upright as much as possible.
Gastro-oesophageal reflux disease (GORD) is a different condition, which may require medical treatment. A baby suffering from GORD may exhibit symptoms including:
- unexplained crying
- feeding refusal
- choking or gagging when feeding
- poor weight gain
- projectile vomiting
- vomiting blood or bile
If your baby has these symptoms, a trip to the GP is in order, and the first step should be assessing the feeding. If you're breastfeeding, this should be with a trained breastfeeding counsellor or lactation consultant, although unfortunately this often doesn't happen. If initial changes to the feeding don't help then some medication might be needed.
Sometimes babies can exhibit these symptoms but without vomiting, which is known as silent reflux.
It's important to note that reflux is often a symptom of something else, rather than a diagnosis in itself, so it is important to look at feeding as starting point for improvement.
Lack of responsiveness
Sometimes, all your baby wants is a cuddle! And that's ok! I cannot stress enough, that YOU CANNOT SPOIL A BABY. Let me say that again: YOU CANNOT SPOIL A BABY. Sometimes, they just need to know that you're still there, or they need you to change their nappy, feed them or just hang out. If you feel that you're having trouble responding to your baby, or boding with them, consider the possibility of postnatal depression, or some unresolved trauma from your birth or feeding experiences, and seek help.
Babies generally have poor circulation, which means their hands and feet are often cold, and they end up being overdressed. A more accurate indicator of their temperature is to feel their tummy. Consider how many layers you're wearing and then perhaps add one for your baby. Don't forget, that a sling also counts as a layer! Most people have a tendency to overdress babies rather than underdress, but that can happen too. Keep an eye on their temperature when sleeping as well; an ideal room temperature for sleeping is considered to be between 18-21 degrees C. If you bedshare, your baby will also gain a lot of warmth from your body so might need a bit less.
Having a wet or dirty nappy can make some babies unhappy, and who can blame them? It's never a bad idea to check of you can't work out what's wrong, especially if it's been a couple of hours since the last change.
Babies can be easily overstimulated. In general, the younger the baby, the faster this will happen. Here, we're looking out for body language such as breaking eye contact, looking away, jerky body movements and unhappy noises. When these things start, your baby is indicating that they need a little break.
Equally though, babies can be bored! If they're awake and alert, this is an ideal time to do something with them. It doesn't have to be fancy; singing to them or engaging with some simple picture books will be enough.
"High needs baby"
Some babies, for whatever reason, do just seem to need more attention than others. Of course, they are all individuals, and adults are the same in that regard. Sometimes these are known as 'velcro babies' because they seem to need constant contact, even beyond the fourth trimester period. The first thing to remember is that these babies are not the way they are as a result of your parenting! You haven't done anything wrong, and you're not dong anything wrong by responding to their needs. Although it can be exhausting and intense, by responding to their needs you are helping them learn to trust you and develop independence at the pace they need.
Another rather overused term in my opinion! What is colic? Well nobody really knows. It's used to refer to unexplained crying in an otherwise healthy baby. The oft-quoted definition is the rule of 3: 3 or more hours of crying over 3 or more days over 3 or more weeks. The baby may also seem uncomfortable in the tummy, red in the face and clenching their fists. Most theories say that it's a result of gastric distress, but it's important to remember that it is a symptom NOT a diagnosis.
Firstly, have a look at the feeding (have we heard that before?). If you're breastfeeding, get some help to make sure the latch is the best it can be. If you have a fast let down, a laid back position can help, and keeping baby upright as much as you can during the day. Babywearing can be great for this. If you're bottle feeding (formula or breast milk), look up paced feeding. Try feeding baby little and often according to their cues. Baby massage can help too. There is little to no evidence to support use of colic products you can buy in the shops, or formulas that claim to help. The NHS does not recommend the use of "comfort" formulas or similar products. If your baby does seem to have colic, remember that it is not your fault, and get some support.
Responsive bottle feeding
High needs babies
Disclaimer: the information in this blog should not be taken as medical advice. If you have any concerns about your baby, you should always contact a medical professional such as your Health Visitor or GP.