Constipation in infants with mixed feeding Komarovsky

Why does constipation occur during mixed feeding?

A large number of factors lead to problems with stool retention in children in the first months of life. All causes of constipation are conventionally divided into two groups:

1. Organic – associated with systemic disorders in the functioning of the digestive organs. These are congenital diseases, the course of which has nothing to do with changes in diet or diet. These are infrequent causes of stool retention, so you need to look for them after the others have been ruled out.
2. Functional or physiological. This is the influence of the child’s diet and feeding regimen. Functional causes lead to most constipation in infants and newborns.

Among the functional reasons that cause problems with bowel movements, it is worth paying attention to the following factors.

What formula does the baby get?

The choice of modern formulas is large, and it is not always possible to immediately select a suitable breast milk substitute. To reduce the risks of negative consequences of supplementary feeding, for babies in the first months of life, choose formulas with the greatest degree of adaptation to breast milk. No formula can fully replace breast milk in composition, but the more adapted it is, the better.

The following symptoms indicate that the chosen supplement is not suitable for the baby:

• bloating, flatulence;
• excessive regurgitation after each feeding;
• stool with foam, mucus, pungent odor;
• stool retention for more than two days.

Parents of mixed-fed (MF) babies should remember that a baby receiving supplemental feeding should ideally have bowel movements every day. Sometimes stool is allowed once every 2 days if nothing bothers the baby. If it is difficult for a child to go to the toilet regularly, this is a reason to think about whether the child is receiving adequate nutrition.

Constipation due to breastfeeding

The mixed type of feeding assumes that, along with supplementary feeding, the baby also receives breast milk. Often the reason for stool retention is attributed to the fact that breast milk does not combine well with the substitute and impairs digestion. This is a common myth; breast milk, even in small doses, only benefits the baby.

Breastfeeding (BF) often causes so-called physiological constipation,” when milk is completely absorbed by the body and there is no bowel movement for several days in a row. If the baby feels well, this is not a reason for concern and this does not mean at all that the child does not have enough food and needs to be given supplementary feeding in the form of a formula.

In many cases, the transition to breastfeeding is not caused by a lack of breast milk, but by the mother’s excessive worries about whether the baby is getting enough to eat. The frequency of bowel movements while breastfeeding does not indicate adequate nutrition.

Constipation due to starting complementary feeding

When the baby turns 6 months old, the time comes to introduce complementary foods into his diet. It is necessary to understand the difference in the terms “complementary feeding” and “supplementary feeding” so that there is no confusion. Complementary feeding is the introduction of a variety of foods into a child’s diet in the form of cereals, purees, and soups. Supplementary feeding is the additional administration of formula when there is a shortage of mother's milk.

According to the recommendations of WHO and pediatric organizations, complementary feeding should be started no earlier than 6 months. Additional factors in a child’s readiness to receive more “adult” food are:

• presence of at least one tooth;
• ability to sit confidently and independently;
• active food interest;
• lack of an expulsion reflex when complementary foods enter the mouth.

Practice shows that pediatricians often recommend that young parents whose children are bottle-fed or mixed-fed begin complementary feeding before 6 months.

They justify this position by the fact that infant formula is not nutritious enough and the baby needs more nutrients that it can receive from complementary foods.

With the right choice of an adapted milk formula, the baby covers its nutritional needs until at least 6 months of age.

The early start of complementary feeding unnecessarily loads the digestive system, which is fraught with disruptions in its functioning. Problems with bowel movements often begin, especially if early complementary feeding starts with cereals.

In this case, you need to return to mixed feeding, waiting until the introduction of new products for at least 6 months. Children who are prone to constipation are recommended to start complementary feeding with vegetable puree upon reaching six months of age.

Vegetables are rich in fiber, which improves peristalsis and helps fight stool retention.

E. O. Komarovsky about the children's chair

Dr. Komarovsky is skeptical about young mothers who turn to all doctors as soon as they see green feces in their diaper. The test for dysbacteriosis, which modern pediatricians prescribe when parents contact them, according to Evgeniy Olegovich, has no clinical significance. Its result does not allow even a doctor to make a diagnosis.

Komarovsky claims that the stool of infants at 1–3 months can have a completely different color and consistency. If the child behaves calmly, eats well and sleeps normally for his age, then the change in the color of the stool should not alarm young parents. The main task of the mother is to put the baby to the breast as often as possible for more intensive production of immune cells.

