Mixed feeding and possible causes of constipation in infants

Diet

To calculate how much formula your baby needs for supplementary feeding, you should weigh him before and after breastfeeding.

Basic principles of proper nutrition:

1. The child must receive a sufficient amount of milk/formula to meet the physiological needs of the body. Children who are on mixed feeding need to normalize their diet and eliminate underfeeding and overfeeding. To know how much formula is needed for supplementary feeding, you should monitor how much the child eats on a scale.
2. Since in children receiving breast milk, much depends on the mother’s diet, it is necessary to normalize her diet. It is recommended that a nursing woman avoid excessive consumption of proteins and fats, as they inhibit intestinal function, and, conversely, consume more dietary fiber. This means that you should limit the consumption of animal fats (fatty meat, butter, chicken, lard, pork fat, etc.), replacing them with vegetable oils.

In addition, a nursing woman needs to introduce foods into her diet that stimulate intestinal function:

• fermented milk products - kefir, yoghurt, cottage cheese, yogurt;
• foods containing a large amount of dietary fiber - vegetables, fruits, cereals, dried fruits, wholemeal bread;
• drink more fluids.

Considering that constipation in a baby can be a manifestation of food allergies and intolerance to certain foods, a nursing woman needs to exclude highly allergenic foods from her diet - cow's milk, nuts, fish, sweets, chocolate, i.e. those foods that children of the first year of life cannot tolerate. Food allergies are more common.

The most common mistake is that functional constipation is not an indication for transferring a child completely to artificial feeding, since this can only aggravate the problem!

Methods for treating constipation

Before starting treatment, you need to consult a specialist.

1. First of all, you need to help the baby with massage. Laying him on his back, stroke his tummy with smooth circular movements. Stroking should be light without pressure. Such simple movements can significantly ease the baby’s suffering.
2. Leg exercises. Place the baby on her back, and, holding both legs together, carefully bend them at the knees. The bent legs should be raised slowly upward and your knees should touch your stomach. Then slowly lower your legs down. Let your baby rest and then repeat the exercise.
3. To improve bowel function, the baby should be on his tummy more often.
4. Use a cotton swab lubricated with baby Vaseline or vegetable oil to stimulate the baby's anus. You need to insert the stick into the anus and twist it, lubricating the walls.
5. You can soften the stool inside with a water enema. Use only boiled water at room temperature. The amount of water in an enema for a three-month-old baby is 50 ml; over 3 months – 100 ml.

The listed measures should be avoided in 90% of cases. It may happen that they are not enough; in such cases, the attending physician prescribes medication. For example, laxatives or rectal suppositories.

Introduction of complementary foods

The introduction of complementary feeding products into the diet of a child suffering from constipation must comply with the norms, which means no earlier than 4.5–5 months of age. The first thing that should be introduced into complementary feeding for this group of children is fruit juices with pulp (apple, plum, prune, apricot, etc.), fruit purees from the same products. Then you can add vegetable puree from zucchini, cauliflower, broccoli, pumpkin, carrots. Among porridges, preference should be given to buckwheat and corn (rice, oatmeal and semolina porridges help to consolidate stool, so they are prescribed for looser and more frequent stools in the baby).

From 6-7 months, the child can be given porridge with the addition of wheat and barley bran. When your baby starts eating solid foods, he needs enough fluids and fiber.

Constipation on artificial feeding

One of the common causes of constipation during artificial feeding is considered to be an incorrectly selected formula.
That is why it is necessary to introduce the mixture into the child’s diet gradually to check how it is absorbed by the body. It is worth noting that formula-fed babies may have slightly less bowel movements than breastfed babies. It is within normal limits if a child poops once every three days. But if your child’s stool is so rare, you need to look at his condition. If the child’s description matches the one described below, then everything is fine with the baby:

• There is nothing unusual in his behavior.
• The child has a good appetite.
• He is awake.
• Sleeps well.
• Doesn't cry for no reason.
• The child is gaining weight well.
• Can go to the toilet independently without assistance - without crying or hysterics.
• The stool should have a yellowish tint.

Selecting formula milk

When mixed feeding, it is important to pay due attention to the choice of formula. For constipation, the mixture should be maximally adapted in terms of protein and fat content. It is necessary to choose a milk formula containing prebiotic oligosaccharides.

If the above measures do not help, then you will need a specialized milk formula, which is created for children with constipation - it contains lactulose and carob gluten. Its therapeutic effect is due to the fact that lactulose is not broken down and enters unchanged into the large intestine, where it serves as a breeding ground for lacto- and bifidobacteria that are beneficial to the body. As a result of these processes:

• the acid-base balance of the intestine changes;
• the acid produced stimulates intestinal receptors and thereby enhances peristalsis;
• more fluid is retained in the intestinal lumen.

The mixture with lactulose should be introduced gradually, bringing it to the required amount. It can be given in full or in a volume of 1/3–1/2 (400–800 ml), combined with the usual adapted formula and breast milk. The child needs a mixture with lactulose until the stool is completely normalized.

How can you tell if your baby is constipated?

The normal frequency of stool in a child depends on the method of feeding. In the first months of life, if the mother feeds the baby only breast milk, he defecates from 4 to 10-11 times a day. On mixed feeding, the baby defecates less often. This is due to the fact that artificial formula lingers in the gastrointestinal tract longer than breast milk. Often, the frequency of stools in mixed or bottle-fed babies is only 1-2 times a day. If the baby does not experience any discomfort, then there is no need to sound the alarm.

