Feeding Issues

    Helping parents manage common feeding issues just got easier.

    Digestive Concerns for Moms

    When moms have a baby who is fussy, gassy and crying, they come to you for answers. Sometimes a little parent education can go a long way in easing their issues. For breastfeeding babies, it may help to counsel moms to recognize their baby’s hunger signals or watch out for certain foods in their own diet. For formula-feeding babies, changes in formula type may be what they need.

    Help educate parents to ease and enjoy feeding times with their infants. Download this FAQ for parents about easing gas and crying.

    Download FAQ

    What causes tummy issues?

    Problems digesting some nutrients, such as protein and lactose, may be presented as fussiness or gas in some infants, and it is common practice to consider a change in formula at this time.

    The enzymes lactase and enterokinase are involved in the breakdown of lactose and protein, respectively, in the digestive system. Due to the immaturity of the digestive system in infants, these enzymes may not be produced in adequate amounts resulting in some lactose and protein traveling to the large intestine without being fully digested. They may be fermented by bacteria.

    Bacterial fermentation in the large intestine may cause gas, which may lead to fussiness or crying.

    Research suggests enzyme activity may be reduced in infants at birth 2,3

    Lactase

    Enzyme that breaks down the lactose

    Enterokinase

    Activates enzymes that break down protein

    A Range of Options

    Standard milk-based formulas have intact proteins derived from cow’s milk. Through a process called hydrolysis, proteins can be broken down during manufacturing. Formulas with partially hydrolyzed proteins are designed to help ease digestion4. Extensively hydrolyzed formulas should be considered for cases when cow’s milk allergy is suspected.

    Recommending the correct formula can help your patients and give moms peace of mind.

    See the Study

    See the Difference

    Partially hydrolyzed formulas are easy to digest, and help with mild gastrointestinal issues4.

    The Right Solution for Every Baby

    Formulas with a reduced amount of lactose may help with digestive comfort while providing some lactose as an energy source for babies’ growth. Lactose also shapes the intestinal microbiota and promotes the absorption of some nutrients such as calcium.

    Intact Protein Formulas With Full Lactose

    Healthy babies' first choice when breastfeeding is not possible.

     

     

    Partially Hydrolyzed Formulas With Reduced Lactose*

    Easy to digest for healthy babies rejecting first choice formula or with digestive discomfort.

    73% of babies experience digestive discomfort.1.

    Extensively Hydrolyzed With No Lactose

    For confirmed or suspected cow's milk protein allergy (CMA).

     

    2%-7% of babies experience CMA.6.

    Extensively Hydrolyzed With No Lactose

    For confirmed lactose intolerance.

     

    Lactose intolerance is extremely rare under 3 years of age7.

    Looking for Formula Solutions for Your Patients?

    Learn More About Mead Johnson Nutrition’s Solutions

    See MJN Solutions

    It’s Time for a Gut Check

    When to Recommend a Probiotic Supplement

    Emerging data show that probiotics may be beneficial for supporting overall digestive and immune health8-10. Fostering a healthy infant gut microbiome regularly—not just after a bout of gastroenteritis or following a round of antibiotics—may be beneficial for baby.

    Learn more about the link between gut bacteria and immune health.

    See the Link

     

    Strains Matter

    Probiotics Most Commonly Used in Infant Nutrition

    Lactobacillus rhamnosus GG (branded LGG®)
    The most widely studied probiotic, LGG has been used in food and dietary supplements for close to 30 years with a well-documented safety and efficacy profile.

    Bifidobacterium lactis (BB-12®)
    Also well-studied, BB-12 may have beneficial effects on gastrointestinal and immune function.

    Lactobacillus reuteri (RC-14®)
    Originating from healthy vaginal sources, this strain has been used safely since 2004.

    Lactobacillus reuteri (DSM 17938)
    This strain was isolated from the breast milk of a woman living in the Andes.

     

    Nourishing a Robust Microbiome Can Help Support Digestive and Immune Health

    Depending on the strain, probiotics may help your infant patients in the following ways:

    • Improve gut barrier function11
    • Support immune health8
    • Lower risk of atopic/allergic disease9
    • Ease digestion issues like colic8

     

    While most studies at this time revolve around individual strains, emerging evidence suggests combining some probiotic strains can have synergistic effects9.

     

    Provide Your Patients with Clinically Studied Levels of LGG® and BB-12® Probiotics

    See the options Mead Johnson Nutrition has to offer.

    See Now

    LGG and BB-12 are trademarks of Chr. Hansen A/S.

    Could GER or GERD be causing your patient's spit-ups?