Komarovsky perceives the diagnosis of “lactase deficiency” as a fictitious commercial move by manufacturers of low-lactase mixtures. He claims that 60% of his patients come to him with this particular problem. In fact, the production of such a substance as lactose does not depend on the mother’s nutrition, so he does not see the need to complete breastfeeding.

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How to understand that a child is constipated on the CB

Since the frequency of bowel movements varies between newborns and children in the first months of life, parents should be aware of what symptoms indicate constipation. With a mixed type of feeding, the situation is complicated by the fact that the baby receives two types of food at once - breast milk and its substitute.

If you are fully breastfed, the absence of stool for several days is often the norm; if you are bottle-fed, you should have stool every day. As for the mixed type of feeding, it is also desirable that the baby cleanses the intestines every day.

Even the best adapted formula is not absorbed as well as breast milk. Therefore, the frequency of stool in babies receiving formula milk is an important factor indicating the correct choice of supplementary feeding.

A child receiving supplemental feeding normally has bowel movements daily or at least once every 1-2 days. The baby should feel good. The following symptoms should not be observed:

• severe straining when trying to poop;
• crying during bowel movements;
• overly formed, hard stools;
• the presence of blood streaks in the stool.

If a baby cannot go to the toilet even for one day, he is capricious, has a hard stomach, and also has pain during massage or gymnastics, he pushes until he turns red, but there is no result - this indicates the onset of constipation, which needs to be dealt with. In this case, consult a pediatrician who will choose the appropriate method of therapy.

Normal stool during mixed feeding

If the baby is fed only by the mother's breast, the frequency of bowel movements in the first month of life ranges from 4 to 12 times a day. The consistency of stool in this case is quite liquid, because breast milk consists of 90% water. The digestive organs are still poorly formed, the production of enzymes is not established, the food consumed quickly goes through the digestion process and is excreted naturally.

Any changes in the infant’s diet (introduction of complementary foods or replacement of breastfeeding with artificial formula) will result in a change in the appearance of feces. The normal frequency of bowel movements is half that of breastfeeding, from 2 to 6 times a day, and the consistency becomes denser, resembling a thick ointment or paste.

From two months, bowel movements become less frequent; by six months, bowel movements can occur 1-2 times a day. The color and smell of feces becomes more similar to adult stool.

Helping a child on SV with constipation

There are different ways to help overcome constipation that occurs in a mixed-fed baby. What needs to be done is decided by the pediatrician, based on the cause of the problem. You can help your child cleanse the intestines using medicinal and non-medicinal methods.

Normalization of nutrition

The first thing you should pay attention to if your baby has constipation is how and what he eats. In the case of SV, this will be formula and mother's breast milk. It is preferable that the proportion of breastfeeding be greater than formula feeding.

To do this, it is important to put the baby to the breast as often as possible, upon request, and to supplement with formula only after the baby has received breast milk.

Prolactin (the hormone responsible for lactation) is actively produced at night, which is why it is important to put the baby to the breast at night. More frequent breastfeeding of children on the SV helps to cope with the appearance of constipation at the initial stage.

Separately, it is necessary to say about the drinking regime. A baby who receives formula milk must be supplemented with water.

In a mixed-fed baby, constipation in a baby can be caused by a lack of fluid, since its reserves in the baby's body are small.

Choosing the right mixture

If the selected formula is not suitable for the child, which leads to constipation, the supplementary feeding is changed. Preference should be given to adapted mixtures containing probiotics. These substances improve the functioning of the gastrointestinal tract, which prevents constipation.

The mixture must be changed gradually, replacing part of the volume of the old supplementary feeding with a new one. The pediatrician will draw up an exact plan indicating the volume and time of nutrition individually for a particular child.

Nutrition for a nursing mother

To ensure that breast milk is well absorbed and does not cause problems with the baby’s digestion, you need to carefully monitor the diet of the nursing mother. Too fatty, fried, spicy dishes are excluded from the menu. An excess of light carbohydrates (sweets, baked goods, baked goods) also causes constipation in mother and baby.

Consumption of such products should be minimal, while preference is given to healthy foods that are easily digestible. These are stewed vegetables, cereals, whole grain bread, lean meats and fish.

Correct introduction of complementary foods

Just as you should not introduce complementary foods before the age of 6 months, there is no need to rush with a variety of foods. New components should be introduced gradually, no more than one new product per week. It is important to monitor your body's reaction to new foods. If complementary feeding causes difficulty with bowel movements, you need to give up the problematic product for 2-3 weeks.

Among complementary feeding products, porridge has a strengthening effect. To make it easier for your baby to digest them, you can combine cereals with fruit additives. Prune puree is effective.

