Questions and Answers

Formula fed babies can become constipated sometimes. Milk is usually all young babies need as their food and drink, but sometimes if a baby is constipated offering small amounts of cooled boiled water to help increase hydration can help- this shouldn’t replace formula feeds. You can offer this split over the course of the day. You shouldn’t offer your baby any other “remedies” that may have been recommended many years ago- eg fruit juices or brown sugar in water, as these can be unsafe and are not suitable for babies under six months old. Babies under six months should only be offered milk, and water if essential.

It’s also important to make sure that the formula feeds are being prepared correctly as this can contribute to digestive problems- a reminder of how to prepare feeds safely is here: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/making-up-baby-formula/

You might also find that giving your baby a gentle tummy massage in a clockwise direction, leg cycling and warm baths help.

If the issue continues and the stools passed are very firm, please consult your GP.

Constipation is really common in young children (its affects up to about a third of all children at some point) and there are lots of things that you can do to help prevent and treat it.

The key things to think about are diet, fluids and physical activity as getting all these things right is the key to prevention. We would recommend keeping your child well hydrated by offering plenty of water and foods that contain lots of water (eg cucumber, strawberries, grapes), lots of fibre in their diet (fruit, vegetables, beans, cereals and wholewheat bread/pasta) and plenty of exercise to help keep their bowel moving. Having a good toilet routine is really important too. Children are more likely to have their bowels open around 20-30 minutes after a meal so that’s a good time to take them to the toilet.

If you’ve tried these things and they haven’t helped or if your child is having hard, infrequent bowel movements and finding having a bowel movement distressing, we would recommend contacting the GP as soon as possible to discuss laxatives and also implement the advice above at the same time. Being constipated can cause other issues like making toilet training more difficult and urine infections, so it’s really important to get it treated quickly.

The ERIC website is brilliant and has lots of information here about preventing and managing constipation in children: https://www.eric.org.uk/Pages/Category/bowel-problems

It’s really common for toddlers’ likes/dislikes to change and for their eating to become more “fussy”. It’s a very normal part of their development and will pass with time, although it can be a really worrying time for parents!

Try to think more about what your child eats over a week rather than day to day to get a good idea of how they are eating- we all have days where we might not eat as much. As long as your child is eating a least some food from each of the main foods groups and they seem active and healthy it’s usually nothing to worry about.

There are lots of ways you can encourage your child to be more adventurous with food

• be a role model and eat with your child
• messy play with food
• encouraging your child to help safely with food preparation, growing things you can use in cooking
• trying a food in lots of different ways e.g. carrot could be raw with a dip, roasted, as a soup, or steamed
• allow your child to feed themselves (under supervision) to promote feelings of choice and independence.

There are also LOTS of common pitfalls to be aware of to try and avoid -

• Don’t put pressure on your child to finish food they have refused or to clear their plate
• Don’t use food as a reward (e.g. “If you eat your dinner, you can have pudding”, “If you do X you can have some chocolate”- this makes the sweet food seem even more desirable and the main meal/ healthy foods even less likeable).
• Food restriction - if your child knows there are unhealthy but desirable foods at home e.g. biscuits, crisps, but they are not permitted to eat them unless in certain circumstances, this can make them more desirable. It’s best to only have food in your cupboards that you are happy for your child to eat.

There are lots of ways we can help children make good eating habits and healthy relationships with food that will last for their whole lives.

This website is full of brilliant advice about overcoming fussy eating: https://www.childfeedingguide.co.uk/

These websites are also helpful:

https://www.nhs.uk/conditions/baby/weaning-and-feeding/fussy-eaters/

https://www.firststepsnutrition.org/eating-well-early-years

Sleep deprivation can be one of the most challenging aspects of being a parent and these challenges can vary and change depending on the age of your baby or child.

The following websites are full of helpful information and advice about what is normal and how you can cope:

https://www.nhs.uk/conditions/baby/caring-for-a-newborn/helping-your-baby-to-sleep/

https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/sleep-and-night-time-resources/caring-for-your-baby-at-night/

https://www.lullabytrust.org.uk/safer-sleep-advice/coping-with-sleep-deprivation-as-a-new-parent/

https://thesleepcharity.org.uk/information-support/children/

https://www.basisonline.org.uk/

When managing with limited sleep it is still really important to adhere to the safe sleep advice at all times (day and night) to help to reduce your baby’s risk of Sudden Infant Death Syndrome (SIDS). Safe sleep advice can be found here: https://www.lullabytrust.org.uk/safer-sleep-advice/

It can be normal for babies to have a small amount of vomiting called “posseting” after they have fed. Babies with reflux tend to have larger vomits after most feeds and struggle to lie flat particularly after feeds and can be quite difficult to settle. We worry about reflux when babies are vomiting significant amounts and this is affecting their growth and development. If they are continuing to grow well you can usually make a few adjustments to feeding to help manage the symptoms.

