To poo or not to poo…

It is amazing how many of my conversations since becoming a mom centers around feeding, sleep and poop! And when one of those are out of balance it feels like your whole life is upside down. Most of these issues do not warrant a visit to the pediatrician on own merrit, but the correct advice and understanding could improve your (and your child’s) quality of life immensly. In the next few blogs I want to address a few common issues that many of my mom-friends have asked me about. I hope I can answer a few of your questions too!

I want to continue with the “hard” topic from my previous blog, so let us talk about constipation in toddlers. Not such a big problem, all kids go through some degree of constipation at some point and they grow out of it, right? Yes, but it is not so simple. I have seen a 5 year old boy admitted for appendicitis who in the end “only” had severe constipation. It is important to understand what happens when toddlers become constipated and to be ready to treat it early to prevent long-term complications.

Toddlers are prone to constipation when they potty-train, start school or when any other life-altering changes happen in their lives. They can also just be too busy enjoying life to waste time on the loo! 😉 That first hard stools can then trigger a chain-reaction of bad experiences. Painful defecation due to large, hard stools or even anal fissures (a small tear in the skin around the anus) can cause withholding behavior and this turns into a very vicious cycle.

Withholding behavior can be anything associated with not responding to the urge to poo.  If you ignore the urge for long enough, it goes away, but the problem does not. Are you ready for the gory details?

The “urge” is triggered by the stretching of the rectal wall (the part of your colon just before the anus) when it is filled with stool. If you do not relax your anal sphincter muscles, the stools are pushed back and the urge goes away. However the rectum is still stretched, and over time becomes less sensitive to stretching when the next stool enters. The rectum’s main function is to extract and conserve as much water as possible. This is why the stool gets harder and dryer the longer it stays in the rectum. Children with fecal loading (where large masses of stool heaps up in their rectum) or impaction (where it is very difficult / painful / impossible for the child to pass the stools without help) can sometimes even seem to have diarrhea when the “newer” stool trickle past the hard stool. This can also manifest as fecal soiling (also called encopresis) where stool leak into the underwear (overflow incontinence).

So what can you do to prevent this? Or how do you treat it when your toddler already has some of these problems?

Acute treatment:

If there are any signs of fecal loading / impaction, it is important to first empty the colon to break the vicious cycle of hard, large, dry stools causing pain – causing withholding – causing hard, large, dry stools. This can be done at home or your doctor might feel it is necessary for your child to be admitted if there is a risk of dehydration.

Disimpaction is done by the aggressive use of poly-ethylene glycol (a laxative called PEG eg Pegicol / Miralax), or enemas or a combination of the two. (1)  This breaks up and softens the hard stools and enables the child to pass them. Once the colon is empty you can start with phase 2 of the treatment.

Maintenance treatment:

It is important that your toddler’s colon is “retrained” to be sensitive to minimal stretching and that the anus can relax and withhold as needed. This takes time. So it is crucial that you and any other caregivers buy into the gameplan for the next 4-6 months.

The treatment consists of a combination of laxative use and behavioural therapy. (2)

In short you need to ensure that your child passes 1-2 soft stools DAILY. (3) You become the laxative-expert by increasing or decreasing the dose as needed. The prescribed laxatives (PEG or lactulose) is very safe and is not absorbed, so you cannot “overdose” your child. It is also safe for long term use and does not cause the bowels to become “lazy” as it does not stimulate contractions of the bowels. (4) See more about the use of laxatives in babies in my previous post.

The behavioural therapy adds a crucial part of the treatment. As a child needs to learn and practise walking / talking, they also need to learn and practise a healthy toilet-routine. Start by encouraging and supervising regular “toilet-sitting” times, 2-3 times a day after meals (this is when there is a natural reflex to pass stool, so use all the help you can get). Make these toilet-sitting times fun and stress-free. Sit for 5min even if there is no poo, and just keep at it. Make sure your child has a good posture on the toilet (a squatting position opens up the pelvis and aligns the rectum in such a way that it is easier to pass a stool) and that they do not have any fears of the toilet. (For some comic relief of all this poo talk, do yourself a favour and watch this video about “The Squatty Potty“).

