Illness in a new baby can be a daunting and worrying time, and little ones can lose weight quickly when they are unwell. The most important thing is not to panic, and to follow your instincts. Your pediatrician will be a source of practical, reassuring advice, so be sure to talk to him or her about any worries you may have.
Q: My baby often vomits after feeds; is this normal?
A: Possetting, which means regurgitating a small amount of milk after feeds, is normal. In most cases it is caused when bubbles of air become trapped while feeding. Normal burping will usually bring these up, but a small amount of milk may reappear as well. In some cases, it may reappear quickly, sometimes through your baby’s nose.

You can help prevent possetting by handling your baby gently after a feed, particularly when burping her; turning her upright immediately after a feed; providing smaller, more regular feeds, rather than filling her tummy to brimming; keeping your baby at an upright angle while feeding her; and, if she falls asleep soon after the feed, raising the head of her bed slightly by placing a folded blanket underneath her mattress, to lift her to a slight angle (about 20°).

If you are breastfeeding, you can also try reducing gas-producing foods in your diet, such as cabbage, beans, lentils, broccoli, and onions.

Bottlefeeding? Try to avoid overfeeding by letting her have a break before the bottle is finished, and burp her about halfway through the bottle.

Q: What is gastric reflux?
A: Gastric reflux is a more severe form of possetting, but it has a physiological cause. It is usually the result of a weak valve at the top of your baby’s tummy, which allows the feed, along with gastric juices, to come back up, causing vomiting and a burning sensation, similar to heartburn. If your baby continually brings up her feed, seems in pain during feeding, is taking only small amounts of milk, and cries excessively, he may have reflux.

In most cases, it resolves itself during weaning and doesn’t harm your baby. However, see a doctor for a diagnosis and treatment. In more severe cases, a pre-thickened formula milk or antacid may be given. Elevate your baby’s bed slightly (see My baby often vomits after feeds; is this normal?) to help ease discomfort, and refer to the other tips for easing possetting, too. It may also help to offer solids a little earlier (see Time for the First Taste?); it’s best to discuss this with your doctor.

Q: What should I do if my baby has a diarrhea and vomiting virus?
A: The best thing to do is to continue with her normal milk, offering feeds little and often, and if this continues beyond two days, take her to the doctor. It’s very easy for small babies to become dehydrated, which can become a serious problem if it is not treated. Signs of dehydration include a sunken fontanelle (the soft spot on your baby’s head); listlessness; sunken eyes; dry mouth, eyes, and lips; dark-colored urine; and much fewer wet diapers (fewer than six per day).

Once diarrhea and vomiting start, monitor your baby for signs of dehydration and ensure that you keep up her milk intake. Breastfed babies will need increased feeds, and possibly some additional oral rehydration solution. Bottle-fed babies are likely to need 24 hours on oral rehydration solution, with a little formula in between, although it might be necessary to continue to offer water and oral rehydration solution for a further few days. The most important thing is to keep your baby hydrated, and any fluid, such as water, will do.

If the diarrhea and vomiting are not accompanied by a fever, and do not seem to be linked to gastroenteritis, it is worth seeing your doctor to establish if your baby is allergic to milk (see My baby has persistent diarrhea—should I change his formula? for more information on food allergies in babies).

Furthermore, many little ones develop lactose intolerance after a tummy bug. This is because they lose the enzyme to digest lactose. In this case, your doctor will suggest switching your baby to a lactose-free formula for a short period (around four to six weeks in most cases), after which your baby will be able to tolerate her normal formula milk again.

Q: My sick baby doesn’t seem interested in her regular milk; what should I do?
A: Just like adults, babies who are unwell may not feel hungry, and will refuse feeds. However, because babies can become dehydrated so easily, it is very important to offer plenty of water. If your baby does become dehydrated (see What should I do if my baby has a diarrhea and vomiting virus? for symptoms), it may be necessary to offer an oral rehydration solution, and in this situation, you should always pay a visit to your doctor. Do continue to offer him regular feeds, but don’t be tempted to dilute his regular milk, which is carefully blended to ensure the right balance of nutrients and fluid. It’s particularly important that you continue to offer your baby feeds if you are breastfeeding, because your milk contains antibodies that will help him to fight any infection.
Q: Could my baby’s colic be the result of the formula I’m giving him?
A: Colic is one sign that your baby may not be tolerating the formula you give him. You could try switching brands, although most are identical, and this may not make a difference.

