Is My Baby Normal? Colic, Reflux, Sleep & Other Newborn Questions

Why won't my baby stop crying? Why do they spit up after every feed? Why won't they sleep through the night?

Every new parent has questions—and many wonder whether their baby is developing normally.

In this episode of Healthy Beginnings, Dr. Edgar Kalimba answers some of the most common questions submitted by parents of newborns. From infant colic and reflux to newborn sleep patterns and feeding concerns, this episode explains what is normal, what deserves closer attention, and when it's time to seek medical advice.

The first weeks with a newborn can feel overwhelming, but understanding what's normal can help you feel more confident and less anxious as a parent.

Healthy Beginnings offers clear and evidence-based conversations about children’s health, family wellbeing, and the systems that shape our lives. 

New episodes every Monday 

Have a question? Email: healthybeginningspodcast@gmail.com

Produced by LF Media

Transcript

SPEAKER_00 0:00

It's always a pleasure for me to have you back to these conversations at Healthy Beginnings Podcast. And lately we've been getting feedback from listeners, from parents telling us that they are listening in, that they find it very engaging, very informative, and that is really such a pleasure because that's the purpose of Healthy Beginnings Podcast. Our purpose is really to reiterate that every child deserves the healthiest possible beginning in life. That's what we all want as parents, as guardians. So today's episode is uh one that every new parent probably needs to hear. In fact, uh I decided to have this conversation because of feedback from parents, particularly uh concerns around the first three months of life for your baby. Um, this is a period that is filled with incredible joy, but also many questions, and typically a lot of sleepless nights, and some moments of uncertainty. And often parents will ask, why does my baby cry so much? Or why does milk keep coming back after every feed? Why is my baby spitting up? Is it normal or are they spitting up too much? How do I tell that this is okay and it's not a problem? Why does my baby wake up every two to three hours? Is this okay? Is it healthy? And really, a lot of questions about uh your baby's sleep cycle and really wondering if something is wrong. So by the end of today's episode, I hope you'll understand that many of the behaviors that worry you as new parents, especially mostly during the newborn period, are actually signs of uh your baby learning to live outside the womb and learning to adapt. So I'm going to speak briefly through three things. The first one is infant colic or baby colic, the abdominal pain, the discomfort that many, many mothers consult for and get worried about. The second one is gastrosophagal reflux. So, reflux, you know, which is spitting up or um refluxing the feed immediately after you've you fed your baby, bringing back a portion of their feed. And then lastly, we'll we'll discuss sleep, something about sleep. So, um, whether you're listening while feeding your baby at midnight or driving home from work or preparing for your baby's arrival, you're most welcome, and I'm glad you're here. So imagine this. Imagine it's 2 o'clock in the morning, 2 a.m. Your baby has finally fallen asleep after feeding, you quietly place them in the crib and you tiptoe away. And just as your tired head touches the pillow, the crying begins again. You check the dapa, you try to feed again, you burp your baby, you cuddle them, you walk around the room, but nothing seems to work. And eventually you begin asking yourself questions that almost every parent asks. Am I doing something wrong? Or is my baby sick? Why won't my baby sleep properly and settle down? If this sounds familiar, I really want you to know that it's uh something very, very common. You're not alone, and millions of parents deal with exactly the same thing. So, the question really is why are the first three months of life uh so challenging for both your baby and yourself? Now, we need to go back to the very beginning. You know, often the first three months are referred to as the fourth trimester. Remember, your pregnancy is made up of three trimesters: the first trimester, the second trimester, and then the third trimester. And then the first three months after your baby is born, sometimes we refer to that period as the fourth trimester. And the reason for this is because although babies are born, uh, many of their organs are still developing. If you think about it, before birth, your baby lived in an environment that was always warm, dark, quiet, uh cushioned, food arrived continuously through the placenta, and there was no hunger, there was no bright lights, there was no loud noises. Uh, your baby wasn't breathing before they are born, and then in a single moment, everything changes. The lungs open up at birth with a first cry and start working immediately. Then the stomach has to start receiving food for the first time, and the intestines have to actually digest milk for the first time, and then there's all the stimulation, the sights, the sounds, the smells, the sensations. So your baby and your brain is being bombarded from all sides. And then, of course, your baby has to learn to regulate body temperature, they have to feed, they have to sleep, um, and really adapt to all of these things. If you think about it, it's actually an enormous transition. So when your baby cries frequently or wakes up often or wants to be held, remember that they are not trying to give you a hard time. Your baby is having a hard time themselves adapting to a brand new world. But this is all normal for a baby who is born at full term. Uh, this is completely normal. So, first, why do some babies cry for hours every evening or every night? And what exactly is infant colic? Um, so I'm going to delve a bit deeper into this uh before I speak about the other topics. Um, so imagine again that your baby feeds well, they are growing normally, you've changed the diaper, they are not sick, but every evening, almost like clockwork, they begin to cry. Not just fussing, really, really crying. Sometimes