Tag Archives: baby

When the going gets tough… Constipation in babies

31 Jan

“I got something to tell you

I got something to say

I’m gonna put this dream in motion

Never let nothing stand in my way

When the going gets tough

The tough get going”

This Billy Ocean hit from the eighties has become somewhat of an anthem in my household. You see, the start of the new year also marked the start of a new era for Boy Wonder – eating solids. It was an exciting time for all involved. Mr Wonderful and I basked in the joy of another milestone reached. Our two labradors set up camp beneath the highchair waiting for precious morsels of food to rain down on them. And the squeals of delight Boy Wonder made after swallowing each mouthful of food left us in no doubt as to how he was feeling about solids.

A couple of weeks later, Boy Wonder’s squeals of delight were accompanied by bouts of grunting and panting. At the end of his evening meal he would gaze off into the distance, a look of sheer determination enveloping his cute little face. What is he trying to do? Why is his face turning various shades of red? Where did that bulging vein in the middle of his forehead come from? Wait a second – when was the last time I changed a soiled nappy? That’s when it hit me, my little man was constipated.

Constipation in babies is a topic I am often asked about at the pharmacy. According to Billy Ocean when the going gets tough, the tough get going. How exactly does one get going? As a parent or carer what can you do when the going gets tough?

Baby bowel movements

Understanding your baby’s bowel movements can be pretty hard (sorry, I had to go there). Generally speaking stools should be formed, soft and easily passed. When it comes to a baby’s bowel movements, there’s no “normal” number – only what is normal for your baby. Your baby may pass a stool after each feed, or wait a day or more between bowel movements. A baby’s individual pattern is determined by several factors including what they eat or drink, how active they are, and their metabolic rate. For example babies that are exclusively breastfed very rarely become constipated, although they may not poo for several days or up to two weeks.  If you pay close attention to your baby, you should be able to tune in to his or her unique bowel habits.

Since it can be hard (sorry, I did it again) to determine what is normal and what is abnormal, a scale can be used to classify the appearance of the stool. One such scale is the Bristol Stool Form Scale shown below.

      

Stools at the lumpy end of the scale are hard to pass and often require a lot of straining, while those at the loose or liquid end may be too easy to pass. The ideal stools are types 4 and 5, as they are most likely to pass easily and are least likely to leave you with an annoying feeling that you left something behind.

What is constipation?

Many babies strain and go red in the face whilst doing a normal, healthy poo. Note that on its own this is not a sign of constipation. Constipation is defined as a combination of:

  • Infrequent passing of stools
  • Excessive straining
  • Excessive stool hardness (see types 1 and 2 above)
  • Pain on passing stools

True constipation in babies is uncommon and should always be checked by a doctor or maternal and child health nurse.

What causes constipation in babies?

There are several constipation-causing culprits including:

  • Not enough breast milk: Exclusively breastfed babies are rarely constipated. Breast milk has the perfect balance of fat and protein, and produces stools that are almost always soft. In the rare cases that constipation does occur in an exclusively breastfed baby, it may be because the baby is not receiving enough milk.
  • Formula: Formula that is made up incorrectly or changes to formula (especially when swapping to follow-on formula or cow’s milk) may cause constipation.
  • Dehydration: Babies not receiving enough fluids become dehydrated. Their system responds by absorbing more fluid from their food and drink and from waste in the bowels, resulting in hard, dry stools that are difficult to pass.
  • Introduction of solids &/or inappropriate solids: Babies often become mildly constipated when they are introduced to solids. It is important to use the correct solid foods for the age of your baby.
  • Anal fissure: Sometimes a hard stool causes a little tear or crack in the skin around the anus. This is called an anal fissure and can be quite painful. Not wanting to be sore, the baby may ‘hold on’ causing the stool to become even harder and more painful to pass.
  • Medical condition or illness: Although uncommon, constipation in babies may be caused by an underlying medical condition.      That’s why it’s always a good idea to seek advice from a doctor, nurse or  other healthcare professional if your baby passes hard, painful stools, just to make sure.

Treating constipation in babies

Suggestions to treat constipation in babies include:

1. Get the formula right

If you feed your baby formula, check the formula tin to make sure each bottle is being made up correctly. Always measure the water first and then add the formula powder. Be sure to only ever use the scoop provided in the formula tin. You may also wish to speak to your doctor, nurse or pharmacist about switching brands.

