Common Pediatric Concerns: Baby Feeding, Development, and Health Issues

I have some questions to ask the doctor?

Hello Doctor,
Question 1: My baby is currently 3 months old and has one feeding of breast milk combined with formula milk, approximately 60-180cc each time.
After feeding, when I burp him, I can hear water sounds in his stomach.
Is this normal?
Question 2: How can we determine if the fontanelle is bulging? When viewed from the side, it appears to be noticeably protruding and feels slightly rounded to the touch.
My baby has a slight curvature; is this considered bulging? If the fontanelle is bulging, what symptoms would indicate increased intracranial pressure?
Question 3: Recently, my baby's stools have been green, and today they were a bit dark green and watery, sometimes quite abundant, even overflowing.
He typically has bowel movements about 1-3 times a day.
Could this be related to the combination of breast milk and formula?
Question 4: Previously, my baby had atopic dermatitis on his neck.
Applying lotion has improved it somewhat, but now his neck has two different skin tones (the original color and a lighter, slightly peeling sunburn-like color).
Is this normal?
Question 5: Sometimes when my baby wakes up, I notice a gurgling sound in his mouth as if there is water, but he swallows it back.
Is this normal?
Question 6: Occasionally, my baby breathes a bit loudly and rapidly, and sometimes it seems like he has phlegm in his throat, but other times he does not.
I’m unsure if this is related.
Thank you!

Shuan, 30~39 year old female. Ask Date: 2010/01/14

Dr. Xiao Kaiwen reply Pediatrics

1.
It is normal for newborns to have thin abdominal walls, which makes sound conduction more pronounced.

2.
There is no specific standard for fontanelle bulging, but a "slight curvature" should not be considered abnormal.
Symptoms of increased intracranial pressure may include an enlarged head circumference, vomiting, sunset eyes (where the pupils are positioned below the horizontal line), and poor activity and appetite.

3.
Green stools are simply a sign of iron content and are not a concern; however, if the stools become more watery and the frequency increases, it is classified as diarrhea.
Feeding with breast milk and standard infant formula does not cause diarrhea.

4.
It is difficult to make a determination without seeing the actual condition; consulting a pediatrician or dermatologist is advisable.

5.
Newborns have immature swallowing mechanisms and the esophagus-stomach junction is not yet tight, making them prone to spitting up when consuming liquid milk.
The gurgling sounds in the mouth during exertion are normal.

6.
Noisy breathing and the sensation of phlegm in the throat are not signs of a cold; rather, they are normal sounds resulting from the soft cartilage in the newborn's respiratory system vibrating during breathing and the immature swallowing of saliva.
Newborns are practicing their breathing, and occasional rapid breathing is acceptable (as long as it is not consistently rapid).

Reply Date: 2010/01/14

More Info

When addressing common pediatric concerns regarding feeding, development, and health issues in infants, it's essential to consider various aspects of a baby's growth and well-being. Here, I will address the specific questions raised and provide additional insights based on medical knowledge.

1. Baby's Feeding and Stomach Sounds:
It's quite normal for a three-month-old baby to make gurgling sounds in their stomach after feeding. This is often due to the digestion process, where the stomach and intestines are working to break down the milk. The combination of breast milk and formula is common, and as long as the baby is gaining weight appropriately and seems content after feeding, there is generally no cause for concern. However, if the baby appears uncomfortable or is excessively fussy, it may be worth consulting a pediatrician.

2. Fontanelle (Soft Spot) Concerns:
The fontanelle is the soft spot on a baby's head where the skull bones have not yet fused. A slight bulging of the fontanelle can be normal, especially when the baby is crying or straining. However, if the fontanelle appears persistently bulging or if there are accompanying symptoms such as vomiting, lethargy, or irritability, it could indicate increased intracranial pressure, which requires immediate medical evaluation. Symptoms of increased pressure can include a rapid increase in head circumference, vomiting, and changes in behavior.

3. Green and Watery Stools:
It's not uncommon for infants who are breastfed and formula-fed to have green stools. The color can be influenced by the iron content in formula or the mother's diet if breastfeeding. Watery stools can be a sign of diarrhea, especially if they are more frequent than usual or if there is a change in consistency. If the baby is otherwise healthy, active, and not showing signs of dehydration (such as dry mouth, lack of tears, or decreased urination), this may not be a cause for concern. However, if diarrhea persists, it’s advisable to consult a pediatrician.

4. Eczema and Skin Color Changes:
Eczema, or atopic dermatitis, is common in infants and can lead to changes in skin pigmentation. The appearance of two different skin tones could be due to irritation or healing from eczema. It's essential to keep the skin moisturized and avoid known irritants. If the condition worsens or if there are signs of infection (such as increased redness, warmth, or pus), a pediatric dermatologist should be consulted.

5. Gurgling Sounds During Sleep:
Hearing gurgling sounds while the baby is sleeping is generally normal. This can occur as the baby swallows saliva or during the digestion of milk. If the baby seems to be swallowing these sounds back without distress, it is typically not a concern. However, if there are signs of choking or difficulty breathing, immediate medical attention is necessary.

6. Noisy Breathing:
Occasional noisy or rapid breathing in infants can be attributed to their immature respiratory system. Babies often have soft cartilage in their airways, which can lead to sounds that may seem alarming but are usually benign. If the baby exhibits persistent wheezing, difficulty breathing, or if the noisy breathing is accompanied by lethargy or feeding difficulties, it is crucial to seek medical advice.

In summary, while many of the concerns raised are common and often benign, it is always best to consult with a pediatrician for personalized advice and to ensure that the baby is developing healthily. Regular check-ups and monitoring growth patterns are vital in addressing any potential issues early on. Parents should feel empowered to ask questions and seek clarification on any concerns regarding their child's health and development.

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