Fussy Breastfed Baby

Breastfed babies might be extra fussy for a variety of reasons.

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1. Colic

2. Hunger

3. Maternal medication, drugs, alcohol, smoking, or caffeine

4. Gastro-Esophageal Reflux Disease (GERD) 

5. An abundant maternal milk supply with excess foremilk intake and lactose overload

6. An overactive milk let-down reflex with rapid milk flow

7. Food intolerance in the infant 

Since there is no diagnostic test for fussiness, you will answer specific questions about your baby’s behavior, and your provider will use her experience and judgement to diagnose and manage the problem. Make one change at a time, so it will be clear what is making a difference. Babies usually outgrow these issues over time.

Colic

A colicky baby is otherwise healthy and gains weight well. Such fussy and inconsolable babies are thought to have troube “changing states” from fussiness to calm. Evening crying spells start around 2-3 weeks of age and finally stop at around 3 months.
After a thorough evaluation, other causes of fussiness can hopefully be identified and managed, as noted below. 
Repetitive motions, vibration and white noise may help your baby calm down, and a good swaddling may help your baby sleep (stop swaddling when your baby can roll over).

Hunger

Fussy babies need a weight check to rule out hunger, because hungry babies are usually fussy.
Poor milk removal from the breast, low milk supply, or both, results in poor weight gain and hunger.
Over time, a hungry baby may become very quiet from lack of energy.
Severe heartburn from spitting up is a rare cause of poor feeding and thus hunger.
It’s also quite rare for a baby to fail to gain weight from spitting up more than they keep down. 

Maternal medications, drugs, nicotine, caffeine, or alcohol

Maternal medications, drugs, nicotine, caffeine, or alcohol might pass through breastmilk to your baby and cause fussiness.
Or, perhaps a medication you took while pregnant passed through the placenta to your baby.
Since the placenta is gone now, your baby may react with fussiness as the substance works out of your baby’s system (withdrawal symptoms).
Most medications are OK to take while pregnant and breastfeeding. Just ask!    

Gastro-Esophageal Reflux Disease (GERD)                                             

Reflux is referred to as “reflux disease” when the effortless spit ups cause a problem, like heartburn pain, feeding refusal, or aspiration. Most spitty babies, though, are “happy spitters” without heartburn. Spitty babies rarely aspirate or refuse feedings, and they usually gain weight just fine.                                 

Abundant maternal milk supply

An abundant maternal milk supply with excess foremilk intake and lactose overload may cause a fussy baby.
Lactose overload happens when a baby drinks too much sugary foremilk and too little high fat hindmilk.
The excess lactose sugar in the baby’s tummy dumps into the intestine and overwhelms the lactase  
enzyme that’s waiting there to digest it.
Symptoms of “relative lactose intolerance” evolve, such as bloating, gassiness, explosive watery stools with mucous (rare blood), belching, and spit ups, all of which cause fussiness.
Also, the low-calorie foremilk leaves the baby feeling hungry, like he was eating lettuce all day, which also makes him fussy.

An overactive milk let-down

An overactive milk let-down relfex allows milk to flow rapidly from the breast, which is sometimes faster than a baby can swallow! The baby must rapidly gulp, and thus coughs, chokes and swallows air. The air bubbles in the baby’s tummy can make spit ups worse, which can cause heartburn and fussiness.

Food Intolerance

Your baby may grunt as if he’s constipated, and there might be blood or mucous in the stools from the gut irritation. The stools are usually yellow and seedy like normal.
After considering all the other causes of fussiness, you may end up trying a food elimination diet to isolate what food could be a problem. This can be challenging.

Kay Anderson MD, IBCLC
5/23