2. Keep baby hydrated

In warm weather, formula-fed babies require extra fluid such as cooled, boiled water between feeds. Breastfed babies may require more frequent feeds.

3. Move it baby

If your baby can crawl, encourage them to do a few laps. If we’re not at the crawling stage yet, try some leg pumping. While lying on their back, gently move baby’s legs in a forward, circular motion like pedalling a bicycle.

4. Make the right food choices

Switching from rice cereal to barley or oat cereal, or adding pureed fruits or vegetables to cereal, once your baby is ready for them may assist with constipation. Cut down on constipating foods like rice, bananas and carrots, and consider introducing some pureed prunes, apricots or pears to loosen those stools. Ask your doctor, nurse or an accredited dietician if you are unsure about what foods to introduce when.

5. Have a bath

A nice, warm bath may help baby’s muscles to relax. Just be prepared for them to poo in the bath…

6. Healing hands

A gentle tummy massage may help move things along. Measure three finger-widths below the navel and apply gentle but firm pressure with your fingertips. Gently but firmly move your fingers in a clock-wise direction for about three minutes.

If the idea of touch appeals to you, you might consider an osteopathic treatment. Sometimes the nerves that supply the lower third of the bowel don’t function as well as they could due to lower back tightness. This causes a slowing down in gastric motility resulting in a sluggish bowel. Once any serious disease has been ruled out by a doctor, osteopathic treatment aimed at improving lower spinal and pelvic movement often improves bowel function. Babies often enjoy this hands on treatment and leave feeling relaxed and sometimes even asleep!

For those of you in Melbourne I highly recommend the experienced, baby-friendly folk at St Kilda Osteopathy.

7. Seek help

It is extremely important to talk to a healthcare professional about treatment options. Many over-the-counter treatments that make bowel movements more comfortable are available, but should never be used without the advice of your baby’s doctor, nurse or pharmacist.

There are also some things you should NOT do to treat constipation in babies:

  • Don’t give prune juice – it contains a natural bowel irritant and is not suitable for infants under nine months of age, even when diluted.
  • Don’t add any form of sugar, malt extract or rice cereal to formula – it will not help the constipation.
  • Don’t introduce solids before four to six months of age – it’s not recommended as a way to treat constipation.

Hopefully by following the above advice, constipation need not be a constant worry for you. By providing your baby with a healthy diet and enough fluids, your baby’s bowels should stay healthy. But at least you’ll know what to do when the going gets tough…

Where to get help

  • Your doctor, maternal and child health nurse, or pharmacist
  • The Maternal and Child Healthline: 13 22 29
  • Nurse-on-Call: 1300 606 024
  • The Royal Children’s Hospital: +613 9345 5522

Good, better, breast. What happens when breast isn’t best?

10 Jan
breastfeeding

“You are starving your child.” Five words no parent ever wants to hear. Five words that can shake you to your very core. Five words that transform you from a confident, stable being into an irrational, blubbering mess. Well at least that is what those five words did to me…

About a month ago Boy Wonder and I ventured out to our local Maternal and Child Health Centre for his 4-month check-up. Over the weeks, Mr Wonderful and I had come to look forward to having our little boy weighed and measured so that we could track his growth and marvel in the miracle of what we created. During this visit, I discovered that my baby had dropped a percentile for weight. I was shocked by the news. How could this have happened? What have I done wrong? Will my baby be okay? The nurse’s response to my questions, “YOU ARE STARVING YOUR CHILD!”
I left my appointment that day a broken woman. What sort of mother starves her baby? I had done everything that was expected of me hadn’t I? For 17 long weeks I acted as a 24-hour milkbar for my baby, breastfeeding him on demand. I had been terrified about breastfeeding throughout my pregnancy. I wasn’t sure I’d be both physically and emotionally capable of doing it. After extensive reading of available literature, interrogating my friends and family members and lengthy discussions with Mr Wonderful, I decided I would give breastfeeding a red-hot go for either the first six months, or until Boy Wonder’s first teeth showed up – whichever came first.
Well as it turned out, Boy Wonder fed well from the moment he was born and I took to breastfeeding like a duck to water. I absolutely loved it! The closeness, the cuddling, the feeling that I was the only one in the world who could do this for him. I was so proud of myself and Mr Wonderful was so supportive. As the weeks went by though, I discovered that breastfeeding was making me feel exhausted. I was constantly hungry and always on call. To be perfectly honest, sometimes I wished I wasn’t the only one who could feed Boy Wonder. I was too scared to ask for help with my growing feelings of exhaustion and resentment, because when you are a ‘good breastfeeder’ you get put on a pedestal. I thought I would get fed the same old line of “keep up the good work” and “breast is best”. These were in fact the very same words the nurse said to me right after telling me that I was starving my baby. So while we all know that breast is best, what happens when things don’t work out?
A few days after my incident with the nurse, a news story caught my eye.