for an hour, sometimes for three, you hold them, you rock them, you feed them again, and nothing seems to work. So many parents get worried and think my baby must be in pain, perhaps I'm not giving enough milk, I'm not producing sufficient amounts, or maybe my baby has a stomach problem. So this is what we call infant colic, which is very common and happens in 20 to 30 percent of babies. Um, that's what the statistics say, but from my observation, it's probably even higher than that. So a good portion of babies actually get a significant amount of infant colic, the abdominal pain, the discomfort. Um, and although it can be exhausting for families and for parents, colic usually occurs in babies who are otherwise healthy and growing well. And how do you tell that it's colic? We we always refer to the rule of threes. So a baby cries one for more than three hours a day, more than three days each week, and lasts at least three weeks. So colic is recurrent, it's prolonged crying in an otherwise healthy young infant that cannot be explained by illness or hunger. And it often begins around the second to third week after birth and really peaks around six to eight weeks, so between a month and a half and two months, and then gradually improves and goes away after that, by the age of three months, uh, especially when they are exclusively breastfed, it tends to go away sooner than when they are formula fed. So it really uh always resolves on its own as the baby's nervous system matures. Why does it happen? Nobody can explain uh exactly. What we know is that in uh a new and immature gut, your baby's stomach and intestines are really testing out feeding for the first time. Babies tend to swallow a lot of air, and often they get this crumping, they get a bit of inflammation, and um they're also learning to digest. Um, so that transition is typically what triggers colic. Um, so babies uh really go through uh a transition uh after birth. There's something we call the gut microbiome or good bacteria that may also play a role. Um, but again, these are hypotheses, and we don't have a lot of strong evidence that really supports or explains exactly why uh infant colic happens. And of course, some babies are more sensitive than others, they have more sensitive temperament, uh, and abdominal discomfort uh gives them more trouble than others. So if your baby has a sensitive temperament, they're going to be more irritable, they're going to be more uncomfortable. Um, it's obviously important to underscore that uh colic is not because you're doing a bad job as a parent, and it's not because your breast milk is bad in courts, it's not because you're uh not handling your baby correctly. It is certainly not your fault. The other thing to note here is that there is really no cure for colic. Uh, there are many ways to comfort your baby. Um, you know, you hold them, you can try skin-to-skin contact, because that always helps to regulate heart rate, breathing, and stress, or gentle rocking or rhythmic movement can be soothing. And you try a quiet room, you dim your lights, and just reduce the stimulation around your baby. And of course, you can sing, you can hum, you can put some white noise, um, as these tend to remind babies of the sounds they heard before birth. So, some babies also enjoy being carried in a baby slink uh close to uh the parent's chest. And if breastfeeding, you should continue breastfeeding unless advised otherwise by your healthcare provider. Uh, you don't need to stop breastfeeding because sometimes you know parents think that maybe it's because of my my milk or because of something I'm eating or something I'm not eating. So, all of these really are not concerns and shouldn't be considered. Uh, there's also something about probiotics. I I know some people have heard about probiotics. So, probiotic is the opposite of antibiotic, it promotes good gut bacteria. Uh, but again, uh the benefit is not very clear. Um, and this is the same with all the other remedies that are on the market that people often propose. So, generally, we do not encourage giving your baby medication for colic, we don't treat it medically. It is something that we wait out as long as you exclude alarming signs. So, what would those be? Not every crying baby has colic, understandably. Some babies cry because they are sick, that's a possibility, and you should definitely seek medical attention if your baby has a fever, or um if there is difficulty to feed, or if your baby is refusing feeds, or if there's persistent vomiting, particularly if it's green, uh what we call bilious vomit, or if there's blood in the stool, or if your baby is not gaining sufficient weight, or if there's anything else that is really unusual, excessive sleepiness, if they are if their tummy is swollen, if they have a high-pitched or unusual weak cry, um, all of these are signs that uh should not be ignored and you should seek help. So if something doesn't feel right to you, you should trust your instincts and you should seek medical advice. Now, that was colic. I would like to transition to something else that again, similarly, worries parents and uh is a frequent cause of consulting. You know, we see this in the clinic very frequently, and this is what we call gastroesophageal reflux. Now, gastro is the stomach, esophageal is the pipe or the tube that moves feeds from the mouth to the stomach, the esophagus, and then reflux is coming back or coming back from the stomach up into the esophagus and sometimes uh back into the mouth. So we all know that virtually every baby spits up to some extent after feeding. Uh babies spit up, and this is normal in the first few months of life. Uh, gastroesophage reflux simply means that stomach contents are flowing back into the esophagus, and babies are particularly prone to this because their digestive system is still developing, and the muscle at the lower end of the esophagus, at the entrance into the stomach, is not yet fully mature, and to that, uh, a liquid diet frequently uh comes back up, is easy to come back up, and the babies also have a small stomach, and the fact that babies spend much of their time lying down, it is easy to