By Dr. C Groenewald
Oh, the joys of baby poop. Since becoming a mommy, you went from being a normal, intelligent, strong woman, to a slightly neurotic, poop obsessed, sleep deprived nutty woman (with one or two instances of finding baby poop under your finger nail an hour after changing the last diaper). Nothing sends chills down a new mother’s spine than changing a diaper, and seeing something you are sure cannot be normal. Whether it be the color, smell, consistency, too many or too few diapers per day - nothing can send you into a frenzy, like your new-borns’ poop.
So, let me put your mind at ease. When it comes to your little darling’s poop, ‘normal’ is relative. One poop diaper in ten days, or ten poop diapers in one day is perfectly normal, if that is what is normal for your baby.
Frequency, or lack thereof, should remain constant. A sudden change in their bowel habits, is a better sign of gastric discomfort. Furthermore, when it comes to color, it is as varied as the 11 national languages of South Africa. From tarry black meconium (baby’s first poop) to shades of yellow in exclusively breastfed babies to tones of brown once you start introducing solids.
There are a few color guides available online, for your peace of mind. The only three colors that should worry you are:
• red stained poop (unless there was beetroot in last night’s dinner);
• black stools (except the first meconium poop diaper the first few days after baby is born);
• and pale or grey stools
All of which should also be reported to your child’s primary health care physician as soon as possible.
Now, let us talk about consistency. Parents often report that their new born is constipated based on the frequency of the stools. As mentioned above, frequency is very varied in babies and some babies can have only one poop diaper per week, which is normal for them. Rather than focusing on frequency, if it remains constant, note the consistency of the poop. Healthy bowel movements in a baby 0-6 months (minimum), is not formed (i.e. not solid). Parents often confuse this with diarrhoea. A normal healthy bowel movement, is a ‘mushy’ consistency. Diarrhoea is often accompanied with an increase in frequency, as well as a very watery discharge containing little to no solids, that often ‘explodes’ out of the diaper. Formed stools, hard, dry or pebble shaped stools, are signs of constipation.
Now that we have cleared all this up, let us focus on constipation, and what you can do to alleviate your babies discomfort.
Here are my top ten tips for treating constipation:
1. Any change in diet will affect baby’s digestion, so take it easy.
This remark is twofold. Firstly, remember that what you eat, affects your milk production, which in turn can affect baby’s digestion and bowel movements. Secondly, introducing anything into baby’s diet, other than breast milk, will affect their gut flora, and in turn their bowel habits. This is especially true when introducing formula, changing from one formula to another, or introducing solids. When at all possible, try to introduce any new formula or food, gradually (See top ten tips when introducing solids), to allow the gut some time to adjust to the transition.
2. Formula vs breast milk.
When choosing a formula, discuss your baby’s specific needs with your primary health care physician. I found that hypoallergenic and anti-colic formulas, are softer on the gut, while AR (anti reflux) tend to cause constipation due to the thickness of the formula. When preparing the formula, always ensure that the formula is prepared correctly as per instructions on the formula container. Too much formula powder vs water can aggravate constipation, while too little milk powder prepared with too much water, can dilute the nutrients and cause serious health problems.
As for Breast milk, ensuring baby drinks both the thin fore milk, as well as the thick, nutrient rich after milk, is essential. To ensure baby gets enough of both, make sure he/she spends enough time on one breast, before moving on to the next breast.
3. Choose a probiotic to support the gut.
Probiotics are often useful when there is a disruption in gut flora, which can cause or aggravate constipation. Choosing a probiotic especially formulated for baby’s immature gut, can assist in correcting any imbalance, and aid in alleviating constipation.
Healthy breastfed and formula fed babies, do not require any additional water in their diet. It is recommended to start offering baby water only from 6 months of age. When it comes to constipation, grandparents are fast to convince you to give your infant water, however, both formula (when prepared according to the labelled instructions), as well as breast milk, contain enough water to keep baby hydrated. Adding additional water to their diet, can lead to dilution of nutrients which can have adverse health effects. Please speak to your baby’s primary health care physician regarding the introduction of water before 6 months of age to alleviate constipation, as every child is different and each case should be considered individually.
5. Prune Juice.
Introducing pure, unsweetened prune juice (like Safari prune juice available from Dischem), from 6 months of age, is a great way to stimulate bowel movements. You can dilute it 1 part prune juice to 3 parts water, and offer it to your baby in a sippy cup. Prunes contain both insoluble fibre, as well as the natural laxative sorbitol.
6. Fibre rich foods.
When introducing solids at 6 months of age, it is important to introduce food groups in accordance with the anti-allergic food list (see list here). These foods are not processed, and naturally high in fibre. Steamed prunes are very effective in treating constipation, however, if your baby does not like the taste, try making the following:
Frozen prune popsicles.
They are easy to make and kids love them. I use the baby food range ‘Squish”, prune flavour available from all major retailers. Simply squeeze the contents into a popsicle mould, freeze and enjoy. They contain pure prune puree only, no added sugar or preservatives.
7. Baby Massage.
Stimulating baby massage works wonders on gut motility. After bathing baby, ensure baby is comfortable and the room is warm enough. You can use some soothing chamomile oil, or edible oil like coconut oil or olive oil. Warm the oil by rubbing your hands together. Ask baby’s permission before you start, “Is it ok if mommy massages your tummy now?”. Place your fingertips (or palm of your hand), below baby’s belly button, then applying firm but gentle pressure, massage baby’s tummy in a circular clock wise motion.
There are various Youtube clips that illustrate the various techniques you can use to massage baby’s feet to alleviate constipation. Alternatively, you can visit a reflexologist, who can show you how to treat baby at home.
Mal alignment of the spine, can contribute to poor nerve conduction to baby’s gut. Correcting this malalignment, stimulates healthy nerve conduction and blood flow to the gastro intestinal tract, including the small and large intestines, which lends itself to a healthy functioning bowel.
In Homeopathy, we use a system of medicine - ‘likes cures likes’- to treat all ailments, including constipation. There are many homeopathic over the counter products (OTC), that incorporate the most common remedies used in constipation. These may or may not contain the specific remedy for your child’s constipation ‘picture’. Finding the perfect similimum for your baby, is cardinal to homeopathic success, so if you have tried OTC products, and they have failed, book an appointment with your homeopath.
Dr. Marike de Klerk