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It is also important in the long term to address the child’s diet to increase fiber and water intake. These are important skills that you teach your children for maintaining healthy bowel habits for the rest of their life, so it is well worth the effort!

Do you have any poop-related stories to share? It sometimes feels gross and uncomfortable to talk about, but just maybe you encourage the next mom that it is ok, it gets better and there is help available!

 

 

1. Dobson P, Rogers J; Assessing and treating faecal incontinence in children. Nurs Stand. 2009; 24(2):49-56

2. Brazzelli M, Griffiths PV, Cody JD, Tappin D; Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children. Cochrane Database Syst Rev. 2011; (12):CD002240

3. Beck DE; Constipation and Functional Bowel Disease; Clin Colon Rectal Surg; 2005 May, 18(2): 120-127

4. Pashankar DS, Loening-Baucke V, Bishop WP; Safety of polyethylene glycol 3350 for the treatment of chronic constipation in children; Arch Pediatr Adolesc Med. 2003 Jul; 157(7):661-4.

A ‘Hard’ problem – Constipation in Babies

Eran was always very conservative with nappies. After 6 weeks of age he would only have a dirty nappy once a week. His record was no poo for 14 days!! This totally freaked me out, but he looked quite happy and comfortable. He was exclusively breastfed, so he had really good absorption of the nutrients, and when he did pass stool it was always soft and yellow.

There is such a large variety of normal when it comes to baby-poo. So how do you know when to start worrying and when is it constipation?

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(Warning: this is quite a “crappy” topic, excuse all the puns! 😉)

Stool-patterns vary by age and diet. The number of stools passed decrease as your baby gets older (with an average of 4-5stools per day for the first week of life, then 3-4 for the first three months and 1-2 by 2years of age). In exclusively breastfed infants it can be normal to pass stools 7 times in one day, or only once in 7 days!1  There is also a difference in stool-patterns with different formulas: soy-based formulas produce harder and less frequent stools, while hypo-allergenic formulas can produce looser and more frequent stools.

“When the going gets tough, the tough get going.” – Joseph Kennedy

There are a few developmental milestones in your baby’s life when constipation is more likely to be a problem:

  • Introduction of formula
  • Introduction of solid food
  • Introduction of cow’s milk
  • Potty training
  • Going to school

Constipation in an infant (below 1year) is diagnosed when there is a change in the stool pattern for your baby, it looks like your baby has pain / excessive straining while passing the stools AND the stools are large, hard, dry or pellet like. This last part is especially important, because many babies have dyschezia.2 This big word just describes what we see with most young babies: they strain, become red in the face and cry before passing a stool. The stool is then always soft and the baby is otherwise healthy.  This is not constipation, but happens because the baby is still too young to coordinate his muscle movements when trying to pass a stool. You can help your baby to relax the pelvic floor by gently bending his hips and bringing his knees up to his stomach. Dyschezia usually resolves as your baby grows and no further treatment is necessary.

So when should you worry? And when is it something more than functional constipation (meaning it is a common childhood/lifestyle problem with no serious pathology causing the problem)? Constipation in babies and toddlers are mostly (>95%) functional, so take a step back and relax, this too (like all poo…) shall pass! 😉

RED FLAGS :

(These are signs or symptoms that will worry me if you tell me your baby does not poo and he has one of the following. Please consult your doctor asap.) 3

  • No stools passed in the first 48hrs of life
  • Constipation before one month of age
  • Associated with other symptoms such as a distended abdomen, vomiting, fever, not passing any gas
  • Any blood in / on the stools
  • Any abnormalities of the spine, buttocks, genitals or legs
  • Not growing well
  • Recurrent lung infections

When we introduced solid foods (in the form of vegetable purees) for Eran at 5months of age, he became very constipated. His normal “once a week poo” changed from easy to pass and soft, to a hard dry mass that caused him severe discomfort and effort and even a small tear to his anus. Luckily he had none of the red flags, so I knew I could safely treat him at home.