If the problem is recurrent, and associated with other symptoms (see If my baby seems uncomfortable after a feed, could she have food allergies?), or if your baby seems very distressed or unwell after feeds, see your doctor, who may prescribe anti-reflux medication or, if unsuccessful, a hydrolyzed formula.

Q: If my baby seems uncomfortable after a feed, could she have food allergies?
A: A baby may seem uncomfortable after a feed for a variety of reasons, and allergy is only one of them. Food allergies are more common in families with a history of allergies and babies with eczema. A sign of allergy in babies is discomfort, as well as rashes on her face or body, and even eczema. Diarrhea, vomiting, colic, distress, and constant crying, hives, and breathing difficulties are also possible signs that something in her milk is not agreeing with her. It’s very important to take these symptoms seriously—talk to your doctor if you’re concerned (and in the case of breathing difficulties, call for an ambulance immediately).
Q: My baby has persistent diarrhea—should I change his formula?
A: If your baby has recurrent diarrhea or vomiting, and doesn’t seem to be thriving on the formula you have offered, it’s most certainly worth looking at the potential causes.

If you suspect that your baby’s formula is making him ill, see your doctor immediately. If a milk allergy is diagnosed, in most cases a hydrolyzed formula will be offered. This contains all of the nutrients your baby needs for normal growth and development, and is perfectly safe. They are not very pleasant-tasting, however. Babies who don’t know any different accept the taste, but it can be difficult to introduce if your baby is used to normal formula.

Be aware that goat’s, rice, oat, pea, and nut milk are not recommended for babies, and soy milk should not be introduced before six months.

Q: My baby seems to be reacting to my breast milk. Should I switch to formula?
A: Breast milk is still the very best nutrition for your baby. Whether your baby is truly allergic, or simply experiencing a temporary reaction to certain foods in your diet, making changes to what you eat, with the help of a dietitian, can make a difference. Remember, too, that many babies are fussy in the first few months, regardless of what you are eating. Unless your baby experiences other symptoms, such as vomiting or diarrhea (see My baby has persistent diarrhea—should I change his formula?), chances are she’ll outgrow this and continue to breastfeed happily.
Q: My baby has a cold and is having trouble feeding because he can’t breathe through his nose—what should I do?
A: It can be very difficult for babies to feed when their nasal passages are blocked, and they may end up going on and off the bottle or breast with a series of gasps for air. Place a few drops of eucalyptus oil in a bowl of hot water near the feeding chair to open his airways, or squirt a little saline solution into his nose before feeding. Holding him upright can help, and, if all else fails, buy an aspirator—to suck the mucus from his nostrils.
Q: Is it possible to diagnose food allergies this early?
A: Even young babies can have food allergies diagnosed, but it’s important to remember that not all symptoms are the result of allergies. In some cases, your baby may simply be irritated by something you are eating, and become temporarily fussy. For example, onions, cauliflower, and broccoli can cause your baby to experience gas, and other foods such as chocolate may cause your baby to have diarrhea.

On very rare occasions, newborns can be allergic to foods passing through their mothers’ breast milk—for example cow’s milk and eggs. The reaction in this instance tends to be eczema flare-ups or an upset tummy, rather than wheezing or hives.

In other cases, make a note of any symptoms that appear after feeding your baby , and see your doctor to work out how best to eliminate them.

Feed a fever?

If your baby has a fever, continue breast or bottle-feeding as normal, and if she seems resistant, offer her more frequent, smaller feeds. Any baby under the age of six months with a fever should be seen by a doctor. If your baby is older than this, use your judgment, and keep a close eye on her. If she is listless and failing to take her feeds, you should call a doctor right away.

Allergy worry

It is important to note that the symptoms associated with allergies (see If my baby seems uncomfortable after a feed, could she have food allergies?) commonly occur during infancy, and allergy is only one explanation. Also, although allergies are increasingly common, only a small proportion of the population are affected by food allergies (approximately 6–8 percent of infants and 3.7 percent of adults in the US and UK). There is no need to worry unduly that your baby will suffer from allergies unless your family has a history of allergy (including hayfever, asthma, eczema, or food allergies) or your baby suffers from eczema. However, if you are concerned that your baby has an allergy, or you’re worried about your baby’s health in any way, speak to your doctor.

Did you know…

that an increasing number of little ones are showing signs of vitamin D deficiency? Vitamin D is important for the formation of healthy bones and immunity. The best way to ensure your baby has adequate levels is to get him out in the sunshine for a few minutes each day. Some dark-skinned babies in northern climates may require a little extra vitamin D, in the form of vitamin drops, because their darker skin makes it harder for them to absorb the sun’s rays.

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