Hard Baby Tummies: What's Normal And What's Not?

A newborn's stomach hardness could be due to several reasons. It is important to note that a certain degree of bloating and hardness is normal, and newborns tend to cry a lot to communicate hunger, discomfort, or displeasure. However, excessive crying could indicate a more serious issue. Here are some common causes of a newborn's stomach hardness:

- Gas or air in the stomach: This can occur when a baby swallows air while feeding or crying.

- Food that is not properly digested: This can be due to a variety of reasons, such as lactose intolerance or an immature digestive system.

- Swallowing air while feeding: Bottle-fed babies tend to swallow more air than breastfed babies, leading to gas and bloating.

- Lying down after eating: Gravity pulls the food in the stomach upwards, which can cause bloating and discomfort.

- Certain medical conditions: Such as lactose intolerance, pyloric stenosis, or gastroesophageal reflux disease (GERD).

- Certain medicines: Some medications can cause stomach bloating and hardness.

- Food allergies or sensitivities: Newborns may have immune reactions to certain foods, leading to bloating, gas, abdominal pain, and diarrhea.

Swallowing air during feeding

It is not uncommon for newborns to have a bloated or hard belly. One of the reasons for this could be that the baby is swallowing air when suckling, crying, or feeding. This can lead to gas, colic, and abdominal pain.

• Avoid waiting until your baby is desperately hungry to start feeding. Frantic sucking while feeding can lead to air-swallowing, resulting in gas and colic. Learn to recognize the early signs of hunger in your baby, such as sucking fingers or hands, lip-smacking, or sobbing. Set alarms to remind yourself to start feeding your baby before they get too hungry.
• Instead of shaking the contents of the bottle, stir the breast milk or formula to mix. Shaking creates air bubbles that mix with the milk and end up in your baby's tummy.
• If you are using a baby bottle with an air vent or lines, consider switching to a different type of bottle. Vented bottles introduce air into the bottle, increasing the chances of air-swallowing. Bare® Air-free feeding systems allow you to expel the air from the container before feeding your baby.
• Keep your baby in an upright position during feeding. This allows gravity to keep food and acids in their bellies. The Australian hold is a great option for breastfeeding, as it keeps the baby upright. When using a Bare® bottle, you don't need to turn it upside down; it works with suction and no gravity, allowing you to feed the baby comfortably in a 100% upright position.

Lying down after eating

It is not uncommon for newborns to have a bloated or hard belly. This could be due to typical gas, cow's milk allergy, gastroesophageal reflux disease (GERD), or lactose intolerance. To ease your newborn's discomfort, you can try burping them during and after feeding, doing some tummy time fun, or keeping your baby upright for up to 30 minutes after feeding.

Now, lying down after eating may cause indigestion due to the rise of stomach acid, especially if your baby has GERD. Therefore, it is recommended to keep your baby sitting or propped up following a feeding. Avoid letting your baby lie down for about 30 minutes post-feeding. This allows gravity to aid in digestion and prevents stomach acid from rising into the oesophagus, which can cause discomfort and irritation.

However, if your baby experiences postprandial hypotension, which can cause lightheadedness or dizziness after eating, you should consider lying them down for an hour after feeding. Additionally, certain breastfeeding positions, such as the side-lying position, are safe as long as your baby does not have issues with spit-up or reflux disease.

In summary, while it is generally recommended to keep newborns upright after feeding, there may be exceptions, such as in the case of postprandial hypotension or certain breastfeeding positions. Always monitor your baby's reaction to feeding positions and adjust as needed to ensure their comfort and safety.

Allergies or sensitivities

A newborn's stomach feeling hard could be caused by allergies or sensitivities. Food allergies occur when the immune system reacts to a certain food protein, and they can be serious or even life-threatening. Food intolerances, on the other hand, do not affect the immune system.

If your baby seems to get fussy after mealtimes, it could be related to their diet. Food allergies can cause swelling of the lips or face, difficulty breathing, and stomach pain. Even if your newborn doesn't have a food allergy, they may have a sensitivity to certain foods that causes a bellyache.

The most common food allergies are considered IgE-mediated, caused by immunoglobulin E antibodies reacting with food. This reaction leads to histamine or other allergic substances being released. In the US, the nine major food allergens are: eggs, milk, peanuts, tree nuts, wheat, soy, fish, shellfish, and crustaceans. Nearly 8% of children under the age of 5 have food allergies. Allergies to milk, eggs, wheat, and soy often resolve in childhood, but allergies to peanuts, tree nuts, fish, and shellfish are typically lifelong.

If your baby is formula-fed, their stomach pain could be caused by the ingredients in the formula. Some babies also experience an upset stomach when transitioning from breast milk to formula. If you suspect that your baby has a food allergy or sensitivity, talk to your doctor or dietitian, who may recommend an elimination diet or clinical testing to identify the problem.

Additionally, if you are breastfeeding, something in your diet may be transferred through your breast milk and irritate your baby's stomach. Spicy foods, dairy, and caffeine are potential contenders that may unsettle your baby's stomach.

Constipation

It's not uncommon for newborns to have a bloated or hard belly. This can be caused by gas, which is typical in babies, or by constipation.

• Switching from being formula-fed to being breastfed, or vice versa
• Exposure to new foods and flavours
• Not drinking enough liquids
• A lack of fibre in their diet, if the baby has started eating solid food

It is more common for bottle-fed babies to experience constipation than breastfed babies.

Symptoms of constipation include:

• Straining when trying to pass a poo
• Fussiness or irritation
• Eating less, or feeding less well than usual
• A tear or crack in the skin around the anus, which may bleed
• A bloated stomach, which may feel larger than usual, and may contain hard, solid lumps

If your baby is constipated, you can try the following:

• If your baby is not yet eating solid food, give them 1 to 2 ounces of 100% fruit juice (pear, prune, cherry, or apple) once a day. Stop if their stools become loose.
• If they are old enough to eat solid foods, feed them pureed pears, peaches, or prunes instead of giving them juice.
• If your baby eats cereal, give them oatmeal, wheat, or barley cereal. Rice cereal can cause constipation in some children.
• Try giving your baby a warm bath to relax them or exercise their legs, like riding a bicycle, to help stimulate the bowels to move.
• If your baby hasn't pooped in a few days and the juice or pureed food hasn't worked, try a glycerin suppository. Place your baby on their back and gently push the suppository into their anus.
• Contact your baby's healthcare provider before giving them laxatives, baby mineral oil, or enemas to treat constipation.
• Speak to your baby's doctor about medication to help treat constipation.

Gastroesophageal reflux

While a newborn's stomach should feel soft between feedings, it is not uncommon for newborns to have a bloated or hard belly. This can be caused by gas, which is a normal bodily function, or by something more serious, such as gastroesophageal reflux disease (GERD).

GER can cause regurgitation, or spitting up, which may be accompanied by poor feeding, choking, and stomach pain. However, for some babies, reflux is more serious and affects their ability to take in enough nutrients. They may experience additional symptoms, such as blood in their vomit, poor weight gain, or chronic coughing. This is known as gastroesophageal reflux disease (GERD).

GERD refers to chronic acid reflux that may affect a person's quality of life and damage their esophagus. It is characterised by more severe symptoms, including discomfort or irritability, refusal to nurse or drink from a bottle, difficulty swallowing, noisy breathing, and forceful or frequent vomiting. Babies with GERD may require closer monitoring and treatment, such as medication or, in rare cases, surgery.

If you are concerned about your baby's hard stomach or suspect they may have GERD, it is important to consult your paediatrician or healthcare provider. They can evaluate your baby's symptoms, medical history, and growth to determine the appropriate course of action.

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