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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

Wakey wakey… Coping with sleep deprivation

17 Jan

Greetings faithful reader. Let’s play a little game I like to call “Have you ever…?” Have you ever loaded up the car, put the keys in the ignition ready to head out for a play date only to realise that your most precious cargo is still in his cot inside the house? Have you ever hurled abuse at your life partner for hiding the TV remote only to open your handbag and find said remote sitting in the compartment that normally houses your mobile phone? Have you ever stared blankly at a pregnant customer asking for a headache tablet that is safe for her to use? You know that there is some sort of medication she can take; you think it might start with a ‘p’. What’s it called again? Have you ever had an entire conversation with Janet from your mother’s group only to walk away and remember that her name is actually Sarah, you do Pilates together and she in fact has no children? If you answered yes to any of these questions then you are either a few letters short of an alphabet, or more likely you’re a few z’s short of a decent sleep.

Everyone warns you, but no one can truly prepare you for the reality of postnatal sleep deprivation. Having suffered from insomnia for most of my adult life I thought the sleepless nights with a newborn would be a breeze. Sleep deprivation, or the reduced length of sleep due to an externally imposed restriction of the opportunity to sleep, was a whole new ballgame. Many people say that sleep deprivation is like torture. I’m here to tell these people that they are mistaken. Sleep deprivation is not like torture, it is torture – a tactic favoured by the KGB and the Japanese in PoW camps during World War Two. While I’m fairly sure Boy Wonder isn’t working for the Mossad or CIA, his recent night-time activities have transformed me into a perpetually exhausted zombielike being. So why is sleep so important?

As human beings we spend one third of our lives sleeping. The consequences of not getting enough sleep are pretty clear. If you’ve ever pulled an all-nighter or had to deal with a screaming baby at all hours, you would be familiar with these consequences – forgetfulness, grogginess, grumpiness and reduced awareness. As mother Fiona Sugden wrote in a recent post on Mama Mia, “It is a first world problem, but long-term sleep deprivation can be a serious one for many people.” Losing sleep affects mental agility and response time. Studies show that chronic sleep deprivation leads to a decrease in performance equivalent to a blood alcohol level of 0.05%. The Chernobyl nuclear accident, the Exxon Valdez oil spill and the Challenger space shuttle disaster have all been attributed to human errors in which sleep-deprivation played a role. While raising a child may not be the same as running a nuclear power plant, trying to operate a child while sleep deprived is not without its own dangers.

A new baby typically results in 400-750 hours of lost sleep for parents in the first year. While there isn’t much you can do to change the quantity of sleep you get, it is possible to manage the quality of sleep you get. Here are a few things you can do to improve your sleep.

1. Listen to your body

Most bodily processes including the sleep-wake cycle are controlled by an internal ‘clock’ within the brain. To get quality sleep you need to obey your clock.

  • Don’t ignore tiredness. If you find yourself falling asleep on the couch or in the rocking chair in your baby’s nursery, GO TO BED.
  • Create a relaxing bedtime routine. Once you’ve established a regular bedtime routine for your baby, do the same for yourself. About an hour before bed, turn off the TV and put aside the work you’ve brought home. Make a cup of herbal tea or warm milk, take a warm bath, curl up with a good book, anything as long as it is relaxing.
  • Don’t force yourself to fall asleep if you’re not ready. If you haven’t fallen asleep after 30 minutes, get up, go to another room and listen to some soothing music or read until you feel sleepy.
  • Get enough early morning sunshine. Exposure to light during early waking hours helps to set your body clock.

2. Make your bedroom more inviting

Quality sleep is more likely if your bedroom is a restful and comfortable place.

  • Keep your bedroom at a comfortable temperature. To drop off we must cool off, which is why those hot summer nights can cause a bad night’s sleep.
  • Block out light and noise which can wake you from a light sleep. If noise is a problem, consider purchasing a sound machine or even just a pair of earplugs. Don’t worry, you will still hear your baby. Parents are hardwired to hear their offspring’s cries.
  • Use your bed only for sleep and sex. If you are in the habit of paying bills or watching TV in bed, stop. You should associate your bed only with bedtime activities. Remember: Try to clear your mind; don’t use bedtime to solve your daily problems.

3. Just say no!

Some people resort to medications or ‘social drugs’ in the mistaken belief that sleep will be more likely. Here’s why you should just say no:

  • A cup of coffee or a cigarette in the afternoon can delay sleep onset even hours later, and more than a couple of standard drinks may make your sleep more restless. Don’t forget that caffeine may also be found in chocolate, soft drinks, and various medications.
  • Sleeping pills may also be more of a hindrance than help. They may cause daytime sleepiness, and may also have a ‘rebound’ effect whereby falling asleep without them tends to be even harder.

4. Relaaaxxx

Stress often reduces sleep quality.

  • If random thoughts are keeping you awake, keep a notepad by your bed so that you have a place to unload them until the morning.
  • Move your body with some exercise during the day, making sure to finish up at least three hours before going to bed.
  • Give relaxation exercises such as yoga, progressive muscle relaxation and deep breathing a try. Baby Centre has a great article on relaxation techniques for parents.

5. Miscellaneous suggestions

A few more handy hints include:

  • Avoiding heavy meals close to bedtime.
  • Snoozing for a maximum of 15- to 20-minutes during the day to help improve alertness, sharpen the mind and generally reduce the symptoms of fatigue.
  • Turning your clock to face the wall to prevent you from counting the minutes you are still awake.
  • Reminding yourself that this phase of your life will pass and that one day soon you will experience uninterrupted sleep once more.

Well, it’s time to practice what I preach, shut down the old computer and lie down on that thing with the mattress where you sleep. What’s it called again?

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