To determine whether your baby has problems with bowel movements, observe his condition and pay special attention to the number of bowel movements.

• The baby has no bowel movements for 1.5-2 days or more.
• It is difficult for the baby to defecate: he cries, blushes, puffs, and strains heavily.
• The stool is hard.
• The baby's tummy is swollen and hard.

If you notice these signs in your child, then he is constipated.

Other causes of constipation

If you have taken into account all our recommendations, but your child’s constipation does not go away, his well-being is suffering, you need to consult a doctor. Indeed, in addition to eating disorders, there are a number of other reasons that can lead to stool retention:

• neurogenic;
• inflammatory;
• psychogenic;
• improper intestinal development;
• toxic;
• stool may be delayed after an infectious disease;
• as a result of endocrine diseases - with insufficiency of thyroid function, diabetes mellitus, hypoestrogenemia, and note that these diseases very often cause constipation in young children;
• An increase in the intervals between bowel movements can be observed when using medications - anticonvulsants, antacids, diuretics, iron supplements, calcium supplements and barbiturates).

A tendency to constipation in children is caused by early introduction of formula milk, damage to the central nervous system if the child is born premature or immature, if there is food intolerance to certain foods, and intestinal dysbiosis.

What medications can be used in infants for constipation?

It is not recommended to give babies any medications without consulting a doctor. Even the safest drugs approved for use from birth can harm the immature intestinal microflora of a child. Therefore, only in extreme cases is it recommended to use medications to cure constipation in infants.

• It is best to use preparations containing lactulose. This is the safest laxative. Lactulose syrup is a prebiotic. It stimulates the production of beneficial bacteria in the intestines and helps remove feces. The following drugs containing lactulose are recommended: Duphalac, Normaze, Portalak, Lizalak and some others. To begin with, it is better to give these medications in a reduced dosage. And if you need long-term use, you should definitely consult your doctor.
• To reduce gas formation in the intestines, doctors prescribe the following drugs to children: Espumisan, Plantex or Sub-Simplex. They help relieve cramps and gently remove gases, relieving bloating.
• Komarovsky considers glycerin suppositories to be the best remedy for constipation in infants. Children's ones are very rarely sold on sale, but regular ones can also be used. One candle needs to be cut in half lengthwise and then crosswise. You will get four parts. You need to smooth out all the edges of one piece of candle with clean hands and carefully insert it into the baby’s anus. Gently squeeze his buttocks and hold for a while. This suppository will help soften stool and gently move it out.

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Note to parents

Chamomile or fennel tea will help ease the process of bowel movements for the baby.
Dyschezia often occurs in infancy; this is when, during prolonged attempts to poop, the child becomes tense and screams. This behavior can last up to 20 minutes, after which good soft or even loose stools pass. This can be repeated up to several times a day during the first months of the baby’s life. All symptoms disappear spontaneously, without treatment; sometimes the pediatrician may recommend chamomile or fennel tea to the baby.

Infantile dyschezia is thought to result from the baby's inability to coordinate pressure within the tummy and relax the pelvic muscles.

Do not leave your child’s illnesses to chance. With the hope that everything will go away on its own, parents should always have increased vigilance regarding the health of their baby. Don’t be lazy once again to show your child to your local pediatrician and get a consultation with recommendations. After all, if you go to the doctor for advice and then don’t come, the doctor is sure that everything is back to normal for your baby.

Pediatrician E. O. Komarovsky talks about constipation in children:

Constipation during mixed feeding

Mixed feeding involves feeding the baby both breast milk and formula. Often, this feeding system is observed in children who do not have enough mother’s milk, and they have to be supplemented with formula.

In order to avoid problems with feeding, the baby needs to be put to the breast at least five times a day , because he must receive nutrients from his diet, which are mainly contained in breast milk. The causes of constipation during mixed feeding include the following:

• Incorrect mixture.
• Improper maintenance of the child's body temperature. Due to the fact that parents often overheat their children, constipation may occur.
• Stressful situations. If you sharply reduce the number of breast milk intakes, your baby may become constipated due to stress. It can also appear in a child if he lacks maternal attention, care and love.

If your child is mixed-fed, then your doctor should help you choose a formula, since not every formula is suitable for children. You also need to pay attention to the consistency of the prepared food; of course, it needs to be diluted according to the instructions, but if the child has difficulty going to the toilet, then it is better to make it as thin as possible.

You also need to pay attention to the temperature of food; it is worth noting that warm food can eliminate the development of constipation.

Features of choosing a mixture

Not only the baby’s health, but also his overall development depends on how correctly and efficiently the mixture is selected.
That is why, when choosing a formula for a child, you need to pay attention to the following factors:

• The level of adaptation of a particular mixture can be seen on the packaging. If the child is a newborn, then he should be as tall as possible. This is the only way to avoid gastrointestinal problems.
• Pay special attention to the age of the baby.
• Before choosing a formula, any parent should take into account the individual characteristics of their baby, since a lot depends on them.
• What is the baby’s health status at the time of choosing the formula and whether there are any chronic ailments.
• How does a baby's body metabolize lactose?