Treatment in infants for functional constipation:

To treat any constipation successfully you need to remove the dry, hard stools that are currently causing pain, and then you have to address the cause and keep the next stools soft so that it is easier to pass (for more detail see the next post on Toddler constipation). The longer stool stay in your gut, the more fluid is absorbed and it is thus important to maintain a frequency of at least 1 stool per day.

We used the following treatments when Eran was having a HARD time:

To help your baby remove the initial hard, dry stools :

  • Glycerine suppository for babies (you can cut it in ½ or ¼ and insert it with some lubricating jelly). You can also squirt 1ml of liquid glycerine into the anus with a small syringe. This softens the stool and the insertion also stimulates the bowels to pass the stool.
  • Bend baby’s legs at the hips and push his legs toward his stomach to relax the pelvic floor.

To keep the stools soft:

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Diet:

  • Constipation often occurs after starting a solid diet as there are insufficient fibre and fluid in the transitional diet (often only consisting of cereals). It is thus important to increase the fibre by adding fruit and vegetable purees. Prune, apple, pear and pea purees worked for us. Be aware of banana and sweet potato as these often have the opposite effect. Try to change from rice-cereals to whole-wheat / mixed grain / barley cereals. Try to rather stay away from fruit juices as these contain a lot of sugar and very little fibre.

* If your baby develops constipation when you change from breast-milk to formula milk, it is worth-while to consult your doctor to discuss the best type of formula to use for your baby. You can also add a teaspoon of olive oil or sorbitol-containing fruit juice to their formula.

* If your baby develops constipation when adding cow’s-milk to their diet, it is important to ensure that they are not allergic to the cow’s milk.

Medication: 4

  • Lactulose is a safe and effective medication in the treatment of constipation. It is an indigestible and osmotically active sugar, which means they do not absorb any of it and it only works by pulling water into the bowels to soften the stools. It is not “addictive” , it will not make the bowels lazy and you cannot really overdose your baby.  It is safe to start with 2.5mls twice a day, and then increase to three times a day /  increase the dose by 2.5ml increments until your baby passes 1-2 soft stools per day. Decrease the dose or frequency if the stools become too loose.
  • Polyethylene Glycol (PEG) can also safely be given as an osmotic laxative after 6months of age.
  • Glycerine suppositories: Rather keep these for a backup as baby can get used to the anal stimulation to initiate a bowel movement, he needs to stay sensitive to the internal stimulation that the stretching of the bowels provide.
  • Do not give stimulant laxatives or enemas to infants.

As Eran’s fibre intake increased and he became used to all the new food his bowels had to process, we gradually weaned and stopped the Lactulose at about 6months. Since then we have used it intermittently as needed, and Eran is managing his poo-schedule very well! Did your baby struggle with constipation at some point? What worked for you?

Next week I will discuss constipation in toddlers and some practical solutions to this pain in the b-hind!

 

  1. Den Hertog J, van Leengoed E, Kolk F et al; ‘The defecation pattern of healthy term infants up to the age of 3 months.’; Arch Dis Child Fetal Neonatal Ed. 2012 Nov;97(6):F465-70.
  2. Benninga MA, Faure C, Hyman PE, St James Roberts I, Schechter NL, Nurko; ‘Childhood Functional Gastrointestinal Disorders: Neonate/Toddler.’; Gastroenterology. 2016 Feb;
  3. Nurko S, Zimmerman LA; Evaluation and Treatment of Constipation in Children and Adolescents; Am Fam Physician. 2014 Jul 15;90(2):82-90
  4. Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, Staiano A, Vandenplas Y, Benninga MA ; Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN; J Pediatr Gastroenterol Nutr. 2014;58(2):258.