Methods of non-drug help

Before going to the pharmacy to buy medicine, try to help your child using natural methods. But they are effective only at the beginning of constipation, when the problem has not yet worsened. If you suspect that your baby is becoming constipated, the following will be effective:

1. Massage. Use a clockwise circular motion to stroke your baby's belly around the belly button. The massage should be done with light pressure, which does not cause dissatisfaction with the child.
2. Gymnastics. Alternately press your baby's right and left knee against his tummy. This exercise also helps relieve gas.
3. Warm baths. Warm water is relaxing, which can help relieve constipation.
4. Physical activity. If the baby has already learned to crawl, give him as much opportunity as possible to actively move. Avoid swaddling and excessively tight clothing.

Drug treatment

When natural methods of help do not help or the constipation is severe, they resort to drug therapy. Modern medications make it possible to quickly cope with stool retention, and the likelihood of side effects even in the smallest children is minimized.

The drug of choice for the treatment of constipation in children of the first year of life, according to the recommendations of Dr. Komarovsky, is a lactulose-based laxative (Dufalak, Normolakt).

This medicine is in the form of a sweet syrup, which has an osmotic effect, softens stool and facilitates bowel cleansing. Approved for use in children of any age, including newborns. The dosage is calculated by the pediatrician based on the age and weight of the baby.

In addition to syrups with lactulose, the following are used to combat constipation in mixed-fed children:

1. Glycerin suppositories. Mechanically irritate the rectum and act as a lubricant.
2. Enema. An old proven method of colon cleansing.
3. Preparations with probiotics. The use of drugs with bacteria that improve digestion has a gradual positive effect on the entire gastrointestinal tract.

A laxative is used in young children only after consultation with a pediatrician.

Can the reasons be established?

There can be many reasons for constipation in a child. And only a qualified doctor can help identify the exact cause in a particular child. Often this is only a symptom of some disease, and not an independent problem. Constipation can manifest as pancreatitis, cholecystitis, hemorrhoids, peptic ulcers and other diseases.

Komarovsky says that quite often the causes of constipation are never discovered even after a lot of research. However, parents' attempts to cope with this problem should be under the supervision of a medical specialist. And if the examination revealed the cause of constipation, then all efforts should be directed not at the constipation itself, but at the disease that manifested itself this way.

If examinations of the child do not determine a serious cause of constipation, Komarovsky emphasizes that parents should not consider constipation a tragedy or misfortune. This trouble can be easily dealt with.

Prevention of constipation in children on SV

The following preventive measures will help get rid of problems with defecation in infants and children of the first year of life who are on SV:

1. Justified transition to mixed feeding. Formula supplementation is often prescribed to children who could continue to safely receive only breast milk. As a result, the functioning of the gastrointestinal tract is disrupted, since digestion is reorganized to digest the mixture, and the child becomes constipated. Lack of breast milk with proper organization of breastfeeding is a rare situation.
2. Selection of milk formula. If supplementary feeding is unavoidable, the most adapted mixture is selected. They switch to cheaper formulas only closer to the age of one year, when the baby already receives a varied diet.
3. Proper nutrition for a nursing mother. Regardless of the availability of supplementary feeding, a nursing mother should eat healthy food. Modern recommendations refute the need for a strict diet for breastfeeding, but harmful foods are excluded from the diet of a nursing mother.
4. Complementary feeding started on time. The main rule for the prevention of digestive problems, which is often not followed by parents in practice. There is no reason to introduce additional foods other than formula and breast milk to a child under 6 months of age.
5. Adequate fluid intake. Breast milk contains a lot of water, but when supplementing with formula, it is necessary to add drinking water to the baby's diet.

Proper organization of a mixed feeding regimen will help to avoid the problem of constipation in infants or to easily eliminate them. Treatment is possible only as prescribed by a pediatrician.

Dr. Komarovsky gives useful recommendations on the site

Expert recommendations

Dr. Komarovsky is convinced that for normal functioning of the intestines in infants, sufficient fluid intake into the body must be ensured. For bottle-fed babies, this means supplementing with water, and for those who are breastfed, the mother needs to drink a sufficient amount of liquid. It is known that breast milk consists of 80% water.

It is imperative to monitor the drinking regime if it is too hot or the baby is sick. High body temperature burns fluid, which is necessary for the proper functioning of all body systems.

According to Komarovsky, constipation caused by a lack of your own bacteria can be prevented; you just need to drink prebiotics. Bifidumbacterin is considered the best remedy for newborns; it can be taken from the first days of life.

