Formula for constipation in newborn

Newborn Constipation in Formula-Fed Infants: What to Do

The only thing worse than the dreaded poopy diaper? Worrying about why your baby isn’t having one.

If your baby has gone several days without a dirty diaper, you may be ready to tear out your hair trying to figure out what’s wrong.

As you run through all the potential causes, one thing likely to cross your mind is their diet — especially if you’ve recently started them on formula.

Is it true that formula can cause constipation? What should you do if your baby is constipated? When do you need to contact your child’s pediatrician? Let’s take a look.

It’s true: Formula-fed babies are more likely to be constipated than those exclusively on breast milk. Why is this?

Well, breast milk is generally easier for babies to digest and considered a natural laxative.

Formula, on the other hand, is thicker. It has larger proteins that can be harder to digest. This makes gastrointestinal problems — including constipation — more likely.

But keep in mind that this doesn’t mean it’s impossible for a breastfed baby to become constipated or that all babies on formula will be constipated.

Every baby is different. Also, whether formula-fed or breastfed, your baby may show signs of constipation when you introduce solids into their diet.

One other note: Some babies fed exclusively with breast milk don’t poop frequently, but in those cases it’s likely because their bodies are absorbing all the nutrient-filled breast milk they’re eating.

Wondering if your baby is constipated? Signs of constipation include:

infrequent or less common bowel movements
hard bowel movements that can appear like pellets, rocks, or hard balls
blood on the surface of the stool or when wiping
pain while passing bowel movements — for a baby who can’t communicate with words, this may appear as an arched back, a red face, and crying
a tight belly
lack of interest in food

The number of poop-filled diapers a baby will have each day or week can vary greatly. Use your baby’s normal — not your neighbor’s baby or your brother’s baby — as the baseline to help you determine if they’re constipated.

And it’s important to remember that constipation isn’t just about how frequently your infant is pooping, but also about how hard it is for them to do so.

If they poop once every 3 to 4 days, but the poop is soft and seems to pass easily, they may be just fine. On the other hand, if your baby poops every other day but is straining and crying while pooping and the poop is hard, they may be constipated.

If you’ve recently switched to formula after exclusively breastfeeding your baby, you may notice changes in your baby’s poop. It’s not uncommon for it to become harder or change color.

You may also notice an increase in gas, particularly if your baby is transitioning to using a bottle. Every baby is different though, and you may not notice much of a change.

Looking at supermarket formula displays can be enough to set your head spinning.

First, there are three different forms of formula you can choose from:

powders
concentrates
ready-to-use

Then, within these forms, they may be:

milk-based (cow or goat) formulas
soy-based formulas
specialty formulas, like organic options

Some formulas advertise themselves as easier to digest.

This can be because they are homogenized, which means they’re processed in a way that breaks down molecules for easier absorption. Or they may be made with ingredients designed to be easier on the digestive system.

Despite this advertisement, there’s no guarantee that any formula will sit well in baby’s stomach. So, how do you choose?

For many parents, the answer lies in asking fellow parents and caregivers about their experiences with formula and researching the ingredients to find one that feels right.

After choosing a formula, you might decide that you’d like to change to another one. Is this a good idea?

Switching your baby’s formula may make a difference in their poop, since their sensitivity to some of the ingredients in the original formula may have led to their constipation.

However, changing formula styles or brands can also make things worse, especially if you do it too often.

In other words, it’s not a good plan to give your baby one formula for 1 or 2 days, then changing to another formula right away when you see that they’re constipated. Instead, try giving baby a few weeks to adjust to any newly introduced formula.

In some cases, though, changing formulas might be wise. Even so, it’s best to speak with your child’s pediatrician first.

Reasons to consider changing formulas can include:

food allergies
extreme fussiness
a need for more iron in a baby’s diet, as determined by a doctor (though most infant formulas do contain iron)
weakness or fatigue
vomiting (more than just spit-up)
bloody stools
diarrhea

Especially if your child is showing signs of allergies or wheat or dairy aversions, changing to a brand with different ingredients may make digestion easier.

It’s never a good idea to create your own homemade formula, however. Your child’s doctor can help you find an approved formula if your little one needs something special.

For many babies, a simple home remedy or two is all you’ll need to relieve constipation.

