You’ve fed your baby, changed two wet diapers, rocked kiddo to sleep and carried them around the house with you all afternoon… but they're still fussy. It seems like nothing makes them happy or content. In fact, they seem downright uncomfortable.
While all babies are fussy from time to time (hello, witching hour), and growth spurts can cause frequent crankiness, there’s a point when that fussiness can begin to seem atypical. (Like when it goes on… and on… and on… without relief.) You might wonder if there’s a problem, and if you’re breastfeeding, you might even wonder if the problem is you.
Adults get gassy and uncomfortable when we eat something that doesn’t agree with us, so if your baby is miserable, it’s easy to assume your breast milk is the reason. You are your baby’s primary food source, after all. Could your baby really be allergic to something in your breast milk? How can you tell normal infant fussiness from real discomfort? And if the problem is actually your breast milk, what the heck are you supposed to do about it? Read on for the latest from the experts.
What’s considered “typical” fussiness?
“Most babies have fussy periods, especially in first few months of life,” pediatrician Phil Boucher, who practices in Lincoln, Nebraska, tells SheKnows. “Some babies have fussy times of day that parents can predict, and during those periods, the parents are meeting the child’s needs but they continue to fuss. We don’t know why that is other than they spent nine months in the womb, and now they’re in a totally new environment.”
This newborn baby existential angst is commonly referred to as the “fourth trimester” of pregnancy, a term coined by popular pediatrician and author Harvey Karp (who wrote The Happiest Baby on the Block, one of the most recommended parenting tomes around). Karp argues that new parents can alleviate much of the distress newborns experience by simulating a womb environment through things like swaddling, shushing and white noise.
Assuming you’ve been doing all that and your baby is still a total disaster, it’s worth checking in with your pediatrician to see what’s up.
“A child that gets my attention,” Boucher explains, “is one that’s fussy 24-7, day and night. They might also be fussy during feedings, not growing appropriately and really throwing up — not just spitting up — a lot of their feedings, so they’re not getting enough calories.”
What could be the problem?
“Dairy and wheat are the two big [triggers], and soy and corn can also be problematic,” Leigh Anne O’Connor, an international board certified lactation consultant from New York City, tells SheKnows. “But the truth is, depending on the person, anything could [cause a reaction]… I really hate to go there with parents because they feel like they can’t eat anything. People like to put restrictions on nursing mothers, but it’s mostly unfounded.”
It’s important to note, says Boucher, that true food allergies are rare in babies under 6 months of age. If a baby is having a reaction to something in the mother’s breast milk, it would likely be categorized as a sensitivity or an intolerance, not an allergy.
“An allergy is when the body has an immune response to a given antigen, [for example] milk, peanuts or eggs,” says Boucher. “The body makes antibodies against those proteins and causes a reaction, like vomiting, breathing difficulty or rash. But some babies just aren’t as good at breaking down different components, like the protein and sugars found in milk, which can cause gas and discomfort.”
In those cases, a baby likely has an intolerance, not an allergy; while intolerances are slightly more common — affecting 1 to 5 percent of babies, says Boucher — they’re also somewhat harder to identify and diagnose.
“It’s often how parents perceive the baby’s fussiness and discomfort that leads us to believe they have a sensitivity,” he says.
Signs & symptoms to look for
In addition to being fussy all the time and having feeding or weight-gain issues, a baby with a dietary intolerance may also have skin rashes or eczema and blood in their stool.
“A baby’s stool can run the whole gamut of color and texture: mucousy, stringy, seedy, yellow and green and brown and any color in between,” says Boucher. “Parents bring in a lot of diapers for me to look at, and almost all of them are normal. The ones that get my attention are the ones that have persistent blood in the stool.”
A family history of food allergies or intolerances is also usually taken into consideration when diagnosing a problem, Boucher says.
Sometimes, a baby’s discomfort is related to his feedings or mom’s breast milk — but not because he has an intolerance to something in her diet.
“Sometimes, it’s a structural thing, like a misalignment in their body that affects digestion,” says O’Connor. “When I’m working with a family, we look at tongue function, because if a baby’s tongue isn’t functioning well and they’re sucking air [that can cause gas]. Torticollis from the birth or in-utero position… can also really affect the baby’s mood, comfort and feedings.”
According to Connecticut Children’s Medical Center, torticollis (i.e., stiff neck) is a common newborn affliction, affecting boys and girls equally, and typically resolves with simple interventions performed at home. A certified lactation consultant can help a baby with torticollis or other feeding problems by suggesting alternative nursing positions that increase the baby’s comfort, like side-lying.
Another potential problem is the actual volume of breast milk (i.e., oversupply). Since a large milk supply will be higher in foremilk — which La Leche League notes is higher in lactose — it can cause discomfort.
“One thing I like to do before moving on to dietary changes is make sure that the mother’s milk supply isn’t too strong,” Boucher says. “If it is, we can mitigate that so the baby gets both foremilk and hindmilk. Hindmilk doesn’t have as much lactose, is more filling and doesn’t make babies as fussy, typically.”
It’s definitely an intolerance… now what?
If you’ve worked with your baby’s pediatrician to troubleshoot other solutions, and your baby is still fussy around the clock or displaying other signs of an intolerance, it’s time to start testing that theory. O’Connor and Boucher both recommend parents keep a diary to identify what food(s) might be triggering discomfort and then begin a trial of elimination lasting 1 to 2 weeks.
If eliminating a particular food seems to have helped, O’Connor recommends reintroducing the food for one day to see if problems crop up again. If they do, that’s reasonable evidence to suspect your baby can’t tolerate that food right now.
Before you fall into a pit of despair over having to give up dairy or gluten until your baby weans off breast milk, take heart; if it’s an intolerance, your child may be able to handle increasing amounts as he or she gets older.
“Every month or so, reintroduce a little [of that food] and watch your baby, because a lot of the time it’s short-lived,” says Boucher. “You don’t always have to abstain from that food for a whole year or more.”
Even for true food allergies, there’s a bright side: The American Academy of Pediatrics estimates that about 80 to 90 percent of egg, milk, soy and wheat allergies go away by the age of 5, and while the American College of Allergy, Asthma and Immunology is more conservative with their estimates, the prognosis is still good.
What to keep in mind
Though some babies genuinely do have an intolerance to something in their mother’s breast milk, it’s probably less likely than you think — and trying to pinpoint what the problem is (or focusing on the existence of a “problem” in the first place) may put unnecessary anxiety on parents.
“Before making any sort of plan to change what [a mother is] doing, I like to review in-depth what the normal expectations are for fussy babies,” says Boucher. “Sometimes, the baby’s fussiness is just a little outside normal but there’s nothing wrong. I hate to add to maternal stress and guilt [by implying] they’ve been doing something wrong all this time when the fussiness is actually within the scope of normal.”
If your baby does have an intolerance, you have two choices: Eliminate that food from your diet until your baby can tolerate it or is no longer breastfeeding, or switch to formula (which may or may not need to be hypoallergenic, so check with your baby’s pediatrician).
You have to decide what’s right for you. If cutting out the problematic food is a hardship, consider formula; if you don’t want to give up breastfeeding, make sure you read food labels, inquire at restaurants about ingredients and food-prep protocols and hit up the internet for the best allergen-free recipes (coconut milk ice cream, anyone?).