see why uh their feeds come back up. So, this type of reflux is what we call physiological, it is normal. These are happy spitters, if I would call it that. Um, so if your baby spits up but remains comfortable, they feed well, they are gaining weight appropriately, and they continue to thrive. Um, this should be reassuring that what you have, what your baby has, is physiological reflux. And this naturally improves as your baby grows. Now, most infants experience the most spitting up around three to four months of age, and then it significantly improves by six months and sometimes goes on up until 12 months as they begin to sit upright and they eat solids, and the valve between the esophagus and stomach becomes stronger. Now, not all reflux is the same. There's a difference between gastrosophagal reflux that I just described, which is normal, and there is gastroesophageal reflux disease where reflux now becomes complicated. Uh, and you get things like insufficient weight gain, feeding refusal, or your baby seems to chalk very frequently, what we call recurrent aspiration. And often the esophagus is inflamed, it becomes inflamed. So gastrosophagic reflux disease is much less common than physiological reflux and should only be diagnosed after a careful medical evaluation rather than assuming simply because the baby cries or spits up. Now, one misconception that has become widespread is that every unsettled baby has reflux and therefore needs medication. But that's not what the evidence tells us. In fact, acid-suppressing medicines have a very limited role in an otherwise healthy infant with simple, normal physiological reflux and may expose babies to unnecessary side effects. So for most babies, just reassurance and time all you need without any additional treatment. So if your baby uh speeds up somewhat excessively, you could try a few things. One, you should feed smaller amounts and rather feed more frequently than giving one big feed that might end up coming back out. The other thing is that uh it's very helpful to burp your baby gently during and after your feeds, and generally avoiding overfeeding. So it's usually good if your baby is a heavy spitter to keep them upright after they have fed for about 20 to 30 minutes after feeding, while remembering that the safest position for sleep is always flat on their back, or at least even if they are propped up, they they sleep on a flat surface and they sleep on their back. We'll come back to this when we speak about sleep, and then of course, continue breastfeeding. It's always helpful. Never place your baby to sleep on your st on their stomach because of reflux. I've seen parents do this because the safest sleep position remains sleeping on their back, even for babies who spit up frequently. So, when should you consider getting medical help or evaluation? First of all, if they are vomiting greenish or yellow, uh, whether it's vomiting or excessive spitting up, uh, or if there is blood in their vomit, or if there is forceful vomiting, what we refer to as projectile. So, not this easy, comfortable spitting up, but this projectile, like they really forcefully bring back, and kind of it's like a jet coming out. Um again, when they are not gaining weight, or if they're refusing or struggling to feed with recurrent chalking tendency, or breathing pauses, what we call apnea, or breathing difficulties during feeds. The other thing is if they have persistent coughing, every time you try to feed them, they are coughing, coughing. Um, again, that's associated with uh chalking, or if there are signs of dehydration. So most babies who spit up are healthy, but reflux uh that is physiological is something that babies grow out of and generally does not need to be medicated, except when they are alarm signs, some of which I just mentioned. And now this brings me to the third part of our conversation today, which is sleep. I've heard uh from different mothers, different parents asking me questions about the baby sleep, um, especially the first couple of months, because often it is very challenging. Uh often your baby cannot tell the difference between day and night. Um, and you really start to wonder, you wondering everyone else's baby seems to sleep through the night. Why doesn't mine do the same? So, one of the greatest misconceptions about newborns is the belief that they should sleep for long, uninterrupted periods. The truth is, newborn sleep is completely different from adult sleep. And that's actually a very good thing. If you think back to life inside the womb, your baby didn't know the difference between day and night. And they were always warm, there was it's it was always dark, always close to the comforting rhythm of your heartbeat. And like I said earlier, nutrition arrived continuously. There was no need to wake up for feeding, and then suddenly everything changes. Your baby now needs to feed every few hours after being born, and they have to digest, and they have to do all the new things that they're adapting to after birth. So it takes time for the body to adjust. And one of the last systems to mature is what we call the circadian rhythm, which is the internal body clock that helps us to distinguish between day and night. And this rhythm develops gradually over the first few months of life. But until then, your baby has no idea that nighttime is supposed to be for sleeping. Now, many parents also are surprised to learn that newborns actually sleep a lot, and most healthy newborns sleep somewhere between 14 and 17 hours within a 24-hour period. But here is the important part those hours are spread across many short periods. Some babies sleep for two hours, others for three, occasionally for four. Then they wake up again. Not because something is wrong, but because they need to eat and their stomachs are tiny during the first weeks of life. Babies have little energy reserve. So frequent feeding protects them from dehydration, from low blood sugar, and from poor weight gain. In other words, waking to feed is a sign of healthy newborn physiology. Now, adults spend most of the night in deep sleep. That's how it is. And in newborns, it's not the case. Almost half of