Having an unsettled baby is very distressing for parents. With a plethora of conflicting advice out there, it can be hard for parents to know what to try. The most important thing you can do is to listen to your gut – you know your baby the best! If the advice you receive doesn’t sit well with you, that’s ok. Take the advice that makes sense and leave the rest.
Babies can be unsettled in the first 3 months. It’s usually at its worst until 6-8 weeks and then improves by 12-14 weeks. This time is often referred to as the “Fourth Trimester”. Normal infant cry-fuss behaviour is typically about 2 hours total per 24 hours. If your baby is crying for more than 2 hours total per day, it’s likely we can help reduce that.
Dr Rhiannon Smith and Dr Briony Andrew are here to help you navigate the first few months with a baby, making the transition to parenthood as smooth as it can be. Using an evidence-based method, we will assess the whole situation using a 5-domain approach. Together, we will come up with a management strategy to help you enjoy the days more and dial down your baby.
We will ensure that we have assessed your baby for medical issues that may be contributing to your baby being unsettled. Many parents are concerned about reflux and allergy and we are able to assess for this. Many babies are unsettled due to undiagnosed feeding problems, and again, we are in the perfect position to assess and correct these.
A consultation while you are pregnant is a great idea to get you off to a good start. We can teach you the common causes of infant cry-fuss behaviour, how to manage it and modify your approach using cued-care. We look forward to helping your family.
While you may have heard about the risk of “over-stimulation”, the reality is our babies are often crying out because they are bored! Their brains are little sponges desperate to learn about the world in which they live.
If you have an unsettled baby, you might just find they settle down by changing their environment and stepping outside. Getting on with your day and bringing baby along with you will allow baby to get a rich and changing sensory bath, which usually helps to dial baby down.
MEDICAL CAUSES OF UNSETTLED INFANTS
Many parents are worried their baby has reflux. This condition has been over-diagnosed in recent times, often being blamed as the cause for an unsettled baby, with many babies being prescribed medication to suppress acid secretion (PPIs).
Firstly, all babies have “reflux”. Babies have a very weak lower-oesophageal sphincter which means it is easy for their stomach contents to come back up their oesophagus, into their mouth, and commonly onto the shoulder of their parent. Some babies seem to do this significantly more than others, but as long as they are gaining weight, there is no need for concern.
The good news is, that the stomach contents in babies under 4 months of age is close to pH neutral for 2 hours after a feed. This means their stomach contents are not acidic and are not causing any damage to their oesophagus. It also explains why the recent research proves that PPIs (medications prescribed to reduce acid in the stomach) are no better than placebo for babies under 4 months of age where reflux has been blamed for their unsettled behaviour.
Unfortunately, PPIs (ie Losec, Nexium) are not without potential harm and should only be used in those proven to have GORD (Gastro-oesophageal Reflux Disease). This is where there is proven damage to the oesophagus. Babies that have this condition do not gain weight, they might vomit blood, they might aspirate, and they will be unsettled. These babies need referral to a paediatric gastroenterologist for an endoscopic assessment. This is a very, very small subset of unsettled babies.
- Royal Children’s Hospital – Clinical Guideline
- Scientific Papers:Dr Pamela Douglas “Diagnosing Gastro-oesophageal Reflux Disease or Lactose Intolerance in Babies Who Cry A lot in the First Few Months Overlooks Feeding Problems”.
- Dr Pamela Douglas “Excessive Crying and Gastro-Oesophageal Reflux Disease in Infants: Misalignment of Biology and Culture”
Cow’s Milk Protein Allergy and Intolerance
Allergy to cow’s milk protein seems to be on the rise, although it is also often blamed for causing a baby to be unsettled despite little evidence that cows milk protein allergy (CMPA) causes this. The diagnosis is not to be taken lightly, so a thorough assessment needs to take place. Rarely, babies or children will develop a true IgE-mediated allergic reaction to cow’s milk protein and present with quick-onset hives, lip/tongue swelling, wheeze, diarrhoea and anaphylaxis. The more common presentation is non-IgE-mediated allergy, where symptoms occur 2-7 days after ingestion of the protein. This allergy causes a colitis (inflammation of the bowel) and is more commonly referred to as cow’s milk protein intolerance (CMPI). Babies who have this allergy can present with blood in their stool, diarrhoea, failure to thrive and/or severe reflux. The treatment is total exclusion of all dairy products. If the baby is breast fed, then mum has to exclude all dairy from her diet. If the baby is formula-fed, then a special formula needs to be prescribed. Unfortunately, a percentage of babies with CMPI will also be allergic to soy. A dairy and soy exclusion diet is very challenging and you will need help to navigate this path. Luckily, most babies will outgrow their allergy to cow’s milk at some stage.
Functional Lactose Overload
Breast milk production can be problematic when women have a very generous supply. If the breasts are not emptied well, it can result in engorgement, blocked ducts and even mastitis. Women with a generous supply may find their baby has copious stool production (green and frothy), a bloated stomach, passes wind frequently, is unsettled but with good weight gain. These symptoms are typical of a baby with functional lactose overload – they are getting too much of the sugary milk and not enough cream. There are breastfeeding strategies we can implement to help dial down the milk production to be more in keeping with baby’s needs, while being mindful not to risk mastitis or reducing supply too much. See Dr Briony Andrew or Dr Rhiannon Smith for a full assessment and plan if you feel you may have an overly generous milk supply.