 

Looking for a travel stroller? Banimal Kids stroller.

*** Just a heads up…I do not usually do reviews, this is just an honest opinion from one mom to another about a product that I was blessed to find and I am so excited to share with you! I did not get any payment / compensation for writing this review.***

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In the months leading up to our big trip from SA to Belgium I spent a lot of time researching the perfect travel stroller. I knew I would be taking my Ubuntu Baba carrier, but I also wanted to have a stroller that folds up really small and handles easily with one hand. I read many many blogs, but most of the strollers that were reviewed were not available in South Africa. If they were available, it was mainly in baby-boutiques, and the price-tags reflected that. I prayed about it and decided to forget about it for a while.

One morning while scrolling Facebook, a random stroller caught my eye from one of the “suggested posts”. It was a brand new South African company, Banimal Kind Creatures, that was only launched in May 2018, but the stroller looked a lot like one of the top-range strollers I have been researching. On further inspection I also found it was for sale at a very affordable price. I sent them a message via their Facebook company page to hear more, and they were quick to reply and very caring. (The customer care is amazing and just keeps getting better!)

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Within a week my stroller was delivered fully assembled in a teeny-tiny box. Yes, it folds that small! It weighs only 6kg! The material of the seat and canopy is of a good quality and looks stylish and neat. We chose the grey model and love the melange as it hides spills and spots! It is easy to clean with a wet cloth and after 2 months of use it still looks like new. The frame feels sturdy and there are not a lot of gadgets that can break. It comes with a carry-bag and a cup holder. We ditched the cup holder as it makes the stroller more bulky when folded.

The canopy has good coverage, it kept most of the seat dry during a European-rainstorm and it keeps the sun out of Eran’s eyes. There is also a peek-hole in the canopy which comes in very handy if you want to see if baby is asleep yet. The storage basket looks deceptively small, but it can hold a 6-pack 1 litre milk containers (or beer here in Belgium 😉) and the Ubuntu Baba carrier fits perfectly!

We could not wait for Daddy to get home so that we could all go for a “test-drive”. The stroller opens with a quick shake (possible with one hand) and Eran sits in it quite comfortably. He likes holding / chewing the handle bar, and it its possible to fold the stroller with this bar in place. You can change the seat position from upright to flat with one hand, but need a second hand to put it back to the upright position. It reclines to about 150 degrees which is more than enough for baby to take a nice nap. Eran is quite tall, so his feet does dangle from the edge when he is sleeping, but it does not seem to bother him at all.

Closing the stroller is a little bit more tricky, but after a few practise-tries you get the hang of it. Just make sure there is nothing in the storage basket and that the canopy is fully folded before attempting to close the rest. Unfortunately this is not a one-hand process. Once folded the stroller is really compact and easy to fit into most plane/train luggage racks or cupboards, keeping the isles clear and my house neat. There is also a carry-strap fitted on the stroller which has come in very handy when Eran is in the carrier and we have to hop from train-to-metro-to-bus quickly. We live on the second story with very small, windy stairs and no lift, so it is also very convenient to get the stroller in and out of the apartment.

The wheels are solid and handle all sorts of surfaces well. We have tested it on grass, dirt, tar, pavements, carpets, woodchips and tiles and it is really easy to steer with one hand. The handle bar is also quite high, which is an important point for us as we are a tall family. Even the Grannies and Grandpas where able to operate the stroller with ease.

This little stroller is packed full of punch and we have used it for much more than just travelling! It works well on shopping trips and saves a lot of boot space! The price also makes it perfect to have as a backup stroller in dad / granny’s car. (Most of the other travel strollers I was looking at retailed between R4000-R8000, the Banimal is currently on sale for R1899!!) It is now available online and in Baby Boom stores so you can look and feel and steer for yourself! I hope you enjoy it as much as I am.

