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Parenting with Grainne Ryan-Top 3 Baby Ailments

Tuesday, 21 April 2009

Today Grainne Ryan is here to talk about the most common ailments she sees with babies on her rounds as a public health nurse. These are:
1. Colic
2. Reflux
3. Constipation

Grainne Ryan:
Presenter of Baby on Board Series 2. Grainne is a public health nurse and midwife and mother of three children. Areas of interest child development, parenting issues, adolescent development and post natal depression and works as a public health nurse in Ennis Co. Clare.

The term colic is used to describe an infant with excessive crying, irritability or fussiness.

What causes it?
There are various theories as to what causes it. Some see it as a term that covers digestive problems (allergies to food, wind or reflux), neurological problems (hypersensitivity or highly reactive temperament), and unfavorable environmental conditions (nervous or parents, tension in the home). In my experience it is more often digestive problems. Some pediatricians still use the old 3/3/3 rule: three hours of nonstop crying, three days a week, for three weeks. It usually begins within 2weeks of birth, and lasts until three to four months of age, at which time it generally disappears on its own. If he cries after feeds, it's probably wind or reflux. If he cries at the same time every day if could be colic (other two conditions being ruled out). If her crying is irregular, it might be her temperament - some babies cry more than others.

What body movements does he make when he cries?
If he pulls his feet to his chest, it is most likely wind. If he goes rigid and arches his back it could be reflux. If his face is flushed, and he clenches his fists and draws up his legs against his tummy which can feel hard, this could be colic. your baby may also pass wind or have a bowel motion immediately before or after the screaming bout.

What comforts him when he cries?
If winding him or moving his legs in bicycle motion eases his crying, you probably helped him pass some wind. If sitting him upright in car seat or sling does the trick it could be reflux. Motion, sound of vacuum cleaner or tumbler dryer might distract a baby with colic.

What helps?
To calm the crying, first check the most obvious causes of distress - hunger, a wet nappy, excessive heat or cold or simply wanting to be held. When all this is sorted try the following tips:

. Colicy babies for some reason like their tummies supported. When sitting down place infant along forearm, face down, cradling head in one hand. This takes practice to perfect the technique. When you want to walk around, continue holding the baby on your forearm, with the head in your hand. But bring the baby close to your chest, supporting with your other hand.
. Soothe a baby by warming its tummy with a warm (not hot) hot-water bottle. Ensure that the hot-water bottle is covered and check the top is securely in position, then place on the baby's tummy while he sits on your knee. Do not leave a baby wrapped up in bed with a hot-water bottle, in case it leaks or burns.
. Place your infant in a mechanical baby swing. For some reason the back and forth motion has calmed many distressed babies. Continual, stead movements is the key.
. Run the vacuum cleaner. The sound is like a lullaby to the ears of some colicky infants or you can buy a CD featuring sounds that babies find comforting such as mothers heartbeat, waterfall.
. Cut down external stimuli. Sometimes the more you try to calm a colicky baby, the more it seems to cry. This might be due to he baby's nervous system is too immature to handle any noise. Just hold in your arms and avoid making any noises or eye contact which is a form of stimulation.
. Ask for help, share the evening routine with partner, family or close friends. Colic can be very distressing for parents so while you're going through it get breaks when you can, get out in the fresh air and also take time to relax and practice some relaxation techniques. But remember colic does settle down usually between three and four months and in my experience doesn't affect growth, development and temperament of your baby.
Always consult your GP if crying is persistent, infant refusing to take bottles, infant has a fever of if you are feeling stressed not able to cope.


What is it?
When your infant eats, food goes into the mouth and down the oesophagus. If the digestive system is working properly, the sphincter-the muscle that opens and closes the stomach-allows the food to drop into the stomach and keeps it there. If the digestive tract is fully developed, there is a regular pattern of swallowing, and then the sphincter opening and closing as it should. With reflux, the sphincter is immature and doesn't close properly after opening. The food reaches the stomach, mixes with stomach acid and comes back up, burning your baby's oesophagus.

What to look for
One or two episodes of spitting up should not send out alarm bells. If reflux is truly present, your baby will have difficulty getting through her feed. She might splutter and fuss with the bottle or breast, because the sphincter has stayed shut, making it impossible for her to get food down in the first place. She might spit up or even projective-vomit a few minutes after eating because the sphincter didn't close once the food went down. In a minority of cases babies have pain and the problems of reflux without constant spitting. Babies with reflux are hard to wind and are most comfortable sitting upright or held upright on a shoulder. Any effort at putting them down results in hysterical crying (often misdiagnosed as spoilt baby). The important thing is to watch your childs growth, as some babies with reflux are slow to gain weight. When this happens you need to discuss with your doctor.

What can I do?
-Talk to your GP and get his opinion. If he diagnoses reflux there are treatments available.
-Elevate the cot mattress. Raise it to 45 degree by using a baby wedge or a couple of books.
-Do not pat your baby's back when burping him as this can irritate an already inflamed area. Gently rub in circular motions on the left side of back or rub upwards with baby's arm straight over your shoulder so that the oesophagus is straight. Burping your infant several times during the feeding will help minimize gastric pressure, and the reflux it can cause.

-Look at feeding technique; ensure that the tooth is not too free-flowing. I recommend medium flow. If he has taken a good feed and is still fussy, use a dummy to calm him rather than feed again, which will only make him more distressed.
-Infant Gaviscon helps to reduce the acid in the stomach may be recommended by your GP when conservative methods are not helping.

Reflux generally gets better at around eight months, when the sphincter is more mature and baby is eating more solid foods. When children are in the upright position i.e. walking reflux tends to disappear. In the meantime try some of the tips but always ensure that your baby is thriving by having his weight and length checked by your Public Health Nurse, Practice and if he is faltering contact your GP

The frequency of bowel movements in babies can vary a great deal depending on whether they are breast or bottle fed. Sometimes babies can appear to strain and grunt or go red in the face when they have their bowels opened but this does not mean they are constipated unless the stools are hard. True constipation is rare in young babies and if suspected further advice from a health practitioner should always be sought.

How to recognise constipation
-A baby who is passing hard poo which appears to cause pain or discomfort

The consistency of the stool is more important than the frequency. Breast fed babies can poo from several times per day to less than once per week and as long as the poo is soft the baby would not be considered to be constipated

Causes of constipation in babies could include
-Not enough water in made up formula milk
-A change in formula feed (particularly to 'follow on' formula or at the introduction of cows milk/weaning)
-Not enough drinks particularly in hot weather

How to help
. If the baby is formula fed, check the formula is being made up properly with the correct ratio of powder to water
. Offer extra cooled boiled water in between feeds
. If mum is breastfeeding, look at your diet may need to add more roughage.
. For older babies (over 5 months old) offer fruit juice or small amounts of stewed fruit (e.g. prunes) or steamed vegetables
. A warm bath and gently rubbing the babies tummy clockwise may help
. Gentle exercise. 'Cycling' the babies legs can help stimulate bowel movements
Laxatives should not be given unless prescribed by a doctor