Newborns' Bloated Stomachs: A Natural Concern For New Parents

It is common for newborn babies to have a bloated stomach, and this is usually harmless and temporary. However, it can be distressing for parents to see their child in discomfort. A bloated stomach can be caused by gas, which babies may experience up to 21 times a day. This is often due to swallowing air while crying, sucking a pacifier, or feeding. It can also be caused by an allergy or intolerance to certain ingredients in breast milk or formula, or by constipation. In rare cases, a bloated stomach can be a sign of a more serious condition, so it is important to consult a doctor if there are any concerns.

Swallowing air while feeding, crying or sucking a pacifier

It is normal for newborns to have bloated stomachs due to swallowing air while feeding, crying, or sucking on a pacifier. This is because babies swallow air all the time under various circumstances. For example, they may swallow air while crying, laughing, mouth breathing, swallowing saliva, or sucking on a pacifier.

Air swallowing becomes a problem when it happens before and during feeding. This can lead to bloating, gas, abdominal pain, burping issues, and even acid reflux. To prevent this, try to feed your baby before they start crying from hunger, as crying can fill their belly with air. You can also use an air-free feeding system, such as the Bare® Air-free feeding system, which allows you to expel air from the container so your baby doesn't swallow it. Keeping your baby in an upright position during feeding can also help, as gravity will keep food and acids in their belly.

If your baby is swallowing air while sucking on a pacifier, it is important to limit their usage. Pacifiers should only be introduced once your baby has gotten the hang of breastfeeding, usually around three to four weeks after birth. Prolonged use of pacifiers can cause babies to be overly bloated and increase the risk of middle ear infections and teeth misalignment.

If your baby is swallowing air while feeding, there are a few things you can do to help. Firstly, check and adjust your baby's latch. A painful latch or a 'clicking' sound while feeding may indicate that the latch needs adjusting. Shallow latches can be remedied by trying a new breastfeeding position or making minor latch corrections. You can also try hand expressing before latching your baby to slow the flow of milk, or try the laid-back breastfeeding position where you recline on your back while your baby is belly-to-belly with you.

Allergies or intolerances to breast milk or formula ingredients

A newborn's stomach may appear bloated for a number of reasons, and one of them is allergies or intolerances to breast milk or formula ingredients.

Allergies to Breast Milk

It is highly unlikely for a baby to be allergic to breast milk. In fact, a recent study found that less than 1 in 1,000 breastfeeding parents have detectable amounts of cow's milk proteins in their breast milk that could cause an allergic reaction in breastfed babies. However, it is possible for babies to be allergic to something in the mother's diet that is passed through breast milk.

Food Intolerances

Food intolerances, also known as food sensitivities, are digestive issues that occur when a baby's body has difficulty breaking down the proteins in a particular food. According to the American Academy of Pediatrics (AAP), only 2 to 3 out of every 100 infants experience symptoms related to a food intolerance. When these symptoms occur, it is because trace amounts of microscopic food proteins left over from the foods consumed by the breastfeeding parent can sometimes slip into the breast milk.

Allergies to Formula Ingredients

Cow's milk is the most common food allergy in children. Infant formulas are usually based on cow's milk, and babies who are allergic to it may experience a range of symptoms, including swelling of the face, lips, tongue, or throat; shortness of breath; difficulty swallowing; and coughing or wheezing that lingers for several hours after drinking milk.

Preventing Allergies and Intolerances

Exclusive breastfeeding generally helps protect against allergies, but they may still occur. If any immediate family members have allergies, eczema, hay fever, or asthma, the baby is more likely to develop allergies. In terms of formula feeding, the European Society for Paediatric Allergology and Clinical Immunology recommends the exclusive feeding of a formula with confirmed reduced allergenicity in bottle-fed infants with a documented hereditary allergy risk.

Treating Allergies and Intolerances

If a breastfeeding parent suspects that their baby is allergic or intolerant to something in their diet, they should consult a healthcare professional. Eliminating or reducing the offending food from the parent's diet will remove the allergen from the breast milk. For formula-fed babies, the doctor may recommend switching to a hypoallergenic formula where the milk proteins are broken down.