 

Travelling to Europe with an (almost) 1yr old

“All you need to know is that it’s possible.” -Wolf, an Appalachian Trail Hiker

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So many many hours of planning, wondering, worrying, waiting, packing and packing again finally culminated on the 26th of August at OR Tambo airport when we could check in all our baggage and go through customs. We were on our way to Brussels Airport (via Dubai) for our one-year adventure in Leuven. We have travelled with Eran before, but never internationally, so this was a first for all of us.  Here are a few of the tips and tricks that made the journey enjoyable:

  • Pray, plan, pray! The moment we started dreaming about this adventure, we asked God to go ahead of us and open the right doors. It is so comforting to know that we can trust Him with the big plans for our life, but also with the little daily details. I spent many hours researching prams, carriers and blogs to get the best advice for travelling with a little (Thank you @thebugthebird and @stellarizeyourlife).

“Many are the plans in a person’s heart, but it is the Lord’s purpose that prevails.” Prov 19:21

  • Invest in a carrier. It is stressful enough to book in your luggage (we were overweight with 2 of our luggage pieces) and to go through customs (take off your belt, sometimes your shoes) without having to worry about how to get your baby safely through. With a carrier you have both hands free to manage your stuff, and baby stays nestled close to your heart. We LOVE our Ubuntu Baba carrier (currently using the Stage 2), we have used it on an almost daily basis and it is always with us as our first/last resort!

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  • We took a stroller. It made things easier when navigating the airports, and Eran could take his naps in there, giving me some time and space to also relax. It was very important that it could fold up tiny and steer comfortably with one hand. See my review for the Banimal Stroller in my next blog.
  • Timing is everything. We chose a through-the-night flight as we knew this would be the best way for Eran to sleep most of the flight. He fell asleep when we finally cleared customs, and he thankfully stayed asleep even through the chaos of take-off. (We boarded first to have time to settle ourselves before the masses streamed in). One thing we did not know, is that the bassinets are only issued after the seatbelt sign is switched off for the first time. Eran thus slept on my lap for the first hour. You also have to take the baby out of the bassinet every time they switch on the seatbelt sign (for turbulence inflight). This caused some interruptions in his sleep, but it is still nice to have the extra space to use as necessary.
  • Visit your GP / Pediatrician before you go. Eran had his One Year Check up just before we left, so I was confident that he did not have extra fluid build-up in his ears or any other issues that would bother him during the flight. I also asked his paediatrician (yes, even thought I am qualified, I strongly believe in not doctoring my own family) for something to help him calm down / sleep if it should be necessary. We took Vallergan Forte (an old, sedating type of anti-histamine), and we used it once when he woke up at 3AM in the plane. It helped him to calm down and then he could doze back to sleep.

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  • Breastfeeding saved me!! Even though his entire routine was upside down, a quick breastfeed could usually settle him and give him the comfort and reassurance that everything will be ok.

 

  • During our lay-over we booked into a lounge. It was lovely to have access to healthier food (there were a lot of fruit and vegetables and salads available at the buffet), and space for Eran to roam and explore. Eran tasted his first hummus and olives and loved it! He even made friends with one of the welcoming personnel, and the two of them had a lot of fun.
  • Our second flight was during the daytime. Eran took one nap during the flight, but the rest of the time we had to keep those little fingers and toes busy. Granny made a few Ziplock bags with activities / stickers / new toys to entertain him, and that really worked wonders! (Thank you for the idea @thebugthebird) We also had some rice cakes for him to chew on, and he ate from my plate for his meals.

So all in all we had a very blessed trip with minimal tears. We were all very tired when we finally reached Brussels and we were thankful to just fall into our beds at the hotel we booked into for the night.

Feel free to ask if you have any more questions and come back soon for a full review of the Banimal stroller.

