Baby: Hard belly, knees up, and back arching with grunting?

It is normal for newborns to grunt as they get used to having bowel movements.  When we pass a stool, our pelvic floor relaxes and we use our stomach muscles to apply pressure which helps to move the stool through the gut. 

Initially, a newborn’s stomach muscles are not strong enough to do this, so they use the diaphragm muscle to get everything moving. As they exercise this muscle, it can put pressure on the voice box, resulting in an audible grunting sound.

The knees will often raise up, this helps reduce abdominal pressure. This is often accompanied by back-arching, but not always, this can be your baby is tensing as an attempt to push the stools, the other reason could be reflux as this is a common sign also.

If however, your baby is persistently grunting with every or most breaths or has any other breathing issues at the same time (e.g recession, rapid respiratory, blue lips). Then we advise seeing your doctor straight away.

Common causes we see at the clinic:

• Dairy intolerance
• Feeding frequency/issues
• Immature gut

Other reasons for grunting worth noting:

• Irregular breathing patterns. Newborns may grunt as they develop control over their breathing patterns.
• Trapped mucus. Mucus can collect in a newborn’s narrow nasal passages.
• Dreaming. Grunting during sleep can indicate dreaming or a bowel movement.
• Gastroesophageal reflux

Tips

Belly massage with legs movements 

There are many different factors that move the stools through our gut. Our legs pump from below, our big lungs pump from above and we have developed smooth muscle around our gut that helps. 

Newborns have small little legs and lungs, and with still developing bowels it’s no wonder they have trouble getting things moving. If this movement slows, milk due to its compound can ferment, thus creating more gas in the abdomen, making it more uncomfortable for your baby.

So by manually helping this process, you will have a happy and more relaxed baby. Clock-wise movements of your hand over their belly, with light pressure, while rocking back and forth with the legs at 90 degrees will help. ‘Leg cycling’ and or ‘pumping’ the legs gently up and down will also help. Remember to keep it light and rhythmic.

Things to note* try not to do this 20 mins after feeding, as you will find it is like shaking up a coke can, and you will find things get messy above. Should only last 30 sec to 3 mins, and can be done multiple times a day. It is normal to hear increased grunting during massage of the belly, your baby will feel slight increased pressure and will in turn help you push. If your baby gets upset, then stop the massage and try again another time. 

Sometimes you will get lots of noise and movements from down below (farts), other times you will feel like nothing has happened, but all this movement will help with their digestion and abdominal pressure.  

Try your best, and if in any doubt then reach out to your midwife, doctor or health care practitioner. This is something we check and run through at our clinic, which is great for a take-home exercise to help with excessive gas/pressure in your baby’s belly.

Changes to feeding times

Before we can talk about making changes to a baby’s feeding times, it is important to note that this can be done as long as your baby is gaining weight and is meeting their developmental milestones. As if they are not, then increased feeding frequency often is a tactic to get your baby to gain weight faster.

Have you ever been given food when you have not expected it and it feels like it’s just sitting heavy in your stomach? Like adults when we smell food or think about food, our gastric juices get fired up ready to eat and digest. Our salvia glands get to work also, thus the term ‘salivating over food’. 

This process makes sure we are ready to break down the food that we are about to eat. The same goes for a baby. If they have a big feed, then 30-45 mins later your baby starts to cry again and they have another feed (regardless of amount), they are in a way putting new milk on old milk, thus slowing down the whole process. 

As mentioned above if the milk does not flow through the digestive tract within normal time it can ferment and create gas, which in tern creates pressure in the abdomen. They still have an immature gut and it will take time to develop.

Now it is hard to know, especially if you are a new parent, what is a hungry cry and what is a comfort needing cry (sometimes babies just cry for no reason and that is normal too). Feeding for a baby is the ultimate pleasure, it’s warm, rhythmic, smells like mum and milk, skin on skin contact, and being held. So it is hard to know if they want it, as the baby will love the feeding regardless if they need feeding or not. 

Now there are other factors like slow flow, latching issues, or tongue-tie that can see you feeding for a long time with the baby not getting a full feed or being disruptive, so this can be contributing factor and adding to the confusion. 

When we get out of demand feeding, we want to aim for 2-3 hours between feeds during the day (for the first few weeks to months of life). This gives a good amount of time for digestion and also will help your baby sleep better when they are able to have a bigger feed.

If you know your baby has had a big feed, and 20-60 mins after they are crying and look like they want more, I want you to try these tricks to extend the time between feeds slightly, even if it’s 5 mins. These changes may take a week or so to get your baby to 2-3 hour gaps so no rush.

• Finger as a dummy. Holding your baby on their back (so they are facing upwards) place your little finger (palm facing up) into their mouth to soothe them, acting as a pacifier. 

• Dummy. Use of a ‘dummy’ / pacifier to soothe and trick your baby to settle. This is not a long-term solution but short term can help break the cycle. If you find this hard, you can coax the dummy around their mouth/lips so you stimulate their rooting reflex as they try and look for the ‘nipple’. 
• Dummy Con. Another trick with dummies is that you can put a little bit of breast or formula milk on the end to help start the sucking response. Another helpful tip is to have your baby skin on skin and in a feeding position on the mother, so this makes everything feel familiar to them, but then add the dummy instead of the nipple. 
• Dummy Con. The introduction should be done with babies after a few months of birth. We don’t want to create ‘nipple confusion’ in the early stages especially for breastfeeding mothers.

• Distraction. The last one is movement, bouncing, playing. Anything to distract them and stretch out the feeding times will always help. Now there are 100 different ways to move/play/rock your baby. You will know best whats suits your baby as they are all different. 

As mentioned above, even if it’s 5 more minutes you can extend that time between feeds then great, day by day you will be able to increase this, so no rush at all.

Making changes to the type of milk/formula 

Now your Midwife, GP, or other health care provider will have mentioned this or advised this, my only advice would be if you are going to change the type of milk then have the 5-7 day rule in place, this means whatever change we make then in 5-7 days you will know if it’s working. Too many people try a change and within 2 days give up.

The advice above is our opinion only and a few common factors we see in our clinic for this topic. If you are unsure or worried about any symptoms then please do not hesitate to make contact with your Midwife, GP, or other Health Care Practitioner. 

At our Osteopathic clinic, we see a range of complaints with newborns and infants, a few conditions listed below are things we can help within the clinic. If you need help or want further information on how Osteopathy can help you and your baby then please contact us

• Colic
• Reflux
• Crying/screaming/irritability
• Ear infections
• Feeding difficulties
• Sleep disruptions
• Head preference
• Birth complications
• Hip misalignment
• Growing pains
• Adolescent sport/activity injuries
• Asthma

If you have any further questions about the topics covered above or any other questions on how Osteopathy can help you, then please do not hesitate to reach out. 

Our Osteopathic clinic is situated on the North Shore in Auckland. A list below are the areas we serve:

• Albany
• Rosedale
• Glenfield
• Browns Bay
• Takapuna
• Milford
• Wairau Valley
• Mairangi Bay