When to See a Doctor

If a baby is experiencing severe or persistent gas, or gas accompanied by other symptoms such as constipation, a rash with diarrhea or green stool with mucus or blood, or constant crying for no apparent reason, it is recommended to consult a pediatrician.

Overeating or feeding in the wrong position

Overeating

Newborns have a sophisticated self-regulation system, and they will stop eating when they are full. However, sometimes they may overeat, especially if they are bottle-fed, as it is easier for them to ingest more milk than their tiny stomachs can handle. This can lead to discomfort, abdominal pain, and crying. It can also cause spitting up and softer stools.

Feeding in the Wrong Position

Feeding a baby in the wrong position can also cause bloating. When nursing or bottle-feeding, it is important to keep the baby's head higher than their stomach. This helps the milk sink to the bottom of the stomach, allowing air to rise to the top and making it easier for the baby to burp. If the baby is not burped properly, air bubbles can get trapped in their belly, leading to bloating and gas pains.

To prevent and relieve bloating and gas, it is recommended to:

• Burp the baby during and after feeding.
• Adjust the feeding position to keep the baby's head higher than their stomach.
• Massage the baby's tummy gently or move their legs in a bicycling motion while they are lying on their back.
• Use a different bottle and nipple combination to prevent the accidental flow of excess air.
• Be mindful of the mother's diet if breastfeeding, as certain gassy foods can be passed on to the baby.

While a bloated stomach in newborns is usually not a cause for concern, it is important to contact a doctor if the baby exhibits other symptoms such as vomiting, constipation, bloody stools, high fever, or extreme fussiness.

Underlying health conditions like gastroesophageal reflux disease (GERD)

While a newborn with a bloated stomach is common and usually not a cause for concern, it could be a symptom of an underlying health condition such as gastroesophageal reflux disease (GERD).

GERD is a severe and long-lasting form of gastroesophageal reflux (GER), which occurs when food and stomach acid flow back up from the stomach into the oesophagus. This can irritate the oesophagus and cause pain, heartburn, chest pain, and trouble swallowing. In babies, GER is common due to their liquid diet and frequent lying-down position, and they often outgrow it. However, if GER becomes more severe and persistent, it develops into GERD.

Babies with GERD may experience symptoms such as coughing, noisy breathing, and vomiting. They may also have difficulty eating or swallowing, and might not gain weight. In some cases, their vomit may contain blood or green or yellow fluid. Additionally, they could experience breathing problems like wheezing or a persistent cough, and the pain may cause them to cry inconsolably.

If you suspect your baby has GERD, it is important to consult a doctor or healthcare provider. They can diagnose GERD based on your baby's symptoms and recommend lifestyle changes or, in some cases, medication to reduce stomach acid.

Constipation or other digestive issues

Constipation is when a baby has bowel movements less frequently than normal, or their bowel movements may be hard, large, or difficult and painful to pass. It is common for babies to experience constipation when changing from breast milk to formula or solid foods. It is also more common for bottle-fed babies to experience constipation than breastfed babies.

If your baby is constipated, they may show signs of straining when trying to pass a bowel movement, and their stool may be hard, dry, and difficult to pass. They may also seem unsettled, fussy, or irritated, and may eat less than usual. In some cases, constipation may lead to a tear or crack in the skin around the anus, which may bleed.

If you think your baby is constipated, there are some things you can do to help relieve their discomfort. Try giving them extra drinks of water if they are older than 4 months (but no more than 1-2 ounces per day, and always check with your doctor first). If your baby is eating solid foods, offer them foods that are higher in fibre, such as pureed prunes or peaches, or cereal with bran, barley, or whole wheat. You can also try gently moving their legs in a bicycling motion to help stimulate the bowels.

In rare cases, constipation may be caused by a lack of nerves going to the intestines or by a problem with the way the intestine formed at birth. Your baby's healthcare provider can advise you on this and recommend further tests if needed.

If your baby is constipated and has a swollen belly, this could be a sign of gas. It is normal for babies to have gas, and there are some things you can do to help relieve it. Try keeping your baby upright for up to 30 minutes after feeding and burp them during and after feeding to help release gas pockets. You can also try different positions to see what works best for your baby. Gently massaging their belly may also help to relieve gas.

If your baby is very fussy and you are unable to calm them down, they are constantly vomiting, or they have blood in their stool, consult a doctor immediately.

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