Fussiness in Breastfed Babies

Almost all babies are fussy sometimes — and most fussy babies are perfectly healthy. Fussiness, gassiness, grunting, and straining while pooping are normal newborn behaviors. Some people worry that fussiness is due to something in the mother’s diet, but this is rarely the case.

This handout will help you understand what is normal, what is not, and when to talk to your baby’s physician or other healthcare providers.

Normal Fussiness

Healthy babies cry and fuss an average of about 2 hours per day in the first 6-8 weeks of life. This is completely normal. Crying is a common way for babies to communicate- they have few other options! Crying usually peaks around 6-8 weeks of age and then gradually improves by 3 months.

Normal fussiness often looks like this:

• Fussy periods that happen around the same time each day, often in the late afternoon or evening between 3-12 weeks of age
• Crying that starts and stops on its own, or stops easily when baby is held, rocked, fed, or bounced
• Your baby is otherwise feeding well, gaining weight, and has periods of being calm and content
• Grunting, straining, turning red, or pulling up legs while passing gas or pooping — this is very common and usually just means your baby’s digestive system is still maturing
• Grunting and straining intermittently while sleeping
• Fussiness that gradually improves after 10-12 weeks of age

Some babies are also fussier than others — this can be a part of a baby’s personality.

Fussiness with Stooling or Gas

Breastfed baby stools can look very different from what you might expect, and almost all these variations are normal:

• Color: Yellow, mustard, light brown, and green are all normal. Nearly half of healthy babies have green poop at some point in the first few months.
• Consistency: Breastfed baby poop is usually soft, loose, seedy, or even watery.
• Frequency: Some breastfed babies poop after every feeding (up to 7+ times a day). Others may go several days — even up to a week — without a poop. Both can be completely normal if the poop is soft and the baby is eating well and not vomiting.
• Gassiness: All babies produce gas as they digest milk. Passing gas, or farting, is normal especially in the first 2 months of life as the bacterial balance in babies’ intestines is maturing. Farting does not mean your baby has a food allergy or intolerance.

Babies have immature digestive systems and have the added challenges of weak abdominal and pelvic muscles along with having to poop while lying down. These factors lead babies to grunt, strain, and turn red in the face when pooping or passing gas. This is called “infant dyschezia” and occurs at some point in most babies. It is not a sign that anything is wrong with your baby or that there is anything in your milk that is causing distress.

Fussiness During Sleep

Babies are notoriously noisy sleepers. They grunt, groan, and move around a lot, which is often concerning to parents. Babies, like adults, cycle through different stages of sleep. The noisy stage is “active sleep,” and is part of a normal infant sleep pattern.

If your baby is grunting or seems restless but their eyes are closed, it is reasonable to wait a few minutes to see if they transition back to a quiet stage of sleep. If they are truly uncomfortable, they will likely wake up and continue crying and appear uncomfortable. If your baby is grunting, restless, and wakes up often at night, try to video record the behavior and show it to your baby’s physician or other health provider so that they can help determine whether it is normal or needs further evaluation.

Could it Be a Food Allergy?

It is very common for parents to wonder if something in their diet is making their baby fussy. The internet is full of advice telling breastfeeding mothers to cut out dairy, soy, eggs, and other foods. Here is what the research shows:

• The most common food protein that can cause infant symptoms is dairy. Common symptoms include:
  • Significant spitting up
  • Fussiness with infrequent stooling
• Other foods in the maternal diet have not been linked to infant gut symptoms, unless there is blood in the stool or vomiting.
• Cutting foods out of your diet without medical guidance can decrease options for a healthy diet, add stress, and is unlikely to help your baby. Even if you think dairy might be associated with your baby’s gut symptoms, talk to your physician or other healthcare provider first before eliminating dairy.

Bottom line: Fussiness alone, gas alone, or minor changes in poop are usually not caused by something in your diet. Do not start an elimination diet on your own without talking to your baby’s physician or other healthcare provider first.