Suggest Treatment For Constipation Followed By Diarrhea In Infant

Posted on Wed, 22 Jul 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Wed, 22 Jul 2015 Answered on

Thu, 13 Aug 2015 Last reviewed on

Question : Dear dr
My 5.5 months baby stopped breastfeeding 3 months back
He was on regular formular when he experienced constipation for days then we switche to another milk( anti constipation) for 2-3 months
Then he stopped eating full formula in each feed ( may be 1/3 or 1/2 formula each time)
He stopped gaining weight for 40 days and diarrhea for 10 days so we checked his stool as per dr's request
His test was normal except for mucus (Present) and fat globules (Present) and diarrhea stopped
Here some doctors thought of lctose intolerance and advised lactose free milk and others thoight of cow's milk protein sensitivity and advised another formula free of this protein
I need your advice to change directly to the right formula
Thanks

Answered by Dr. Dr. Pradeep Kumar Jain (18 minutes later)

Brief Answer:
Just switch to a different formula

Detailed Answer:
Hello

Thanks for the query

The diarrhea persisting for 10 days which resolved on its own and stool test did not showing reducing substance is not suggestive of lactose intolerance.
Not increase in weight may be due to decrased intake of formula feed.
Also in cow milk protein intolerance the stool shows occult blood or there would have been allergic reaction.
I don't think that it is lactose intolerance or cow milk protein allergy.
So I would suggest you to switch to a new formula feed and observe the weight gain.
Please let me know which formula feed you are giving so that I better able to help you out.

Please feel free to ask any further query.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Pradeep Kumar Jain (8 minutes later)

Hello Dr
No blood presence in stool
When discharged after giving birth he was on Nan 1
We changed to similac total comfort because of constipation
When he stopped completing hid feed, we changed again to bebelac
As I told some drs advised now to change blemil HR (cow's protein free) others advised lactose free and one dr advised to use dehydrolized milk or something like that (can not remember the name but its description ; amino acids are broken down) and suggested lots of tests like CBC , IGg , etc

Answered by Dr. Dr. Pradeep Kumar Jain (10 hours later)

Brief Answer:
Changing too many formulas is not the solution

Detailed Answer:
I am so sorry for delayed reply.

I can understand your concern.
First of all I want to tell you that passing stool 7 times a day or once in 7 days in normal in early infancy unless it is associated with other symptoms like vomiting,distension of abdomen,failure to thrive or poor acceptance of feed.
You switched to similac total comfort from nan 1 because of constipation.
I am not sure whether that constipation was really significant.
Now again you changed to bebelac a low lactose formula because baby was not comfortable with similac.
Then the baby was not gaining weight properly and had develop diarrhea.
I won't get worried for diarrhea but not gaining weight for 40 days is really a significant problem.
Now doctors are advising you other formula lactose free,hydrolysate formula and cow protein free formula.
I am not able to understand why so much confusion about different formula when the baby has nothing suggestive of lactose or cow milk protein intolerance(almost normal stool test and absence of vomiting,reflux,excessive cry,abdominal distension,skin reaction)
At 5.5 months of age his weight should be double of birth weight and a daily weight gain of 15 gm is sufficient.
He should consume about 100-150 ml/kg of formula daily.
As he is of 5.5 months now start complementary feeds like cerelac,rice water,mashed boiled potato/apple.
I don't think that switching to lactose free or cow milk protein free formula will help much in such situation.
Prepare the formula with proper dilution and give nan pro 2 with complementary feed and monitor weight gain.Investigations like immune profile is needed if baby is having frequent infection like respiratory or intestinal.You can go for the investigations but I don't think that they will of much help.

I hope this helps.
Please feel free to ask any further query.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Pradeep Kumar Jain (19 minutes later)

Thanks dr
You made it really clear
I just wanted to mention two points you've highlighted;
1-The baby hd excessive crying since born especially when we tried to breast feed him
1 or 2 minutes after breast feeding he starts screaming. This cry continued with him till almost the 5 month and now it is less but he always makes non stop annoying sound more than any baby as per all our relative and friends notice.
2-Sometimes but not regularly we find red patches on his skin but not consistently
Does that , with mucus and fat globules, change your mind in regards to any of the points we discussed ?

Answered by Dr. Dr. Pradeep Kumar Jain (4 hours later)

Brief Answer:
Still points are not in favor of lactose or cow milk protein intolerance

Detailed Answer:
Thanks for follow up

Here you are mentioning that he was crying even on breast feed.Breast milk does not contain any cow milk protein.So if we correlate both,the chance of milk protein intolerance(CMPE) is very low

Breast milk contains lactose and in case of lactose intolerance there should be reducing substance in the stool.So possibility of this condition is also very low.
There can be so many other causes of red patches on the skin apart from milk protein intolerance and for diagnosis of CMPE there must be other suggestive features.

The most common cause of excessive cry in early infancy is intestinal colic and gastroesophageal reflux disease (GERD).
There are other suggestive features of GERD like crying during feed,poor feeding and improper weight gain.
I would like to give some colic drop and acid reducing agent like lansoprazole with GER reducing agent like domperidone considering GERD and colic as possible diagnosis.
There is no harm in swithichng over to cow milk protein free formula.Start complementary feed also.

I hope this will help.
I shall be glad to answer if you have any more query.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Pradeep Kumar Jain (30 hours later)

Thanks dr.
I think this might be my last follow up as I've mentioned almost everything I need to.
Stool test did not include reducing substances.I've attached the report for your kind check..
It included many things but I did not notice this reducing substance..
Should I do another stool test and ask for this " reducing substance"?
Can it be done via blood sample?

I tried the hydrolysate formula but he refused even to take 10 ml. he did not like its taste but when I gave bebelac again, he finished the whole 180 ml.
Should I retry the hydrolysate formula?

Answered by Dr. Dr. Pradeep Kumar Jain (54 minutes later)

Brief Answer:
Get a repeat stool test done

Detailed Answer:
Thanks for writing back

I have gone through the stool report.
It shows fat globules and mucus.
I won't get overly worried if the baby is passing stool normally.The presence of fat globules and mucus may be due to transient episode of diarrhea from which he has recovered.
If he is not accepting hydrolysate formula continue giving bebelac.
Get a repeat stool test done and monitor the growth of baby.Start complementary feed as advice and also discuss with your pediatrician about the possibility of GERD.

If you have any more doubt I shall be glad to answer that.
Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar