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Thread: infrequent and painful bowel movements

  1. #1

    Default infrequent and painful bowel movements

    My little one is 14 months old and still mostly relying on breastmilk for his nutrition. We have been following the “baby-led weaning” approach to introducing solids and he joins us at every meal, is offered some of everything we eat, and he puts it all in his mouth and chews. However, most of it comes back out of his mouth again. He eagerly swallows all the yoghurt, stewed fruit, soft ripe pear/nectarine flesh and bread he’s given but just tiny bits of everything else.

    He has about 4-5 breastfeeds during the daytime and 6-8 during the night.

    Over the past 3 months or so, his bowel movements have become quite infrequent - every 10 days or so, and they cause him a lot of pain and distress, which is horrible to witness. His poo has not changed in colour or consistency - it is still what I consider to be normal, not hard and compacted at all.

    I spoke to the doctor earlier this week about it and she said it’s about nutrition. I asked if she had much experience of breastfeeding and, not surprisingly, she said she didn’t. She prescribed lactulose for him and has given him an appointment at the baby clinic next Tuesday to talk to me about nutrition. She talked about withholding milk so that he was hungry enough to eat more solids at mealtimes, but my understanding is that while he’s not taking much solids in, he won’t recognise that the food will fill him up, so he will probably just get upset at not getting the milk he wants and might even refuse to eat anything at the table.

    Other than this one thing, he is very healthy and happy and continuing to grow and develop normally.

    I wonder if anyone has any experience or advice to offer about how to approach helping him, and also how to approach talking to the doctor and other potential health professionals who probably don’t understand breastfeeding…

  2. #2
    Join Date
    Jun 2009
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    Default Re: infrequent and painful bowel movements

    Hi feetea. My oldest had a pretty mild bout with constipation when he first started solids (so, around 6 months or so?) and then when we were potty training he had severe constipation for a while. I forget exactly how old he was then, but I think it was around 2? So I know how upsetting this can be. I remember feeling awful that my little guy was going through this.

    In both cases he was nursing at the time, in fact, nursing quite a bit, and we solved the problem without changing nursing patterns at all. As far as I know, breastfeeding does not cause constipation and reducing breastfeeding will not cure it. If there is any evidence less breastmilk or less nursing helps with constipation I would love to see it, because biologically it makes no sense.

    Here was our experience in a nutshell. In the first instance, we stopped constipating foods like rice cereal. I see some possibly constipating foods in what your child eats, like bread and yogurt. We offered more peas and prunes and pears (I was spoon feeding him mostly purees at the time, with my subsequent kids we did a more baby led solids approach and did not have the issues with constipation my oldest did.)

    In the second instance, I think the main culprit was the potty training. I realized it was way too soon. I had thought he was ready because he used his little pot to poop and pee early on and I kind of figured that was it. Later I realized that had basically been an accident and he was NOT really ready, at all. I also learned that some kids (like my son) pee in the potty way earlier than they are ready to poop there.

    So, to solve the issue that time, we backed off potty training entirely. I learned from Dr. Sears (The Baby Book) that in some cases, constipation becomes a problem when a child intentionally withholds. They have a painful BM (or a few) and want to avoid that in the future so they decide to just not go! This of course makes the issue far more serious! So giving him gentle encouragement to do what he needed to do helped. For example, we figured out he preferred pooping while standing up, and with some privacy but not behind a closed door. Because he liked pooping standing up, long car rides or frequent car travel could be a problem and we needed to figure out a way around that.

    So in my experience, it is not all about nutrition. Other factors might play into a problem with constipation.

    If baby is nursing lots, presumably dehydration is not part of the problem, but at this point offering water when he eats solids could not hurt.

