A gassy, crying baby with explosive green poo is what I would call an actual demonstration of colic. A baby who is experiencing discomfort due to a build-up of gas in their gut. Explosive green poo with gas is often caused by lactose overload but is generally misdiagnosed as unexplained colic, lactose intolerance, breastmilk intolerance or some other dietary intolerance (in the mother’s diet). Instead, it is likely due to your baby being unable to keep up with the lactose entering their gut.
What is lactose overload?
Lactose overload is not lactose intolerance. Read that again!
But “my baby is intolerant to my breastmilk.”
Said millions of mothers…
Lactose overload happens to your baby when they drink a high amount of lactose. Lactose is the milk sugar present in your breast milk. This is because your breasts make lactose as part of producing milk. It doesn’t come from your diet. It is the most important carbohydrate in human milk. It is dense with energy and provides 40% of your baby’s caloric (energy) needs. The level of lactose in your breast milk stays proportionately stable throughout a feed: the more milk your baby swallows, the more lactose travels into his or her gut. Lactose breaks down as the milk passes through your baby’s gut.
However, breast milk also consists of fat globules (cream). Unlike, lactose, the cream content in breast milk is variable, gradually increasing over a feed. Fat slows down the movement of the milk through your baby’s gut, giving more time for the lactose to be broken down and reducing the chances of the lactose fermenting in the lower colon, highlighting the importance for your baby to suckle those last bits of milk. So if your baby is not emptying a breast before switching over to the other breast it is likely that he or she is not getting much of the cream in the milk.
“Needless to say, when you notice a suck-swallow-suck-swallow-suck-swallow pattern, the baby is dirnking down higher volumes of milk and higher loads of lactose. When you notice a suck-suck-suck-suck-suck-suck-swallow pattern, he or she is drinking less milk and less lactose is going in.”
Dr Pamela Douglas author of The Discontented Little Baby Book.
If your baby is drinking large amounts of milk, switching to the other breast before emptying one breast or having latching issues, they will be drinking large amounts of lactose. When the gut can’t keep up with the amount lactose it ends up in the large colon. When this extra lactose reaches your baby’s lower bowel, normal gut bacteria use it and begin to ferment the lactose, releasing gas in the process. This often causes wind and potentially discomfort.
Your baby may have a bloated belly and many large, green, frothy and explosive poo due to a large amount of fermentation in the lower colon.
Why do some babies get lactose overload but not others?
Lactose overload is a spectrum condition. Babies will often experience some level of lactose overload in the first few weeks when your breasts are trying to figure out how much milk to produce. Some babies won’t get lactose overload very often because they can empty the breast efficiently, which means they drink a good balance of lactose and fat; as your baby feeds, the fat content in the breast milk increases.
Causes of lactose overload
- Generous milk supply (often referred to as “oversupply” by many lactation consultants and midwives – not how I perceive things).
- Fit and hold issues while breastfeeding (often referred to as poor latch by lactation consultants). Latching issues result in your baby not emptying the breast appropriately, meaning your baby is only getting low-fat milk, high in lactose.
- Swapping breasts before your baby is able to drink the fatty milk. If you switch your baby to the second breast without emptying the first one, they will take a large amount of lower-fat milk from both breasts. With less fat, the milk moves through their body too fast for all the lactose to be broken down and absorbed.
- Feeding for comfort rather than hunger. Because they have tummy pain, they may want to suck often for comfort.
- Poor satiety, due to mainly drinking high lactose and low-fat milk. It is the fat in the breastmilk that signals to your baby’s brain that it is full. Without the fat, your baby will want to feed more regularly. Feeding more frequently increases the amount of lactose needing to be broken down in the intestines.
- Classic tongue-tie. This results in your baby not emptying the breast appropriately, meaning your baby is only getting low-fat milk, which is high in lactose.
Signs & symptoms of lactose overload
- Your baby is very unsettled and often cry.
- They may be underweight due to poor fat intake.
- They may also be adequate weight or overweight due to the high volume of milk intake.
- Poor satiety, not really getting “milk drunk”.
- Gassy due to lactose fermentation.
- Large, green, frothy or explosive poo due to lactose fermentation. Green poo on its own can be normal and common in those early weeks. Baby poo can be anything from orange to yellow to green.
- You may think you have a low milk supply because your baby always seems hungry.
- They may also have a nappy rash as the poo is more acidic.
Why is my baby gassy and doing a frothy explosive poo?
Gas is produced in the gut when lactose begins to ferment in the intestines (whether breast milk or formula). It is not caused from a lack of burping. That’s right. The gas bubbles are a result of fermentation, like the bubbles in sauerkraut. They aren’t air bubbles. The build-up of gas can create pressure, causing bloating and explosive frothy poo.
What can I do to help my gassy baby?
Firstly, you need to address if there are any areas to support your fit and hold. Generally, improving fit and hold while breastfeeding improves fatty milk intake. You want your baby to be drawing in a fair bit of boob to empty the breast efficiently.
If you have a generous supply of milk, you may need to feed off the same boob for a few hours and then swap, this is called block feeding. Only use this method if you are certain that you have too much milk by speaking with an ABA counsellor or a Gestalt lactation consultant.
Block feeding is designed to reduce your milk supply. Be careful not to keep block feeding longer than you need to.
Suppose you have addressed these areas of breastfeeding and your baby is still experiencing wind and pain. In that case, you may need to speak with one of our naturopaths to ensure no underlying issues are impacting your baby’s ability to digest.
I can help you there. Bub’s health is intricately interconnected with mama’s health. So addressing any health concerns with mum generally improves bub’s health.