“BREASTFEEDING figures are in steady decline, even though national health guidelines recommend feeding infants the old-fashioned way.

A report by the Australian Institute of Health and Welfare found only 40 per cent of mothers still exclusively breastfeed their babies at three months and 15 per cent of mothers are still breastfeeding at five months.

This is despite health guidelines that recommend breastfeeding for the first six months.

The Australian Institute of Health and Welfare surveyed more than 28,000 parents, with the data to be fed into the national breastfeeding strategy.

According to the survey, the biggest reasons for using formula were a previously unsuccessful experience (38 per cent), wanting to share feeding with a partner (28.5 per cent) and the belief that it was as good as breast milk (26 per cent).

Only 7.8 per cent of mothers said they used formula because they wanted to return to work.”

As a pharmacist I was astounded that only 15 per cent of babies were exclusively breastfed by 5 months. As a mother though, I totally understand. Most women want to breastfeed. According to this report breastfeeding was initiated in 96 per cent of children. Unfortunately, despite our greatest efforts and wishes, sometimes breastfeeding just doesn’t work out.
Breastfeeding is an exceptionally emotive topic. Breast milk is obviously designed for babies, but sometimes women find it difficult or impossible to breastfeed. Sometimes, women don’t even try, because it’s painful, incompatible with family life or they simply don’t want to. Who are we to judge? I know many lovely ladies who have struggled with breastfeeding for differing periods of time and then moved on to bottle-feeding because it just didn’t work out for them. A lot of these lovely ladies were left feeling like they’d failed. Many mothers feel a deep sense of loss when they are unable to breastfeed, either at all or for as long as they had planned. Once you become a parent it’s amazing how much guilt you can feel over a huge range of things. But instead of feeling guilty, perhaps we should be feeling indignant. If ‘the powers that be’ recommend breastfeeding exclusively until 6 months, why is it that less than half of babies in Australia are exclusively breastfed at 4 months? In many cases, I believe that it is because their mothers did not receive the right support and/or information at the right time. Being told by a nurse that breastfeeding is best is just not good enough.
There are plenty of resources available to parents seeking information and support:
  • The Australian Breastfeeding Association has a great article “When breastfeeding doesn’t work out”
  • The Maternal and Child Health Line (13 22 29) is a 24-hour telephone service staffed by maternal and child health nurses for families of children aged from birth to school age
  • Your GP or paediatrician
  • Your friendly, local pharmacist

After lengthy discussions with my GP, a nurse from the Maternal and Child Health Line, and a consultant from the ABA, I decided to continue breastfeeding and supplement with one formula-feed every night. I found that I was able to receive the support that I needed to make the decision that was right for me and my baby rather than feeling pressured into following the guidelines. As a side note, Boy Wonder gained 600 grams the following week and continues to thrive.

So, while I do believe that from a medical and scientific perspective breast is best, I also recognise that there are a host of other factors at play. My advice to expectant mothers is to give breastfeeding a shot. If it works out, good for you. If you switch to formula, good for you. You cannot fail your child when you have given all that you could give.

To Grandma’s house we go… Is it ok to sedate your baby for travel?

