Common Digestive Problems in the Newborn

Gastrointestinal discomfort or digestive problems such as diarrhea, regurgitation/reflux, constipation and colic are very common during infancy. They can occur separately or in combination as more than 50% of the infants suffer from two to three symptoms. These symptoms cause discomfort, pain and unhappiness to the infants leading to excessive crying and irritability which may lead to physical and mental stress to the family especially parents. Therefore, effective solution to these problems is very important to ensure happiness for both parents and babies.
(A) Diarrhea
1. What is diarrhea?
Increase in frequency of unformed or watery stools.
2. What causes diarrhea?
Mostly due to infection either bacteria or viral from the contaminated water or food sources
Other causes may be due to food intolerance (eg: lactose intolerance), food allergy (eg: cow’s milk protein allergy) or cause by certain medications such as antibiotics.
3. What is the danger of diarrhea to my baby?
Uncontrolled and persistent diarrhea may lead to dehydration to your baby causing excessive loss of water and electrolytes. Severe dehydration may cause electrolytes imbalance and circulatory shock.
Watch out for signs and symptoms of dehydration such as dry lips, sunken eyes, poor urine output, lethargy or inactivity.
4. What can I to do if my baby have diarrhea?
Firstly, bring your baby to see doctor to determine the cause of diarrhea. Your baby’s doctor will then treat the underlying cause and replace the water and electrolytes that have already lost by using oral rehydration salt.
5.Should I continue to feed my baby? Will it worsen the diarrhea?
Our aim is to continue to provide adequate nutrition to your baby to build up the body immune systems to fight against the infection. Breast feeding or formula feeds should be continued especially for young infants. If your baby develops secondary lactose intolerance after infection, it is advisable to change to lactose free formula until the diarrhea gets better and then your baby can change back to the normal formula.
6. What should I do to prevent my baby from having diarrhea?
Practice good hygiene while breastfeeding or bottle feed your baby. Ensure proper and correct feeding technique i.e. correct concentration and quantity to the needs and age of your child. Feed more often with smaller quantities.

 (B) Gastro-esophageal Reflux (GOR)/ Regurgitation
1. What is regurgitation
Sudden and effortless return of small volumes of gastric content into the esophagus and mouth, also called reflux.
2. What causes reflux?
The main reason for GOR is an underdeveloped or weak lower esophageal sphincter. It may also be caused by large meal with relatively small stomach, short esophagus and increase abdominal pressure due to straining or excessive crying.
3. Should I worry if my baby has reflux?
Uncomplicated reflux is common and physiological. A lot of babies will regurgitate certain amount of milk after feeding. However, if the reflux is accompanied by other symptoms such as excessive crying due to pain (esophagitis), failure to gain weight or projectile/forceful vomiting, you should bring you baby to your doctor’s attention immediately for further assessment and evaluation.
4. What I can do if my baby has reflux?
You can try feeding your baby with smaller amount of milk but more frequent feeds and give time for him/her to burp. Handle your baby carefully especially when the stomach is full.
Nurse your baby slightly upright position about 30-45 degrees during feeding and for about ½ hour post feeding. . Thickening the milk (thickened formula) with carob bean gum is recommended as a treatment for regurgitation and proven to benefit most infants
5. Can my baby recover from reflux?
Majority of the uncomplicated reflux will resolve spontaneously, normally by 6-12 months of age. With proper feeding technique, slightly upright position and thicken feeds, reflux will be self limiting. Those associated with complication and more severe presentations, your doctor may need to prescribe some medications to facilitate the gastric emptying and suppress the gastric acidity.
 (C) Constipation
1. What is constipation?
Constipation is an irregular bowel movement which leads to dry and hard stool.
2. What causes constipation?
–     Underfeeding causing lack of fluid/water aggravated by high environmental temperature
–     Formula low or free from lactose, high in fat, calcium, protein (casein) and low in phosphate
–     Intestinal diseases or deformities of the digestive tract
–     Neurological disorder causing decrease guts motility
–     Due to certain medications e.g. iron supplementation
3. What constipation will lead to?
Constipation may cause abdominal pain and pain during defecation. Hard and bulky stool will cause tear to the perianal region leading to bleeding and more pain. Children who experience pain during defecation will tend to keep the stool longer which causes the stool to be more bulky and harder and certainly lead to more pain. This vicious cycle will worsen the constipation.
4. How to treat and prevent constipation?
Give correct feeding in quantity and in composition. Breast milk is the best and the most balance milk to prevent constipation. When the infants are older than 6 months, extra water, fruit juices, dietary fiber foods like fruits and vegetables should be introduce in the daily diet.   These dietary fibers in the form of oligosaccharides also called prebiotic help to promote the growth of good and friendly bacteria (probiotic) which acts synergistically to increases volume and viscosity of the stools leading to better gut motility. Probiotic (good and friendly bacteria) supplementation is also proven to be helpful in treating and preventing constipation by improving digestion and absorption through maintaining balance and healthy gut flora.

 (D) Colic
1. What is colic? 
Colic or abdominal pain/cramps are sudden attacks of gut irritation, bloatedness and discomfort. It may present as prolonged crying i.e. unsettled baby. It stops as suddenly as it started. Crying often starts in the evening especially before bed time. The infants seem to be in pain in which they may stretch, arch or lifting their legs. The abdomen may be distended and the infants may pass a lot of wind.
2. What causes colic? Is it real?
The exact causes are unknown but the pain is real. However, there are some factors identified which may contribute to the symptom.
1.   Overfeeding without burping
2.   “Emotional stress” of both baby and parents
3.   Constipation
4.   Food intolerance/allergy
3. What I can do when my baby has colic?
There is no specific treatment for colic and the management of colic is just a matter of “trying out”.   Sometimes whatever you try may just go in vain. However, colic pain can be enlightened by comforting the child by holding him/her in an upright position to facilitate burping or by massaging the baby’s abdomen. Make sure you don’t overfeed or underfeed your baby. Treat the underlying constipation if any.  Some special formula which contains prebiotics (oligosaccharides) may help to promote and stimulate the growth of good and friendly bacteria (probiotics) which may increase gut motility and colonic transit time and thus reduce the colicky pain.


4.When to bring my “colicky baby” to see the doctor?
Inconsolable/irritating cry coupled with abdominal distension and refusal to feed should alert you to bring your baby for medical attention. Your baby’s doctor will then make sure that nothing serious happen to your baby and most of the time will reassure you with some good advise/tips of good feeding techniques. If the symptoms worsen, apart from introducing special formula mentioned above, you baby’s doctor may prescribe colic drops to ease the pain or probiotic drops to facilitate digestion and gut motility. Your baby’s doctor will also try to exclude any possibility of food allergy/intolerance in your baby which may require further dietary modification.

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