One of the most common concerns new parents have when I do an assessment on a newborn is fussiness around feeding. Sometimes this will show up as pulling off the breast or bottle repeatedly. Sometimes it will show up as ongoing fussiness unless the baby is at the breast constantly, or a baby who “needs a bottle” after lengthy nursing sessions. Sometimes there are complaints of spitting up, short, squeaky breaths, or the inability to lie on their back after feeding without fussing.
No new parent likes to see their newborn in discomfort or distress, and we all have times where we feel so helpless to comfort our little ones. Unfortunately, when parents have concerns over these types of behaviors and bring them to the attention of their pediatrician, they commonly leave the office with a prescription for reflux medication. What’s the big deal about a little reflux medication? Well, we holistic providers have said for years that altering the natural pH and flora of the gut with these medications will have a negative downstream affect on digestion, gut health and immune function as a whole. Research is finally catching up and showing us some of the long term negative effects of these medications.
A study published earlier this week in JAMA Pediatrics (https://jamanetwork.com/journals/jamapediatrics/fullarticle/2676167) looked at the use of acid-suppressive medications and antibiotics during the first 6 months of infancy and the subsequent development of various allergies. They looked at almost 800,000 children and found that when antibiotics or acid-suppressive medications were given, there was an increase in incidence in ALL allergic diseases they assessed for including food allergy, anaphylaxis, asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, hives, contact dermatitis, and medication allergy. And the authors found that the problem seems to be dose dependent: those who took acid-suppressive medications 60 days or longer were 52% more likely to have allergies. “These medications are usually given to infants who regurgitate food and appear fussy. For most infants, though, regurgitation of food is not a disease. Rather, it's a developmentally normal process," Mitre (study author) said.
Here’s a typical case history for an infant in my office: Baby is fussy around feeds, pulls off the breast repeatedly, spits up after feeding, cannot lie flat on their back without fussing and maybe even spits up frequently. Mom was told at one and two week checks that baby is slow to gain weight, so pediatrician has recommended supplementation with formula after nursing sessions. The pediatrician has also said baby has “silent reflux” and prescribed acid-suppressive medication. Since supplementing with the formula and adding the medication, digestion has slowed and bowel movements occur only once every 5-7 days, accompanied by lots of distress. Baby is still spitting up, so the pediatrician has now recommended a formula which contains rice cereal for bulk, and mom’s milk supply is waning in the face of supplementation… I see it EVERY DAY.
Here’s what we know to be true: newborn babies have never had to digest food in utero. The whole process is a brand new physiological feat, and some babies transition to this external nutrition better than others. We also know that all of the sphincter muscles involved with digestion are under the control of the Vagus nerve. This nerve is particularly prone to challenges in newborn babies because of the stresses imposed into the cranium and cervical spine during vaginal or cesarean deliveries (this is where chiropractic adjustments can help). We know that breast milk is the ideal food for babies’ digestive and immune systems. We know babies delivered by cesarean lack exposure to their mother’s good bacteria in the birth canal. We know that poor latch, tongue and lip ties and fast milk let-down reflexes in mom can cause a baby to take in air at the breast or bottle, which can manifest as fussiness around feeds. We know that breastfed babies can have digestive stress when mom consumes food which don’t agree with baby’s digestion. We know dairy sensitivities are common, and can manifest as gas, spitting up, fussiness and constipation – even with “sensitive” and “hypoallergenic” formulations of baby formula. We know the importance of a healthy microbiome for lifelong immune system function.
The authors of this study concluded “Acid-suppressive medications and antibiotics should be used during infancy only in situations of clear clinical benefit.” One would hope that any medication or therapy administered to a human being of any age, shape or size would be done so only if there was clear clinical benefit. Too often these medications are used as a sort of litmus test, and they are clearly not as harmless as previously assumed.
Getting to the true source of the baby’s distress takes TIME to dive into the many possibilities which can affect newborn digestion. Sadly, many pediatricians are not well versed in anything beyond that which a prescription pad can help. There are generally few right answers to be gained based on a baby’s fussy behavior alone, and few “quick fixes” with administration of medication. Pediatric chiropractors take great pride in taking comprehensive histories, providing thorough examinations, and in considering potential outside referrals in holistic consideration of newborn fussiness and feeding concerns. The key is getting to root cause for each individual baby, not operate under the assumption that fussy babies were born with a Zantac deficiency. We can do better.