    I have not read Dr. Sears on this for years, but my recollection is he offered sensible, breastfeeding friendly suggestions. His website is www.askdrsears.com

    As far as talking to the doctor, it sounds like your baby is otherwise entirely healthy and consequently well nourished. In that case, personally, I would stick to a discussion of medical treatments for constipation- for example, if you decide to try a medical remedy like glycerin suppositories or something. If they want to suggest certain foods or probiotics or something as a remedy, or certain foods to avoid, great. If a doctor told me to reduce nursing, I would either ignore it or ask them for the source of this recommendation for the treatment of constipation or for the "treatment" of baby not eating "enough" solids. It's nonsense.
    Last edited by @llli*maddieb; January 13th, 2017 at 09:15 PM.

  3. #3

    Default Re: infrequent and painful bowel movements

    Oh thank you maddieb! That's really helpful and so good to know someone else has experienced something similar to me. I feel more confident to be able to talk to the doctor about things other than reducing breastmilk. I had wondered about the dairy and/or wheat being a possible reason though have been reluctant to try eliminating those things from his diet just because he enjoys the bread and yoghurt so much! However, since he's not eating much of anything anyway, it won't be a real problem to give it a go.

    I don't think it can be dehydration, because he's producing plenty of wet nappies, but I don't suppose it will do any harm to give him water with his meals anyway.

    I will look up Dr Sears.

    Thanks again :-)

  4. #4
    Join Date
    May 2006
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    24,912

    Default Re: infrequent and painful bowel movements

    with all the above from MaddieB.

    My first kid had some pretty significant constipation when she was getting interested in solids, around 14-15 months. It was caused by a combination of factors. First, when it came to solids she loved her pasta and cheese but nothing else. Second, she was nursing less, which meant that she wasn't as well hydrated as she had been. Third, we started offering her opportunities to use the potty- in the most low-pressure way, we thought, but it was still too much. Then she had an episode of hard poop, which more or less taught her to be afraid of pooping, so she started to withhold her poop which made the problem worse...

    The most helpful things I learned about constipation in a toddler are the following:
    - If you are nursing, keep nursing. Cow's milk can be constipating but human milk is not.
    - Keep a poop journal. It can be really hard to remember when your child last pooped. 5 days ago or 7? 7 or 10?
    - If you are engaged in potty-training, stop. Let her go back to diapers for as long as necessary.
    - Young toddlers who are nursing frequently don't need that much solid food. A lot of parents start offering potentially constipating foods just so their child will eat something. But a baby who is breastfeeding a lot doesn't need to be offered only her favorite foods. Give her a balanced and fiber-rich diet, and she will eventually eat it. If she doesn't, she's not really hungry.
    - Constipation takes approximately 2x longer to resolve than it did to become a problem. So if it took a few months for your child to become stopped up, expect it to take double that amount of time to get better.
    - When it comes to treating constipation, the classic mistake parents make is to try to minimize the treatment. They give less stool softener than recommended, and stop the treatment as soon as the baby poops, which just leads to another episode of constipation which the parents treat with minimal meds, etc. I get it- no-one wants to pump their babies full of yucky lactulose or Miralax or whatever! But according to our pediatrician's, the proper way to treat constipation is to use the maximum dose of stool softener until the baby is pooping 2x per day, producing poop that is "the consistency of a thick milkshake". Aer you've gotten to that level for a week, you can start backing off the dosage until the child is pooping once a day.

  5. #5

    Default Re: infrequent and painful bowel movements

    Oh that's really helpful, thank you mommal :-) Especially the bit about how long it takes to resolve - so to be patient and give the treatment time to work its effect.

    I've also been thinking about how much lactulose I should be giving him - the doctor said to take 2.5 ml a time, when the bottle says it should be 5ml for ages 1-5. I've been giving him the 2.5 ml but since he's over 1 year old and big for his age - over the 99th percentile - I wonder whether he shouldn't be on 5ml instead. I'll mention that to the doc when I see her.

    Very grateful for your advice :-)

  6. #6
    Join Date
    May 2006
    Posts
    24,912

    Default Re: infrequent and painful bowel movements

    Found my favorite article about constipation in infants and young children: http://www.aafp.org/afp/2006/0201/p469.html

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