We would initially recommend:

• Winding your baby after feeds
• Keep baby upright (either chest to chest position with you or in your arms) for at least 20-30 minutes after a feed to help digestion
• Sit or hold your baby upright during feeding (if you’re breastfeeding you could try the “Koala” hold to help with this)
• If you are formula feeding or giving expressed breastmilk, then pace the feed- so bring the teat back slightly regularly throughout the feed to encourage the baby to take a break from sucking. This will make the feed more relaxed for them and give them the opportunity to swallow the milk and take regular pauses throughout the feed. If you feel the baby needs winding during the feed, you could use this as an opportunity to do that too.

Here is some info about this: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2019/04/Infant-formula-and-responsive-bottle-feeding.pdf

The following websites may also be useful to you:

https://www.nhs.uk/conditions/reflux-in-babies/

https://www.nhs.uk/start4life/baby/breastfeeding/breastfeeding-challenges/reflux/

It can be really distressing as a parent if your baby is crying a lot or seems distressed, and you can’t seem to find a cause for it. If your baby is otherwise well, it may just take some time for your baby to pass this phase in their development and for the crying to reduce. Most babies’ symptoms usually improve around 3-4 months of age as their digestive system becomes more developed, and resolve by the time they are around 6 months old. Babies cry the most in the first 3 months of their life. It may help to sooth your baby if you:

• Hold or cuddle your baby when they're crying
• Sit or hold your baby upright during feeding to help reduce the air they are swallowing (if you’re breastfeeding you could try the “Koala” hold to help with this)
• Wind your baby after feeds
• Gently rock your baby over your shoulder
• Gently rock your baby in their Moses basket or crib, or push them in their pram
• Bathe your baby in a warm bath
• Have some gentle white noise like the radio or TV in the background to distract them
• Gently massage your baby’s tummy in a clockwise direction.

If you’re finding your baby’s crying overwhelming, it’s ok to walk away from them if you have checked they are in a safe place and return after a few minutes to check on them when you feel calm, or ask someone else to take over for a while.

There’s lots of information about coping with a crying baby at these websites: http://iconcope.org/parentsadvice/

https://www.cry-sis.org.uk/

You can find information about signs of illness in babies and young children here: https://www.nhs.uk/conditions/baby/health/is-your-baby-or-toddler-seriously-ill/

The lullaby trust has an app called ‘the baby Check App’ https://www.lullabytrust.org.uk/safer-sleep-advice/baby-check-app/

If you continue to worry that your baby/child is not well

• During the day from Monday to Friday – it's best to call your GP practice
• Evenings and weekends – call NHS 111
• In an emergency call 999.

If you are unsure if they are crying because they are unwell, then the following resources may be useful;

https://www.nhs.uk/conditions/baby/health/is-your-baby-or-toddler-seriously-ill/

The lullaby trust have an app called ‘the baby Check App’ https://www.lullabytrust.org.uk/safer-sleep-advice/baby-check-app/

Babies do go through natural stages of development, especially around 6-8 weeks of age, where crying can increase.

There’s lots of information about coping with a crying baby at these websites: http://iconcope.org/parentsadvice/

Thrush is characterised by sudden onset of severe breast/nipple pain when feeding had previously been pain free. Pain can last for up to an hour after feeds.

Both mother and baby require separate prescriptions after diagnosis.

http://www.breastfeedingnetwork.org.uk/wp-content/dibm/2019-09/Thrush%20Detailed%20information%20and%20Breastfeeding.pdf

Mastitis: Remember – it’s important that breastfeeding isn’t interrupted, blockage is drained (by effective feeding or gentle hand expressing) and the cause investigated (check position and attachment).

http://www.breastfeedingnetwork.org.uk/wp-content/dibm/BFN%20Mastitis%20feb%2016.pdf

Engorgement: https://kellymom.com/bf/concerns/mother/engorgement/

Breast compressions: Helps increase milk transfer. Useful for babies that aren’t feeding as effectively such as with a tongue tie and poor weight gain / sleepy, jaundiced babies.

https://breastfeeding.support/what-is-breast-compression/

If none of these techniques help, please consult your GP as anti-biotic treatment may be required.