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Cranky Newborn

General Advice

Babies have many reasons to be cranky in the first few months of life. They have very sensitive nervous systems. As a result the littlest things such as people talking, a small breeze, or an unusual texture may irritate them, and they may express their discomfort with long bouts of crying. When this occurs we call this colic. However it is important to differentiate between colic and more serious conditions.

If your baby is crying incessantly always take her/his temperature. A rectal temperature is the most accurate. Newer thermometers have a small tip that is easily inserted in to the rectum with a small amount of petroleum jelly. A fever is considered a rectal temperature of 100.5 or higher. If your baby has a fever please call us right away. In addition if your baby is looking pale, vomiting, not eating well, having difficulty breathing or not looking right to you please call us immediately.

Sometimes a hair or thread tourniquet around a finger or toe or scratch to the eye can cause chronic pain or crying. Always look for these problems if your child continues to cry. (Eye scratches can be avoided by filing (not cutting) the nails or using mitts on your child’s hands). If it is established that your child is colicky certain maneuvers can help soothe your child:

  • Rocking the baby in your arms
  • Putting your child in the car seat and placing, the seat on the dryer and let the rumble of the dryer soothe your baby
  • Placing your baby in a bouncy seat or swing
  • Obtain a white noise machine or even put on the vacuum cleaner. These hums are also very soothing.

Again if these techniques are not working please call us.


Constipation

Babies’ gastrointestinal systems are immature and they may not have bowel movements for several days. If this is their regular pattern and is comfortable then this is an ok pattern. However discomfort before having a bowel movement, tiny pellet stools or not having a bowel movement for greater than 3 days can be concerning.

Recommendations include:

  • Adding prune juice ½ to 1 oz per day to one of the bottles
  • Using a thermometer or an occasional half glycerin infant suppository to stimulate bowel movements.

Note: If the condition does not improve with prune juice or a suppository in 3 days, please contact my office.


Gas

Babies swallow much air when crying and get gas pains as a result. Sometimes they obtain gas by sucking too hard while taking a bottle or if the bottle contains too much air. Gas may present with a slightly distended abdomen and the baby pulling up her/his legs. Rarely is the formula or breast milk itself a source of gas.

Remedies for gas include:

  • Improved burping techniques. Burp in the middle of a feed. Place the baby’s abdomen on your breast bone or shoulder and gently compress the whole back to get a better burp.
  • In general make sure the breast feeding baby who is gassy doesn’t stay on the breast more than 20 minutes at a time (10 minutes of good sucking per side is all that is needed). Babies engaged in long periods of non-nutritive sucking may be swallowing more air from around the nipple. In the same way if a bottle nipple is dripping too slowly (less than one drop per second - turn the bottle over before feeding to count) a baby may suck too hard and swallow more air. In this case you may have to increase the flow of the formula by moving up from a small to a medium flow nipple or increasing the size of your current nipple with a small skewer stick.
  • Mylicon drops may also take the edge off the irritability from gas. (0.3 cc after meals and at bedtime)

Reflux

All babies are born with gastro esophageal reflux - heartburn and /or spitting up. This is because the sphincter at the bottom of the esophagus does not have as much tone as it will later in the first year of life. These babies tend to prefer sitting up after a meal and when sleeping, just as adults do with bad heartburn. Sometimes they even crane their necks backward after or during a meal and cry.

Remedies for reflux include:

  • Keeping the child upright after feeds and possibly even have them sleeping in their car seats.
  • Add rice to the bottle (initially 1 tsp baby rice cereal to 2 oz of formula) to thicken feeds. Sometimes higher concentrations are needed.
  • Sometimes I will prescribe an antacid like Zantac or Axid to help with the discomfort. These medicines take away burning due to acid but do eliminate reflux which itself usually dissipates sometime after 6 months of age if not sooner.