Tuesday, September 23, 2008

My Baby has Gas

In the twenty-five plus years that Corky and I have facilitated the mother support groups, we have noted that the number one concern among new mothers has never changed. If we have heard it once, we have heard it a “million” times, “My baby has so much gas”! There are a myriad of reasons for apparent gastric upset in the infant. The purpose of this blog is to discuss the possible association between cow’s milk protein and colic-like symptoms.

First, a distinction must be made between cow’s milk protein allergy and lactose intolerance. The latter is not an allergy; rather the body is intolerant to a carbohydrate, in this case the milk sugar known as lactose. Babies are rarely born with this condition. Humans may become lactose intolerant because they are genetically predisposed to lose the enzyme lactase which breaks down lactose. The reason why the infant may have problems with dairy is that the actual protein in cow’s milk differs from that in human milk. Depending upon which study one reads, the incidence of a true allergy to cow’s milk protein is somewhere between 15-20%. (This means that at least 80% of breastfeeding mothers can enjoy dairy products without causing their baby any problems).

A true dairy allergy can present itself in any of three ways, upper respiratory, through the skin (eczema), and/or gastric upset. Babies with true dairy allergy often appear to have frequent and extreme bouts of gas, large amounts of spit up after feeding, and some may pass blood into their diaper (see the blog “What’s That Doing in Your Diaper?) Another complaint from mothers is that their infant’s stools are particularly foul. Parents with concerns about possible dairy allergy need to first and foremost consult with their pediatrician.

So what about the baby who just seems to have “so much gas”? A certain amount of gas is totally normal for babies under 3 months of age. I never know how to define “too much”, other than to try and reassure new parents that babies normally and naturally grunt, groan and appear to have trouble passing gas and stool. Until the infant can use her abdominal muscles, relax the anal symphticter and the gut matures, gas is a big complaint. Don’t forget—babies aren’t socialized about the dos and don’ts of “gas-passing”.

Should a breastfeeding mother eliminate dairy from her diet? If your baby appears to have miserable gas attacks more than once a day, it might be worth a try. The general recommendation is to eliminate all milk, cheese, butter, yogurt and ice cream (yikes) from the diet. How long to do this is greatly disputed, but at least 96 hours seems to be the general consensus. Some anecdotal reports suggest up to 9 days. If the infant is not noticeably more comfortable, don’t torture yourself--have a bowl of ice cream! Interestingly, a number of our mothers have reported that they could have occasionally servings of cheese or yogurt, they just could not drink milk.

Mothers of babies with dairy intolerance can often return to cow’s milk protein after the baby is 6 months old. Some mothers can substitute soy for dairy; however some babies are both dairy and soy sensitive. Rice milk may be an option for the mom. Mothers on a dairy free diet should eat other calcium rich foods and may want to take a calcium supplement (consult with your obstetrician). Whatever the cause of your infant’s gas, just remember that parents can’t necessarily fix it. The favorite mantra of The Pump Station, “WITH TIME IT WILL GET BETTER!