newborns sleep is active sleep, also called REM sleep or rapid eye movement sleep. And during active sleep, you may notice smiling, grimacing, small movements of the arms and the legs, or rapid eye movements beneath uh closed eyelids. Um, sometimes they make little sounds or brief cries, and many parents think that baby is waking up, and often they are still asleep. So active sleep is incredibly important because it supports brain growth, memory formation, learning, and the development of the nervous system. So as children grow older, the proportion of active sleep gradually reduces. And often there's a question can I teach my newborn to sleep through the night? And the short answer is no, definitely not during the first few months of life, as I've just explained. Newborns are biologically programmed to wake up frequently, and those night wakings are protective, they reduce the risk of prolonged fasting, they support breastfeeding, and they allow your baby to continue to grow rapidly as it should be in the first couple of weeks and months of life. So trying to force a newborn to sleep for long periods before they are developmentally ready is neither realistic nor healthy. So instead of expecting uninterrupted sleep, parents should focus on helping babies learn the difference between day and night. So, how do you do this? During the day, you open the curtains, you allow natural daylight into the room, you talk, you sing, you interact with your baby. Normal household sounds are perfectly acceptable. And during the night, you should gradually reduce stimulation. You dim the lights, you speak softly, you avoid loud television or bright screens, and try to set up a routine because a predictable bedtime routine, even for very young babies, can begin to signal that nighttime is approaching. And this could be a warm bath, quiet feed, a lullaby, a caddo, just simple, regular, uh predictable routines and signals as babies grow. Now, before we get to the end of the conversation today, uh I would like to mention something about safe sleep. The safest place for every baby to sleep is on their back, on a firm, flat mattress and in their own sleep space. Don't put pillows, don't put heavy blankets or stuffed animals or loose beddings. Um, the safest environment is one where the baby shares the parent's room, but not the same sleep surface. So not in your bed, especially during the first six months, uh, six months of life. Now, these are uh recommendations, global recommendations that help also to reduce what we call sudden infant death syndrome or SIDS or other sleep-related deaths. Um yeah, so most newborns uh have this staggered sleep pattern, and this is normal as long as it evolves and improves as they grow. So, again, the only reason that would be there to seek medical advice is if your baby is uh is struggling to wake up for feeds or sleeps excessively and feeds feeds poorly, and typically that goes with uh poor weight gain, or if they have uh apneas or breathing pauses, and sometimes if you know that can come with uh turning blue, or if they snore loudly with signs of breathing difficulty, uh, these are some of the signs that really deserve uh medical evaluation. So, a few myths or facts. A good baby sleeps through the night, that's definitely a myth. A healthy newborn wakes frequently because their bodies need regular feeding and their brains are still developing. The other assertion: if I pick up my baby every time they cry, I'll spoil them. Now, during the first months of life, your baby is not manipulating you. Babies do not manipulate their parents, so responding to their cries actually builds trust, strengthens attachment, and supports healthy brain development. Another common saying that rice or another cereal added to their bottle helps baby sleep longer. This is a myth. There is no good evidence that adding cereal to your young infant's bottle improves sleep and it may increase the risk for choking and overfeeding, especially when you do this before they are six months of age or around six months of age. Then uh I spoke about sleeping on their stomach. You know, some mothers say if we put, if I put my baby on their stomach, it will reduce the refluxing. Again, this is a myth, and the safest position for most babies is on their back or at least supported on their side, especially if they're already a couple of weeks old. So the first three months are a season of extraordinary adjustment, not just for you, but also for your baby. And your baby is really adapting to the world around them, everything is completely new. Um, you're learning, they are learning. There will be difficult days andor nights, and there will be moments when you feel overwhelmed. Um, so you should accept help when it's offered and rest whenever you can. Take care of yourself with the same kindness that you show your baby. Because, trust me, the sleepless nights that you're having will become memories one day, and the tiny baby who wakes every two hours will eventually sleep through the night, and the crying will turn into laughter. This is just a season, this is just a transition, and your baby will outgrow it. So, my brief take-home messages from today's conversations are that frequent waking is normal during the first three months because newborns need regular feeding and are still developing their day versus night rhythm. Active sleep is essential for brain development, learning, and memory, and dental routines, you know, like daylight exposure and responsive caregiving helps babies gradually develop healthy sleep habits and always follow safe sleep practices. Place babies on their backs, especially the first couple of weeks on the firm surface and in their own sleep space, free of objects and uh staffitoids and all the other things that can pose a risk, especially when your baby is still within the first few months of life. And remember that every feed, every cuddle, every comforting touch, and every sleepless night is helping your baby grow. Not only physically but emotionally and neurologically, and really in every other way. Before we leave, I would like to answer some of the questions that were sent to us by the listeners.

