Does your baby show signs of discomfort after feeding? In this episode, Dr. Carole Keim MD goes over practices to best help your baby through peeing/pooping, gas, colic, and other tummy troubles. If your baby has colic, there are ways to help digestion and alleviate discomfort. Vomiting in infants can be a bad sign; she explains how best to keep your little one hydrated with no treatment for vomiting or diarrhea.

Dr. Carole Kiem MD details different conditions your baby may experience within their first year, such as diarrhea, constipation, vomiting, and reflux. Watch out for blood in the diaper; she goes over the potential causes, from stool to urine or even a “false period” in baby girls. Check out this episode for more information about tummy troubles.

We will cover: 

• Pee
• Poop
• Potty training an infant
• Burping
• Gas
• Colic - dx and tx
• Spit ups / GERD
• Vomiting - gastroenteritis, pyloric stenosis, no tx
• Diarrhea - tx, when to be concerned, signs of dehydration
• Constipation
• Blood in the diaper

Pee (0:21)

• Allow up to 24h for the first void.
• A few pees for the first few days; by day 3-5, mom’s milk surges, and baby voids with each feed
• Volume is difficult to discern, and the color is sometimes pale - diapers with urine stripes are helpful.
• Rust-colored urine in the first 2-3 days (uric acid crystals)
• If a baby less than six mos voids less than 6x per 24h or goes more than four h between voids, they may be dehydrated (nighttime doesn’t count!). Babies >6 mos should void at least once per 6h.

Poop (2:48)

• Up to 48h for first stool
• Meconium (and what it means if passed in utero)
• Transitional stools
• Yellow seedy stools
• Over the first 4-6 months becomes brown and toothpaste-consistency
• Formula-fed babies may have brown, yellow, or green stool; tends to be smellier
• Hydrolyzed formula -> gray stools
• Rule of 7’s
• Once they eat food, their poop becomes like adult poop

Potty training from birth / Elimination communication / Diaper-free method (6:27)

• Involves reading baby’s cues and giving cues when it’s time to potty
• Can start as early as birth; I recommend around 1-2mos of age after the discoordinate stooling phase.
• Decide on a phrase and/or hand signal to use
• Bring your baby to the potty (over the sink, potty chair, or toilet adapter)
• Make a sound to indicate it’s time to go (“psss” or grunt)
• Easy catches: babies who go during diaper changes, right after waking up, after eating, when you see them pooping
• It takes several months; ok to wait until later. Toddlers: takes about 6 mos for daytime and another 6-12mos for nighttime.
• I love it because there are fewer diapers, less discomfort for the baby, less diaper rash, and it is easier than toddlerhood.

Burping (12:28)

• How to
• When to (breastfed, formula-fed)
• Why? Decreases gas, colic, spit-ups
• They can stop when they burp on their own (around 4-6 mos)

Gas (14:20)

• Normal to fart a lot, loudly, and have smelly gas
• Breastfed babies may get more gas when mom eats cruciferous vegetables, beans, garlic, and caffeine
• Check with your doctor before you start eliminating foods
• Simethicone - how it works, when to give it, how often

Colic (16:21)

• Rule of 3s: 3h per day, 3 days per week, for 3 weeks
• Almost all babies get some colic symptoms at some point.
• Tummy Time
• Bicycle legs
• Belly massage - clockwise
• Back rubs - counterclockwise
• Medicines: simethicone, probiotics, gripe water; can consider chamomile, licorice, or mint tea - dilute, 1/2oz per day
• Alternative health: chiropractic, acupuncture, ayurveda - I can’t formally recommend them, but they are sometimes helpful; choose your practitioner carefully.
• What doesn’t work - is the sensitive tummy formula. No formula will treat colic.

Spit ups / GERD (20:47)

• Reflux = stomach contents go up into the esophagus.
• GERD = reflux is so bad that the baby has poor weight gain or loses weight, chokes, arches in pain, or has other problems
• LES
• Spit-ups are not forceful.
• Tx: decrease volume and increase the frequency of feeds (BF vs. formula), burp baby well, anti-reflux formula/breast milk thickeners, add 1 tsp rice cereal to 2oz formula/breastmilk (this is the ONLY time we put rice cereal in a bottle), use gravity, medications such as ranitidine make the stomach produce less acid but don’t decrease the volume
• Call your doctor if the baby spits up more than half of their food, if they look like they are in pain with spitting up, if they appear to choke, or if it starts to become more frequent and the baby seems hungry after spitting up.
• Check out healthychildren.org for more info.

Vomiting (28:09)

• Forceful: Involves abdominal muscles and a retching movement
• Projectile vomiting goes about 2-3 feet, but spit-ups can too
• The baby is upset afterward
• Always a red flag
• No treatment other than to keep hydrated

Diarrhea (29:48)

• Hard to tell in newborns/infants because their poop is so soft/liquid
• If you’re worried, call your doctor
• Stool that is so watery it soaks into the diaper
• A marked increase over what your baby normally does
• Marked increase or “blowout” poops more than twice in a row
• A foul odor that was not there before, sometimes with a change of color
• Fever/blood - go to ER if <6 mos, call your doctor if >6mos
• No treatment other than to keep hydrated
• ​​Signs of dehydration: decreased urine output, fussy/lethargic, dry lips/tongue

Constipation (34:11)

• Infants: the first year of life; does not apply to children >1yr. We will do that episode in a few months.
• 1 mo: discoordinate stooling
• About 3% of infants get true constipation: hard stools like pellets, pain with BM, and rectal bleeding.
• Tx: prune juice 0.5-1oz (15-30ml), once or twice per day; water if they are taking solids/purees; consider eliminating dairy

Blood in the diaper (39:01)

• when it’s normal: pseudomenses
• Abnormal: any other time, call your doctor immediately! Urine = kidney problem, stool = infection or allergy. UA/ Hemoccult
• Foods that mimic blood: watermelon, beets, tomatoes

I hope this helps you guys know what’s within normal range and when to be concerned.  

Remember: It is ALWAYS ok to call your doctor’s office with questions if you’re worried.  

Babies are really different than adults, so it can be hard for new parents to know whether something is serious or not. 

I wrote the Baby Manual for that reason, and I know parents refer back to it often through the first year of life to check whether they need to be concerned.  

Resources discussed in this episode:

• The Baby Manual - Available on Amazon
• healthychildren.org

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