For an older baby, you can consider a dietary change.

If your child is over 6 months old, offer them a small amount of 100 percent apple, prune, or pear juice diluted with water. These include sorbitol, a type of sugar. It acts like a laxative and may be able to help with constipation.

Extra water can soften their poop, too. Of course, don’t forget to check with your doctor first for their recommendations on amount and types of liquids.

And if your baby is already eating solids, you may want to consider offering them fiber-filled options like peas and prunes. You may also consider baby cereals with whole wheat or barley instead of rice, since they include more fiber.

For younger babies, you can try the following:

Bicycle kicks. Gently bend baby’s legs toward their chest or circle their legs in a gentle bicycling motion. (It’s easier to get a poop out in a squat position than lying flat!)
Infant massage. Massaging their stomach and having skin-to-skin time may improve your little one’s digestive system.
Bathing. A warm bath can help your little one’s muscles relax and allow poop to pass.

If these remedies aren’t working, your doctor may suggest other treatments. It’s not recommended to use mineral oil, stimulant laxatives, or enemas to solve constipation in infants, so speak with your pediatrician for safer methods.

Most of the time, infant constipation isn’t a sign of a serious problem, and it can be easily addressed. On very rare occasions, constipation may be a sign of another underlying condition.

Reach out to your baby’s doctor if you notice:

consistent issues with constipation despite dietary changes to attempt to address it
vomiting
weakness
refusal to eat
blood in stools
black stools (after your baby has already passed their meconium, which occurs during the first few days of life)

A constipated baby is one of the few things worse than the smell of a really poopy diaper.

If you’ve recently switched your little one to formula, you may notice that their poops are a little harder and less frequent. You might also notice a change in bowel movements if you’ve introduced solids to your little one’s diet.

If constipation becomes severe or you notice other warning signs of poor health, don’t hesitate to reach out to your baby’s doctor. They can assist you in creating a plan to get your little one feeling better ASAP.

Newborn Constipation in Formula-Fed Infants: What to Do

The only thing worse than the dreaded poopy diaper? Worrying about why your baby isn’t having one.

If your baby has gone several days without a dirty diaper, you may be ready to tear out your hair trying to figure out what’s wrong.

As you run through all the potential causes, one thing likely to cross your mind is their diet — especially if you’ve recently started them on formula.

Is it true that formula can cause constipation? What should you do if your baby is constipated? When do you need to contact your child’s pediatrician? Let’s take a look.

It’s true: Formula-fed babies are more likely to be constipated than those exclusively on breast milk. Why is this?

Well, breast milk is generally easier for babies to digest and considered a natural laxative.

Formula, on the other hand, is thicker. It has larger proteins that can be harder to digest. This makes gastrointestinal problems — including constipation — more likely.

But keep in mind that this doesn’t mean it’s impossible for a breastfed baby to become constipated or that all babies on formula will be constipated.

Every baby is different. Also, whether formula-fed or breastfed, your baby may show signs of constipation when you introduce solids into their diet.

Wondering if your baby is constipated? Signs of constipation include:

infrequent or less common bowel movements
hard bowel movements that can appear like pellets, rocks, or hard balls
blood on the surface of the stool or when wiping
pain while passing bowel movements — for a baby who can’t communicate with words, this may appear as an arched back, a red face, and crying
a tight belly
lack of interest in food

And it’s important to remember that constipation isn’t just about how frequently your infant is pooping, but also about how hard it is for them to do so.

If you’ve recently switched to formula after exclusively breastfeeding your baby, you may notice changes in your baby’s poop. It’s not uncommon for it to become harder or change color.

You may also notice an increase in gas, particularly if your baby is transitioning to using a bottle. Every baby is different though, and you may not notice much of a change.

Looking at supermarket formula displays can be enough to set your head spinning.

First, there are three different forms of formula you can choose from:

powders
concentrates
ready-to-use

Then, within these forms, they may be:

milk-based (cow or goat) formulas
soy-based formulas
specialty formulas, like organic options

Some formulas advertise themselves as easier to digest.

Despite this advertisement, there’s no guarantee that any formula will sit well in baby’s stomach. So, how do you choose?

For many parents, the answer lies in asking fellow parents and caregivers about their experiences with formula and researching the ingredients to find one that feels right.