SPEAKER_01 33:31

First question from Andrew from Kigali. I'm reaching out to ask if it is normal for a four-month-old baby to experience sweaty feet mostly when he is active. When should one get to start to be concerned?

SPEAKER_00 33:43

So, this is something actually interestingly common. Some babies do sweat a lot, not just the feet, but also their palms uh or their head, their forehead. And often this is pretty normal. Uh it should be noted that in in some some babies, some infants, the sweat glands, you know, the glands in the skin, in the palm or in the the plantar surface of their feet uh uh are quite present and active. Um, so the part of the body that controls sweating, heart rate, uh temperature regulation is called the autonomic nervous system, and this is still developing. And as a result, sometimes babies sweat more than adults in certain areas, like hands, feet, and head or scalp. This is usually temporary, and as they grow and mature, it it generally improves. The other thing is that compared to the body of their the compared to the size of their body, babies have a high density of sweat glands. And although these glands are still maturing, they can still produce quite a lot of sweat, especially when it is warm or when we cover we cover their feet. Uh, it's not uncommon to for parents to cover their baby's feet with socks or booties or slipsuits or swaddles, and yet it's very warm. Like now in July, it tends to be very, very warm, especially during the day. So uh you should also remember to dress them appropriately. So, as long as your baby is feeding well and they are growing well, they have no fever, and your baby appears comfortable? Um, this is usually not a problem, and you don't need to worry about it or to seek medical attention.

SPEAKER_01 35:59

Second question from Peter, also from Kigali. Since we moved homes and my daughter changed schools, she has become unusually quiet. She used to tell us everything, but now she spends a lot of time alone. Can major changes affect a child's mental health even when they seem too young to understand what is happening?

SPEAKER_00 36:17

Being quiet doesn't mean necessarily that something's wrong. So, this often happens as part of uh normal adjustments and as a sign of transition or emotional distress. As most parents know, children often express emotions through change in behavior rather than words. For example, they some children will cry or some will become irritable, others will become clingy when you're dropping them off at school, and some may become quieter than usual. So instead of asking, why isn't my child talking as they used to, maybe you should ask, what might my child be experiencing that they cannot yet put into words. And starting a new school is one of the biggest changes in a child's uh experience. You can imagine everything is unfamiliar. A new teacher, new classmates, different rules, different routines, um, and all the other concerns and anxiety. So it can happen that children become quieter for a few days or even weeks because they're carefully observing the new environment. So this is generally okay, um, as long as they gradually become more comfortable over several weeks and they they're talking normally at home and they continue to feed and sleep well and enjoy some parts of school, slowly making friends, showing interest in learning, and so on and so forth. So if that's the case, then really there's no cause for alarm. But obviously, if being quiet is accompanied by additional things happening, like refusing to go to school, completely refusing, or complaining of all kinds of things, stomach aches or headaches, especially when it's time to go to school, and the rest of the time they are fine, or they have um persistent withdrawal or sadness, or uh really things being affected extensively, they're not sleeping anymore, or they have frequent nightmares, um, then it may suggest that your child is experiencing more than just normal adjustment. And you should probably then look further into this, speak to the teachers at school, uh, try to understand what exactly is happening, and if necessary, you need to seek advice, especially if there is excessive suppression anxiety or really, really unusual social difficulties or things like bullying. Uh, I've heard in some preschools that there is bullying, you know, like kids will take uh food from their peers, they will push them, they will do kind uh all kinds of things. So there can be bullying even in young uh children's classes in preschool and in play school. You know, I've seen, for example, children who bite other children. These things can happen. So if there is uh unusual concerns, then definitely that warrants being looked into a bit more deeply. So, once again, um I'm very grateful uh that you listened in again today, and I look forward to continuing these conversations.

SPEAKER_01 40:03

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