Blog

Faltering growth (Failure to thrive)

Many babies fail to gain weight as expected during the first few days of life. Newborns are expected to loose up-to 10% of their birthweight by Day 5-7 after birth. If they are exclusively breastfed, the breast milk starts to come from Day 2-3 onwards. They then start to gain weight from Day 5-7 and usually regain their birth weight by Day 10.

Most common cause of excessive weight loss is inadequate milk supply in mother, for various reasons. The mother should drink plenty of fluids, eat a healthy diet, try to get adequate rest and put the baby to breast at regular intervals. The technique is also very important and midwives are a great help with that. All these factors help increase breast milk production.

A small percentage of babies may need some top up formula milk or Expressed breast milk if the milk supply does not improve despite the above measures. A health professional should be involved and monitor the weight carefully at regular intervals and ensure that the baby is otherwise well and there is no other factor influencing the feeding and weight.

Allergies in children

Allergies to various substances is getting more and more common for various reasons including ‘Hygiene Hypothesis’ (Google it).  Some families are prone to have allergies and these people are known as ‘ATOPIC’. They are more likely to have allergies, asthma, eczema, hay fever, allergic rhinitis etc. These are all related conditions.

Most children grow out of allergies to food like milk and egg, while some allergies like nut allergy are more likely to stay. Milk allergy usually gets better between 1-2 years of age, egg allergy is variable and so is fish / shrimp. Children have a 20% chance of growing out of nut allergy.The treatment usually involves, avoiding the ‘allergen’, emollients, steroid creams, antihistaminics etc. There have been trials going on for ‘Immunotherapy’, to challenge the body with very small doses to develop ‘Tolerance’. It’s availability is limited at the moment.

Diagnosis of allergies should be done by a specialist and diet modified only after discussion with a dietician. Mothers on dairy free diet should consider taking extra Calcium and Vitamin D. The Cow’s milk free formulas usually have adequate supplements. There are some extremely useful websites for patients and even Health Professionals containing useful videos, leaflets etc. like

https://www.allergyuk.org/

http://www.itchysneezywheezy.co.uk/

http://www.eczema.org/

 

 

ODD shaped heads in babies

It’s called Plagiocephaly in medical terminologyPlagiocephaly is a disorder that affects the skull, making the back or side of a baby’s head appear flattened. It is sometimes called deformational plagiocephaly.

There are no symptoms associated with plagiocephaly other than the flattened appearance of the back of the head – either evenly across the back or more on one side. It does not cause any pressure on the baby’s brain and development will not be affected by it in later life. 

Its importance is entirely cosmetic. Nevertheless, if you are worried about any aspect of a baby’s health and are concerned that it might be connected with their head shape, you should always check with a doctor.

https://www.nhs.uk/conditions/plagiocephaly-brachycephaly/

Cow’s milk protein allergy ! (CMPA)

CMPA is quite common and may present as persistent vomiting, diarrhoea / constipation, poor weight gain, dry skin / rash and excessive crying. Treatment is by eliminating CMP from diet but only under specialist supervision.

There are two types, IgE mediated and Non IgE mediated. Basically, the latter is usually presents later and is milder but there is no test for it. If baby is breast fed, then treatment is eliminating dairy from mum’s diet (I know, it’s sad, but luckily only for few months).

If formula fed, then there are several hydrolysed formulas available like Aptamil Pepti, Similac Alimentum, Nutramigen. They are broken down proteins, so taste and smell horrible (Honestly, they have not been able to improve the taste of any of these). Fortunately, babies haven’t developed lots of taste buds, so are usually able to drink these (sometimes takes a lot of perseverance!). Parents can close their noses while making them!

The effect of dairy elimination from maternal diet or change to Hydrolysed formula is not apparent immediately, as CMP takes 2-4 weeks to be eliminated from baby’s body. But slowly symptoms start to resolve like reflux, skin, vomiting, irritability, blood in stool etc.

The good news is that most children grow out of Non IgE mediated CMPA (the much more common one) between the age of 1 to 2 years. We recommend challenging them with milk formulas beginning from 6 month onwards by use of a milk ladder:

http://cowsmilkallergyguidelines.co.uk/downloads-and-resources/downloadable-map-milk-ladder/

Reflux (Gastroesophageal Reflux Disease)

Many babies cry a lot specially after the feeds. This could be Gastroesophageal  reflux.

Gastroesophageal reflux (GOR), the passage of gastric contents into the oesophagus, occurs commonly in newborn infants, especially those born prematurely. Physiologic GER typically is a developmental process that resolves with maturation. GER generally resolves on its own by one year of age. In infants who remain asymptomatic, no further evaluation or intervention is typically required.

In contrast, GOR disease (GORD), is clinically significant GER that causes problems. In infants they include frequent vomiting, aspiration pneumonia, irritability, failure to thrive, and exacerbation of respiratory symptoms, including chronic lung disease and most commonly excessive crying.

I see many babies who have been suffering as the reflux is undiagnosed or untreated. Diagnosis is usually clinical indicated by poor feeding, possetting/vomiting a lot, crying, arching of the back, unsettled babies. Treatment is by burping them after each feed for 15-20 min, sleeping them at an angle by raising the head end of mattress, feed thickeners like Gaviscon Infant/Carolbel and some medications which can be prescribed by doctors.

Babies who are breastfed, can be tried on feed thickeners like Gaviscon Infant or Carobel. They do tend to constipate the child, so dose may have to be adjusted.

There are some pre thickened formulas available now like Aptamil Anti Reflux (AR), Cow & Gate AR, SMA Staydown etc. They can be tried if the baby is formula fed and see if that helps. If the simple measures are not working then professional advice should be sought.