After choosing a formula, you might decide that you’d like to change to another one. Is this a good idea?

Switching your baby’s formula may make a difference in their poop, since their sensitivity to some of the ingredients in the original formula may have led to their constipation.

However, changing formula styles or brands can also make things worse, especially if you do it too often.

In some cases, though, changing formulas might be wise. Even so, it’s best to speak with your child’s pediatrician first.

Reasons to consider changing formulas can include:

food allergies
extreme fussiness
a need for more iron in a baby’s diet, as determined by a doctor (though most infant formulas do contain iron)
weakness or fatigue
vomiting (more than just spit-up)
bloody stools
diarrhea

Especially if your child is showing signs of allergies or wheat or dairy aversions, changing to a brand with different ingredients may make digestion easier.

It’s never a good idea to create your own homemade formula, however. Your child’s doctor can help you find an approved formula if your little one needs something special.

For many babies, a simple home remedy or two is all you’ll need to relieve constipation.

For an older baby, you can consider a dietary change.

Extra water can soften their poop, too. Of course, don’t forget to check with your doctor first for their recommendations on amount and types of liquids.

For younger babies, you can try the following:

Bicycle kicks. Gently bend baby’s legs toward their chest or circle their legs in a gentle bicycling motion. (It’s easier to get a poop out in a squat position than lying flat!)
Infant massage. Massaging their stomach and having skin-to-skin time may improve your little one’s digestive system.
Bathing. A warm bath can help your little one’s muscles relax and allow poop to pass.

Most of the time, infant constipation isn’t a sign of a serious problem, and it can be easily addressed. On very rare occasions, constipation may be a sign of another underlying condition.

Reach out to your baby’s doctor if you notice:

consistent issues with constipation despite dietary changes to attempt to address it
vomiting
weakness
refusal to eat
blood in stools
black stools (after your baby has already passed their meconium, which occurs during the first few days of life)

A constipated baby is one of the few things worse than the smell of a really poopy diaper.

Constipation in children. Prevention. Diet therapy

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Sabitova Vasily Ilyasovna Gastroenterologist

06/21/2019

Constipation is widespread among both adults and children (5-30% depending on the diagnostic criteria). Symptoms become chronic in more than 30% of patients, not only cause discomfort and pain to the child himself, but also disrupt the quality of life of his family. nine0003

CONSTIPATION - a condition manifested by an increase in the intervals between bowel movements (compared to the individual norm) or systematically slow, difficult and / or insufficient bowel movements. Constipation also includes stools with “gruel”, but after defecation was absent for up to 3 days.

Constipation can be related to functional or organic causes (abnormalities, inflammation). In children, 90-95% of constipation is functional. The peak incidence of functional constipation falls on 2-4 years, when they begin to accustom the child to the potty / toilet. nine0003

Main causes of functional constipation

Pain
Fever
Dehydration
Wrong diet of a nursing mother
Insufficient drinking regime of a child with artificial feeding
Insufficient drinking regimen of a breast-fed child with the introduction of complementary foods
Early transition of the child to artificial feeding
Fast transition of the baby from one mixture to another (less than 7 days)
Irrational nutrition of the child (for a long time the child receives food with a large amount of proteins, fats and insufficient dietary fiber, abuse of drinks containing a large amount of astringents - tea, coffee, cocoa)
Excessive use of baby hygiene products or the development of an allergic reaction of the skin of the perianal area
Consequences of perinatal injuries of the nervous system
Rickets, vitamin D deficiency
Anemia
Impaired thyroid function (deficiency - hypothyroidism)
Food allergy, especially cow's milk protein allergy
Forced potty training, period of adaptation to new conditions (nursery, kindergarten)
Physical inactivity - a sedentary lifestyle
Mental trauma or stress
Systematic suppression of the urge to empty the bowels, associated, for example, with the beginning of attending a kindergarten, school, etc.
Taking certain drugs
Constipation in family members

Frequency of defecation in children of different ages

nine0081

Age	Number of bowel movements per week nine0076	Number of bowel movements per day
0 – 3 months breastfeeding artificial feeding	5 - 40 5 - 20	2.9 2.0
6 - 12 months	5 - 28	1.8
1 - 3 years	4-21	1.4
4 years and older	3 - 14	1.0