To prevent potassium levels in the body, you need to consume a sufficient amount of raisins, dried apricots, prunes, and figs. For babies, you can steam dried apricots and leave them for several hours, then give them from a spoon. This also prevents constipation and potassium deficiency.

The temperature in the room where the baby is located should be optimal. This is important for proper bowel function. At the first symptoms of colic, you need to open the window so that the baby calms down and the spasm goes away.

It is better to feed your baby not with boiled water, which is completely devoid of all beneficial properties and minerals, but with compote, which can be cooked from dried fruits or apples. The same applies to nursing mothers.

Do not forget that the main causes of constipation in infants are:

• overheat;
• lack of potassium in the body;
• supplementation with “dead” water;
• improper nutrition of a nursing mother.

To avoid all this, you just need to follow simple rules; they will definitely help you raise a healthy baby.

Other types of stool

Foamy stool

One day you may find your little one has watery, foamy stools with a sour smell. Outwardly, it will be thinner and faster. This is a consequence of a deficiency of a certain enzyme that digests milk sugar. This enzyme is called lactase

, and its quantity can be adjusted externally.

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Foamy stools do not require correction if the child is gaining weight and is not restless.

When such a picture is not observed, the doctor determines the amount of enzyme that the baby should receive in a portion of milk before natural feeding. When formula-fed, the pediatrician recommends low-lactose special formulas.

Fat stool

Enzyme deficiency may result in large, fatty stools. In this case, we are talking about enzymes that digest fat, and this may be associated with an allergic disease called celiac disease, which is accompanied by impaired absorption of cereal gluten.

Stool with mucus

A newborn may have stool with mucus for various reasons:

• reaction to the introduction of a new product;
• the result of dysbacteriosis;
• reaction to .
  dangerous

  In the latter case, accompanying symptoms are possible: fever, vomiting. You can't do without a doctor here.

As for dysbiosis as a disturbance of the normal intestinal microflora, constipation and diarrhea are not excluded: it all depends on the individual reaction of the body.

Chair with lumps

Sometimes there may be white lumps in a newborn's stool. This is the result of incomplete digestion of food. Although if the baby is gaining weight well and is not lagging behind in development, there is no need to worry. This problem should resolve itself, without external intervention.

Stool with cystic fibrosis

From birth, a child may have fatty stools. It leaves greasy stains on diapers, lathers itself while washing, spreads a stench into the room, and is difficult to wash and wash off the toilet. This is a manifestation of rare congenital abnormalities of many glands (including the pancreas), called cystic fibrosis. Here you need to be especially careful, because the problem requires consultation and treatment by specialists.

We must not forget that the color of stool in newborn children and the quality of its composition reflect the state of health of the small organism.

What kind of stool should a baby have?

In the first days of life, the baby's stools are dark olive or black in color - this is meconium that has accumulated in the intestines while still in the womb. Usually, by the third day, meconium is replaced by transitional stool of a greenish tint.

Before introducing complementary foods, the reference is considered to be baby feces that are golden-yellow in color and have a mushy consistency with small white lumps. Only artificial children can claim such permanence. The composition of breast milk is constantly changing - and depending on it, green stools may appear in the baby.

In general, the nature of baby stool may depend on the following factors:

• type of feeding (artificial, breast or mixed);
• health conditions;
• functioning of the digestive system;
• mom's diet.

Variations in the consistency of infant stool are allowed, from liquid to unformed. The color can be any shade of yellow, greenish or brown.

Diarrhea in a newborn

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Once a month from birth to one year it is necessary to monitor the baby’s weight and growth. If he's not gaining weight well and you notice loose stools when you change diapers, there could be several reasons for this.

• Receipt of a large amount of foremilk
  . It is lower in calories and develops lactase deficiency. In this case, the mother needs to change breasts less often so that the baby reaches mature milk or express a little milk before feeding, then the baby will immediately begin to satisfy his hunger with more high-calorie and nutritious milk.
• The eruption of new teeth, the introduction of complementary foods, the reaction to the adaptation of the gastrointestinal tract to other foods
  . In these cases, no interventions are recommended: these physiological manifestations go away on their own.

Sometimes it may seem that the above is not the cause of diarrhea, in which case it is better to consult a specialist. They will help you to expertly understand the issue.

Modern methods of breastfeeding suggest after six months. Sometimes a reaction to the introduction of a new dish may be a newborn's green stool mixed with mucus. There is no need to worry if the color is restored after a few days and the child does not show unnecessary anxiety. Otherwise, the product must be excluded from the diet for a while and try to introduce it a little later.