During the first week home with my oldest son, I was shocked at how noisy this tiny baby was. My first response to the voracious assortment of hiccups, sneezes, grunts and gas was…I didn’t hear all of these noises during residency! Quite honestly, I even sent videos of my little guy’s bodily noises to all of my doctor friends who quickly reassured me….’this is normal!’ These memories bring me to the topic of today’s blog…all those baby noises. The bottomline is that infants are naturally noisy little creatures. There are two topics I would like to shed light on today, newborn nasal congestion and newborn gas and grunting with bowel movements.
Let’s start with that noisy breathing. Your baby’s nose actually does alot of work and thus there is alot of ‘cell turnover’. It functions to warm and humidify air before it reaches the lungs for gas exchange. Basically, ‘alot is going on in there so it can be a bit noisy’. Add to that the narrow nature of baby’s nasal passages and you get the noisy sounds that keep us all up at night. So, what to do? If your little one is feeding well and seems comfortable then I love the ‘less is more approach’. If there is clear fluid coming out of the nose and interfering with your little’s comfort level or feeding, then I recommend infant nasal saline drops and gentle irrigation. You can use either the small nasal syringe you may have gotten in the newborn nursery or the ‘nose-frida nasal aspirator’. As always, if your baby has fever or the congestion is interfering with feeding it could be a more serious condition that would merit evaluation.
Newborns also have a natural propensity toward gas (newborn flatus) and bodily discomfort when preparing to have a bowel movement. The medical term for this common newborn condition is ‘infant dyschezia’. Sounds terrible, right?! BUT, ‘dyschezia’ is a big fancy word to describe a natural and self-resolved condition. Let’s try to understand it a bit! Textbooks describe dyschezia as ‘a functional condition characterized by at least 10 minutes of straining and crying before successful or unsuccessful passage of stools in an otherwise healthy infant less than six months of age.’ All of the crying is rightfully exhausting and anxiety provoking for already tired parents, and often provokes many well intentioned visits to the pediatrician (or worse, the ER) with concerns for constipation.
To help understand why babies do this, you need to understand that ‘defecation’ (the act of passing stool) is a coordinated event that requires 1) pelvic floor relaxation and 2) an increase in intra-abdominal pressure (ie→ bearing down). For a newborn to acquire this coordination takes time and not all infants develop it at the same time. GENERALLY, the painful episodes improve by 4-6 months. To help soothe your baby, you can do infant massage or increase tummy time, or opt for medical remedies such as mylicon (also known as simethicone) or gripe water. The bottom line, though, is that no medical tests or treatments and unless your child is clearly constipated we try to avoid rectal stimulation and suppositories because that will interfere with your baby actually learning how to pass stool on their own. I have seen far too many breastfeeding mamas endure restrictive diets and formula feeding families make multiple formula switches all in an effort to help their baby feel better and end up feeling defeated. In the absence of weight loss or blood and mucus in the stool, I encourage you to take heart in knowing that your baby is learning how to pass stool on their own and even practice massaging babies belly or taking baby out for a walk. Fresh air will do you a world of good as well! Please remember, there definitely are other newborn conditions in which your baby constantly cries that may merit medical evaluation. This discussion is limited to a term healthy newborn who is otherwise growing and whose stools are still soft and non-bloody.