In addition to the frequency of the chair, you should pay attention to its nature. For a more objective assessment, the “Bristol fecal shape scale” is convenient, since it is the shape of the feces, and not the frequency of the stool, that is more consistent with the time of intestinal transit. nine0003

Bristol stool chart

In accordance with this scale, 3 and 4 form of feces is regarded as normal, and 1 and 2 indicate delayed transit (constipation). Quite often, in practice, there are situations when a child has a bowel movement frequency within the normal range, but the stool is dense, fragmented, in a meager amount. These signs indicate incomplete emptying of the bowels and are considered as manifestations of constipation. nine0003

The consistency of the stool in newborns and infants should be mushy. From 6 months to 1.5 - 2 years, feces can be both formalized and mushy. From the age of two, the chair must be decorated.

Signs and symptoms of constipation

abdominal pain, often bursting, aching, sometimes colicky
bloating
change in the shape and consistency of the stool
unpleasant smell of flatus and stool
may have pain during bowel movements
straining during bowel movements
there may be blood in the stool - on the surface of the feces or in the form of traces on a napkin (indicates an anal fissure)

If you do not eliminate constipation and do not establish bowel movements, then there is a risk of coprostasis (formation of fecal stones) and fecal intoxication:

loss of appetite
lack of energy
general malaise
depression, irritability
nausea, vomiting
skin symptoms - dryness, rash, peeling
fecal incontinence, stool spotting
urinary retention and incontinence due to pressure from a crowded bowel on the bladder

The treatment of constipation involves the following goals:

1. Normalization of stool consistency (soft, painless stools)

2. Regularity of bowel movements (prevention of re-accumulation of feces)

The treatment of constipation is a sequential, complex, individual process and consists of several stages:

child and parent education
correction of nutrition and drinking regimen
elimination of existing coprostasis with the help of medications
maintenance therapy

It is necessary to exclude factors that provoke and contribute to constipation (normalization of motor and nutritional regimen, discontinuation of medications that can cause constipation, identification of a food allergen, exclusion or confirmation of neuromuscular disease, celiac disease, etc.). nine0003

Lifestyle normalization includes:

development of a conditioned reflex
active lifestyle
gymnastics
light abdominal massage training
for small children - laying out on the stomach, bending the legs to the stomach.

Education is the first step in the treatment of functional constipation. It must be remembered that episodes of fecal smearing and encopresis (fecal incontinence) are not arbitrary and should not be blamed on the child, who may already be frightened and disoriented. In some cases, when the intra-family situation is difficult, the help of a family psychologist may be needed. nine0084

It is important to understand that the treatment of functional constipation can be lengthy, based on trust, partnership and requires patience. Modern laxatives that are legal in children will not make the intestines “lazy”, will not cause “addiction”, they enter the bloodstream in minimal amounts or are not absorbed at all and are safe for long-term use.

Correction of the behavior of a child with constipation is based on the development of a routine of visiting the toilet, in order to achieve regular defecation. Defecation should be every time at the same time. The urge to defecate is based on the gastrocecal reflex, which manifests itself in the morning 1 hour after eating. A child with constipation needs to spend 3-10 minutes in the toilet (depending on age). It is necessary to plant the child on a potty or offer to visit the toilet after each meal. nine0003

A prerequisite for effective defecation is to provide a good support for the legs (a low bench on which the child can put his feet), which helps to increase intra-abdominal pressure.

If the defecation is not successful, the child should never be punished and vice versa. The daily frequency of bowel movements can be noted in a diary, which can be analyzed at a scheduled visit to the doctor.

Treatment of constipation should begin with lifestyle changes, which include dietary modification, drinking regimen and physical activity. nine0003

Calculation of fluid volume for healthy children

Children under the age of 1 year should drink at least 100 ml of water per day.

For healthy children weighing 10 to 20 kg the water requirement is calculated using the formula:

100 ml (volume of water for children under 1 year old) + 50 ml per kg for body weight over 10 kg.

For example, with a mass of 12 kg: 100 ml + 2 x 50 ml = 200 ml.

A child weighing 20 kg should drink water: 100 ml + 50 x 10 = 600 ml

For children weighing over 20 kg the following formula is suggested for calculation:

600 ml (volume of water for a child weighing 20 kg) + 20 ml for each kg over 20 kg.