20 Dec

A few weeks ago Mr Wonderful announced that his work Christmas party was coming up and he would be flying to Sydney to attend. Since his parents live in Sydney, I thought why not kill two birds with one stone? While Mr Wonderful was off having a ball with his colleagues, I would take Boy Wonder up to spend some quality time with his grandparents. So, to Grandma’s house we went…

I was overcome by a feeling of calm and serenity. We had successfully completed our maiden voyage to Sydney and back with Boy Wonder when he was just eleven weeks old. He was a perfect specimen of baby back then. About three hours of air travel in total, and not a peep out of him the entire time. Surely travel with a twenty week old would be just as easy? Oh how wrong we were! Yes that’s right folks, my baby had the audacity to cry on the plane. My usually placid, happy child turned into a screaming, crying demon child! I broke into a sweat as I felt all eyes lock on us and saw people nudging each other then pointing in our direction. “Oh my goodness,” I said turning to Mr Wonderful. “It’s happened! We’ve become ‘one of them’. We have the screaming baby on the plane!”

Many parents dread taking their baby on a plane or other public transportation for extended periods. How on earth are you going to change your baby’s nappy in the awkward confines of an aeroplane toilet? What is the nicely dressed man sitting next to you going to do when he gets off the plane and realises he has a little baby vomit on his suit? Will your baby scream the whole way? Are your fellow passengers going to give you dirty looks and try to chase you off the plane with pitchforks and torches?

It’s not unusual for parents to consider avoiding such potential problems by medicating their baby to sleep. A recent survey by NBC’s Today Show and Parenting.com uncovered a startling finding. Of the 26,000 mothers asked about their deepest, darkest secrets, one in five admitted to medicating their child to get through a special event such as a plane flight. One in twelve mums does it just to get some peace and quiet on a regular night. Dr Nancy Snyderman, NBC’s medical expert, said she believes the one in five number is actually low.

Medication is a tempting way to keep your baby quiet for a few hours on a plane.  Truth be told, the idea of sedating Boy Wonder during this short trip to Sydney did briefly cross my mind. So is it ever ok to give your baby medication to get through a flight or even so that you as a parent can get some sleep? This very question caused an uproar on channel 7’s Sunrise earlier this year. Sunrise GP Dr Ginni Mansberg weighed in on the debate stating that sleep deprived parents “need our compassion and not our judgement”. She advocates the use of some over-the-counter medicine every now and then for parents requiring a decent night’s sleep.

While I both sympathise and empathise with parents who are sleep deprived, I believe both as a pharmacist and a new mum that any potential benefits are not worth the possible health risks. According to Australia’s drug regulatory body the Therapeutic Goods Administration (TGA), there have been a number of overseas reports of serious adverse effects among infants and children given over-the-counter medicines containing sedating antihistamines. “These things are not ok for under two-year olds” says Dr Ginni, “because their metabolism is still developing and there have been some severe reactions even at the correct doses”. In fact, as of September 2008 medicines containing sedating antihistamines became ‘prescription only’ for children less than two years in Australia.

With Christmas and summer holidays upon us here in Australia, I get bombarded at the pharmacy with requests from parents for sedating antihistamines for their babies. I try to counsel parents about ways to make travel with a baby a little easier without medicating. Some handy hints include:

  • scheduling flights during baby’s sleep times;
  • choosing an airline that has bassinettes in the bulkhead which allow your baby to sleep well in something other than your arms;
  • trying to feed your baby during take-off and landing to help equalise their ears and for comfort;
  • bringing a goody bag of new books, toys and favourite snacks to keep baby occupied while they are awake;
  • trying to stay relaxed yourself because baby can sense when you are feeling tense and will most likely stress out too.

If you do decide to try sedating your baby for travel, be sure to follow these tips:

  • Discuss your plan with your child’s doctor or pharmacist. Some medications are unsafe if your baby has certain health conditions or is taking other medications.
  • Ensure you understand the correct dosage by discussing with your doctor or pharmacist.
  • Do a test run of the medication before you travel, and monitor your baby for side effects.

The bottom line is, YOU ARE NOT ALONE. I guarantee you that someone else feels overwhelmed by the prospect of travelling with a screaming child (lots of people actually). Someone else will medicate their child, or question their decision to medicate or brave it with no sedation at all. Just remember that no matter what you decide to do, be safe, be smart and be confident in your decision. Ultimately all any of us want as parents is to do our best for our children. Sometimes that means spending four days in a foreign city with our in-laws, but that is a story for another time…

Happy holidays to all xoxo

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