    GER Occurs in 66% Healthy Infants12

    Healthcare professionals understand that babies spit up, but parents often worry about it. A lot. In fact, research shows that spit-up is the topic of discussion at 25% of routine 6-month visits12.

    GER is common—it can occur daily in 50% of all infants. Spit-up, regurgitation or vomiting are often the most visible symptoms.

    Knowing the difference between uncomplicated physiologic reflux (GER) and actual gastroesophageal reflux disease (GERD) is key in managing symptoms—and reassuring worried parents.

    Identify the Source of Spit-Ups

    GER is a normal physiologic process caused by an immature lower esophageal sphincter (LES). In younger infants, the LES isn’t strong enough to prevent backflow from the stomach to the esophagus. As the LES matures, GER usually resolves on its own.

    Common Causes of GER

    Overfeeding

    Positioning during/after feedings

    Burping frequency

    Intolerance to maternal diet
    (e.g., milk or egg)

    Type of formula used

    Current Guidelines for Managing Reflux

    Many worldwide expert groups have published recommendations on managing GER and GERD, including the American Academy of Pediatrics. According to their latest guidelines, it is critical to properly distinguish between GER and GERD. In either case, lifestyle changes are the first-line treatment12. This includes:

    • Making feeding changes
    • Positioning therapy
    • Modifications of maternal diet (if breastfeeding)
    • Reducing feeding volume
    • Increasing feeding frequency
    • Educating parents about avoiding environmental factors such as tobacco smoke

    Empiric use of acid suppression medication is not indicated for uncomplicated physiologic reflux. Additionally, in April 2020, the FDA requested that all prescription and over-the-counter products containing ranitidine be pulled from the market due to safety concerns13.

    If there are signs of more complicated GERD, closer evaluation is needed. The newest guidelines emphasize weight loss as a critical warning sign. Subspecialist consultation and pharmacologic treatment may be warranted.

    Figure 1. Approach to the infant with recurrent regurgitation and vomiting 12

    Do Thickened Formulas Work for GER?

    When managing GER, choosing a thickened formula may work for otherwise healthy, non-breastfeeding infants. Commercially available thickened formulas offer a more balanced nutrient profile with less mess.

    By using ingredients such as rice starch, for example, formula flows normally through a standard nipple, only thickening when “activated” by the gastric juices of the stomach.

    Energy of thickened formulas meets the recommended 20 kcal/serving, while adding rice cereal to standard formula can increase the energy density to 34 kcal/serving, effectively diluting the protein and fat ratios.

    See Formula Option

     

     

    Educating Parents on GER Management

    Providing education and reassurance is an important step in helping parents manage GER in their infant. Use this dialogue tool to discuss lifestyle changes to ease stress on parents and help manage their infant's symptoms.

    Download Parent Educator

     

    References

    GER = gastroesophageal reflux
    GERD = gastroesophageal reflux disease

    1. Quantitative online digestive concerns survey. Moms with babies from 0-12 months. Intuit Research Agency, July 2019. Scope: MX, PH, TH, US, CN. N=200 per market.
    2. González HL et al. Acta Pediatr Mex. 2005;26:270-292.
    3. Cummings JH et al. J Appl Bacteriol. 1991;70:443-459.
    4. Berseth CL et al. Clin Pediatr (Phila). 2009;48:58-65.
    5. Scientific Committee on Food, European Commission, Health and Consumer Protection Directorate-General. Report of the Scientific Committee on Food on the Revision of Essential Requirements of Infant Formulae and Follow-on Formulae. Brussels, Belgium: European Commission, Health and Consumer Protection Directorate-General; 2003. Kwak H-S et al. Int Dairy J. 2012;22:147-151.
    6. Vandenplas Y et al. Arch Dis Child. 2007;902-908.
    7. Heyman MB; for the Committee on Nutrition. Pediatrics. 2006;118:1279-1286.
    8. Nocerino R et al. Aliment Pharmacol Ther. 2020;51:110-120.
    9. Schmidt et al. Pediatr Allergy Immunol. 2019;30:335-340.
    10. Hojsak I et al. Clin Nutr. 2010;29:312-316.
    11. Johnson-Henry KC et al. Infect Immun. 2008;76(4):1340-1348.
    12. Lightdale JR, Gremse DA and Section on Gastroenterology, Hepatology, and Nutrition. Pediatrics. 2013;131:e1684-e1695.
    13. Korioth T. FDA wants all ranitidine products off the market. AAP News. Published April 1, 2020. Available at Available at: https://www.aappublications.org/news/2020/04/01/ranitidine040120. Accessed June 17, 2020.