For children over 3-5 years old you can use the calculation of the amount of water: 30ml / kg of weight

Principles of diet therapy for constipation:

satisfaction of physical needs for nutrients and energy
exclusion of excessive consumption of proteins and fats, which can inhibit intestinal motility
enrichment of the diet with dietary fiber
normalization of intestinal microflora with pro- and prebiotics

If the child is breastfed, then the mother's nutrition is corrected (restriction of products that promote gas formation). With artificial feeding, special mixtures are shown. For constipation associated with an allergy to cow's milk protein, therapeutic mixtures are prescribed if the child is bottle-fed. If the child is breastfed, cow's milk and products based on it are completely excluded from the mother's diet. nine0003

After the introduction of “thick” complementary foods, boiled water is necessary for all children, regardless of the type of feeding.

For older children, it is recommended to eat foods rich in vegetable fibers. It is not recommended to “smear food”, puree, “snacks”, “eating on the go”. Food should be crumbly, meat / poultry / fish - “piece”. A “bulk” breakfast is required to stimulate the “gastrocecal reflex”.

The main source of coarse-fiber vegetable fiber, containing a large amount of dietary fiber, is cereal bran, rye bread, as well as a number of vegetables and fruits. According to the principles of evidence-based medicine, a statistically significant increase in stool frequency and improvement in its consistency was demonstrated with the use of fiber compared with placebo. nine0003

Bran, as the main source of vegetable fiber, is recommended to be added to the second and third courses, after pouring boiling water over it and settling for 20 minutes. Bran can also be used in between meals, drinking plenty of fluids. For school-age children, the total amount of fluid when taking bran should be at least 1.5-2 liters per day, otherwise they mainly act as sorbents, absorbing fluid from the intestines, thereby increasing constipation. The dose is selected individually, it is recommended to start with 1 teaspoon 2-3 times a day, with a gradual increase to 40 g per day. When the effect is achieved, the dose is reduced and limited to one dose. nine0003

The American Academy of Pediatrics (2009) recommends a fiber intake of 0.5 g/kg/day (maximum 35 g/day) for all children. Fiber intake below the minimum recommended value has been shown to be a risk factor for chronic constipation in children.

However, long-term intake of a large amount of plant fibers due to fermentation by intestinal microflora is naturally accompanied by bloating and flatulence.

Children with constipation are shown to take cool liquids on an empty stomach (drinking and mineral water, juice, compotes, kvass), to enhance the laxative effect, it is possible to add honey, xylitol or sorbitol. It is very beneficial for bowel function to increase the intake of juices containing sorbitol/sorbitol, such as juice from plums, pears, apricots, peaches and apples, nine0003

With “sluggish” bowel function (hypomotor constipation), cool mineral water of medium and high mineralization is used, such as Essentuki 17, Batalinskaya, Arzni, Donat Magnesium, etc.; with spastic constipation (hypermotor constipation, stool form more often type 1) - warm and low mineralization (Essentuki 4). Calculation of mineral water - 3-5 ml / kg per day.

It is necessary to limit milk in its pure form and in dishes, as flatulence may occur with the appearance or intensification of abdominal pain. It is better to replace whole milk with sour-milk products - kefir, acidophilus, yogurt, yogurt, etc. nine0003

The diet of children with constipation includes dishes rich in vegetable fiber - salads from fresh vegetables, greens 2-3 times a day, baked apples, stewed vegetables, diluted vegetable and fruit juices with pulp. Food is cooked mostly unground, steamed or boiled in water.

It is preferable to take raw vegetables and fruits (in the absence of contraindications). Especially recommended are tomatoes, zucchini, pumpkin, carrots, beets, lettuce, cauliflower, apples. Dried fruits (prunes, dried apricots, figs) are given in soaked form and as part of cooked dishes. White cabbage, young green beans, green peas are allowed with good tolerance. Parsley, dill, celery are good to add to various dishes and salads. nine0003

If after reading the article you still have questions or you do not understand how to apply the recommendations in your particular case, we invite you and your child to be examined by a pediatric gastroenterologist at the DDC. For the convenience of parents, you can make an appointment with a pediatric gastroenterologist at the Children's Diagnostic Center on a weekday and on Saturdays.
We will be happy to help!

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