When it comes to babies, what goes down … must sometimes come up.
From spit-up to food refusal, about 50% of infants develop at least one functional gastrointestinal disorder, or FGID, between birth and six months. These common, typically benign gut issues are often linked to a newborn’s still-developing gut microbiome, nervous system and immune system, and frequently have no underlying medical cause.
Most symptoms improve naturally during the first year of life. But that doesn’t stop perplexed parents from losing sleep, doomscrolling for answers and wondering whether every burp, bottle or diaper change means something is wrong.
Thankfully, pediatric gastroenterologists can help address common feeding concerns in newborns and babies.
While some infant feeding behaviors may seem scary or concerning, they are often part of normal development.
Here’s what parents need to know about spit-up, feeding struggles, growth concerns and the red flags that mean it’s time to call the pediatrician.
Spitting up
On social media, babies often look picture-perfect — and squeaky clean.
Parents aren’t sharing the burp cloths, outfit changes and messy moments that come with feeding a newborn. That can make families wonder whether frequent spit-up is a sign something is wrong.
But spit-up is extremely common in babies. Infants take in a lot of liquid, whether breast milk or formula, and their digestive systems are still gaining strength and developing.
Together, this creates the perfect storm for reflux — and in many cases, it’s simply part of being a baby.
Breastfeeding vs. formula
The breastfeeding-versus-formula debate can create enormous stress for parents.
Breastfeeding provides excellent nutrition for infants, but if it isn’t working for a family, that pressure can become overwhelming. What matters most is that babies are fed, growing and cared for in a calm environment.
Formula is also a safe, highly regulated option, with many variations available to meet different needs.
Is baby eating enough?
One of the clearest signs that a baby’s digestive system is working well is whether they are growing and thriving.
A baby who is following their growth curve and gaining weight appropriately is usually getting the nutrition they need, even if feeding patterns vary from day to day.
One of the main warning signs of a digestive issue is poor growth or a noticeable change in a baby’s growth pattern.
Feeding concerns become more serious when they are paired with difficulty gaining weight or falling off the growth curve.
Pooping
Pooping patterns can cause a lot of stress for new parents, but there is a wide range of normal. Some babies poop multiple times a day, while others may go days without a movement.
The concern is when there is a noticeable change from what is typical for that baby.
Blood or mucus in the stool, or a sudden shift in bowel habits, is a reason to check in with the pediatrician.
Refusing to feed
Most babies will have off days with feeding, but pediatric specialists become more concerned when reluctance to eat turns into a pattern.
Unlike fussiness, persistent refusal is less about preference and more about how well a baby is tolerating feeds.
A baby who consistently pushes away the breast or bottle, becomes distressed during feeds or refuses to eat altogether may be signaling an underlying issue that needs medical attention.
Feeding refusal is one of the signs pediatricians take seriously because it can affect hydration, nutrition and growth.
Medication isn’t always the answer
Most infant digestive issues can’t be solved by a magic pill. Acid-blocking medications can reduce acid, but they don’t stop spit-up itself.
For babies with normal reflux, doctors often focus first on approaches such as smaller, more frequent feeds or keeping a baby upright for 20 to 30 minutes after eating.
Medication is usually considered only when the benefits outweigh the risks.
A warning on online advice
Search results, AI chatbots included, can quickly make parents think normal infant behaviors could be rare medical conditions, without the context of knowing a specific baby.
To help filter the flood of online resources, use information from pediatric organizations, including the American Academy of Pediatrics, and other trusted medical sources, while keeping the child’s pediatrician involved.
When bringing concerns to the doctor, start with what you’re seeing, the actual symptoms, rather than leading with a diagnosis found online.
When to call the doctor
Parents know their babies better than anyone. If you feel something is off, you shouldn’t wait to contact your pediatrician. There’s no extra credit for waiting.
Sometimes, the answer will simply be reassurance and observation — and that’s OK.
Having a pediatrician you trust makes it easier to ask questions before a concern becomes overwhelming.
Remember: It’s a work in progress
Feeding a baby is rarely predictable, and that’s part of what makes the first year so challenging for parents. Some days go smoothly, with steady feeds and a content baby.
Other days are marked by gas, fussiness or feeds that feel harder than they should.
There is no perfect rhythm that every baby follows. Instead, feeding tends to shift from day to day as babies grow and learn how to coordinate their own hunger cues.
Ultimately, feeding is less about getting every day exactly right and more about staying attuned, flexible and connected to your baby.
Melanie K. Greifer, MD, is a pediatric gastroenterologist within the Pediatric Gastroenterology Program at Hassenfeld Children’s Hospital at NYU Langone and clinical professor in the Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology at NYU Grossman School of Medicine. Dr. Greifer specializes in general pediatric gastroenterology, including reflux, feeding disorders, celiac disease, eosinophilic esophagitis, abdominal pain and constipation.
