It’s the middle of the night and your new infant is screaming. You’re exhausted. You aren’t sure if something in your diet is causing her symptoms or if there is another reason. Maybe there has been blood in her stool or more than typical spitting up. Maybe you’ve been through multiple formula changes. Maybe you’re googling reasons infants won’t sleep in the middle of the night. You’ve single handedly kept Amazon Prime afloat with your middle of the night baby gadget purchases.
Sound familiar? We’ve all been there. Parenthood is hard. I had the knowledge of a three-year pediatric residency and experience of thirty-hour inpatient hospital shifts when I had my first child, and I was still not prepared for the utter sleep deprivation that is all consuming in early infancy.
As it turned out, I just had an infant who didn’t need much sleep, but I certainly ran through all the reasons for why that could be. GERD, or gastroesophageal reflux disease, can be a reason why babies are fussy at night when laid down. All babies have some reflux, but pathology is more likely if there is poor weight gain. Reflux affects about 50% of infants in early infancy and tends to improve with age as babies spend more time upright. Reflux can also cause congestion and that perpetually stuffy nose. Reflux precautions or medications can be helpful. A more serious entity called food protein induced enterocolitis should also be considered if there are episodes of profuse vomiting with or without diarrhea.
Food protein induced allergic proctocolitis of infancy is a form of intolerance that can present in early infancy with bloody stools in an otherwise well infant. Sometimes infants can be fussy depending on what is in mom’s diet or their formula. We don’t know how much food protein is communicated in breast milk, but some moms see improvement in how baby feels when they make adjustments to their own diet. Milk and soy are the foods most often implicated. The symptoms in infants are not usually mediated by the allergic antibody. The allergic antibody, or IgE, is part of the physiology of anaphylaxis and is what skin and blood testing identifies. For some infants, infancy can be the start of true milk allergy and so it is important to have a thorough evaluation.
Time may be all that is needed as your baby matures and ultimately sleeps for longer stretches. Dietary changes may or may not be helpful. If you’re wondering where to start or if your mom instinct is telling you a change is needed, bring your child in for an evaluation. Being a mother to three boys has given me practical knowledge I didn’t learn in textbooks and has made me a better physician and allergist. I can offer guidance that melds data from the medical and practical perspectives. As someone on the other side of infancy with the youngest a toddler now, I can say the sleep deprivation gets better but toddlers have their own unique challenges!
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