Nine months in, Nine months out… a reflexion

35wekeI have carried our beautiful little boy for about 18 months now. The first 9 months he was underneath my heart, safely tucked away in my uterus, and the last 9 months he was in my arms, snuggled against my chest. It has been my favourite adventure in life thus far, but definitely also the most challenging. I used to thrive on stressful situations like exams and emergency situations in my job, coping through sleepless nights without needing any supplements (other than jelly-beans and pasta).    I felt almost invincible… but then I became responsible for another tiny human being 24/7 and I became fragile and unsure about myself. I realised that I am just as dependant on God as this baby is on me, because I cannot do it in my own strength. When I look back on the last 9 months, I am thankful to see how much I have grown as a child of God, as a wife, and as a mother. I would like to document and share some of the things I have learned in this process: to remind myself in difficult times to come, and maybe to motivate or help you too.

 

  • It is just a phase

When baby is having a difficult day, crying and clingy, has cramps or he wakes up every hour of the night, or he refuses to eat his food remember… it is just a phase! This too shall pass. Every baby goes through many developmental and physical growth spurts that upset them, but that is just the thing, they go THROUGH them. So next time you are in the middle of a tantrum / sleepless night just remind yourself that it will get better!

  • Treasure each moment

That first gurgling sounds, the first smile, the cuddles, the smell of his newborn skin, the sparkle in his eyes when he looks at you, the first time he rolls over / sits / crawls… there are too many to name! So take a moment and cherish that moment. Be present, put down your phone and just take a mental snapshot of his face, his laugh, the feel of his hand on your face.  Record as much as you can, because when you look back it all becomes a blur. I am thankful that I took weekly photos for the first 12 weeks, and thereafter monthly photos . Babies change and learn so much in the beginning, I am glad I had a plan to record it all.

  • It takes a village

Surround yourself with other moms! I always felt better after a visit with the moms who have babies of around the same age as mine. We talked about dirty nappies, feeding-times and naps without boring or irritating each other. We learned from each other and the “me-too” conversations answered many of my questions.

“Two are better than one, because they have a good return for their labor:  If either of them falls down, one can help the other up.” Eccl 4:9-10

  • Teamwork

My husband has carried me through the last 18 months! He is my hero! He cooked for us, did night shifts for baby and for work, encouraged and spoiled me, read up on important issues and remained the voice of reason when my emotions were out of hand. He loves our son soooo much, and that makes me love him so much more! It is such a privilege to share the good and the bad of this journey with him. I understand why God said it is not good for man to be alone!

  • It is a marathon

Unlike cramming for an exam, motherhood is not something that is “over” once your baby is born / is 6 weeks old / a year old… so pace yourself! Make sure there is someone to look after you while you look after your little one. Decide what is really important for you and your family and focus on that. It is so easy to get carried away by all the ideas on Pinterest or to try and look Instagram-worthy all the time!

“So get your breath back. Parenting is about decades, not days.” Kevin Leman, First-time Mom.

  • Information overload!

The world wide web is a dangerous place at 2am! Choose a few good sources (parenting guides, blogs, websites or family members), and stick with them. You will find a lot of contradicting facts and support for almost any approach to parenting, and this will only confuse your already tired mind! I love the Pregnancy Sense, Baby Sense and Weaning Sense books as they are written by professionals with a lot of experience, always explains their facts in a scientific way and have easy-to-follow plans. Even if I do not follow their schedules 100%, it helped me to have a practical guideline to fall back on.

  • I am not in control

I can try my best to keep to all the rules and awake times / meal times / make the right food / buy the best baby-gear but in the end our little baby will grow and develop at his own rate. Teeth will come on- or off-schedule and poo will surprise you time and again! When I realised I could let go and let God, a huge burden dropped from my shoulders. Yes, I will do my utmost to be the best mom I can be, but I have to surrender our son and his future into God’s hands where the things that I have no control over will be safe.

 

9months outI am so grateful for every lesson I have learned as a mother! (These are only the tip of the iceberg; it was a steep learning curve even for me who was supposed to know everything about children. Unfortunately we are taught very little about healthy babies when training to become a pediatrician). Reading up, experiencing things first hand and talking to other mothers have enabled me to improve as a mother and as a pediatrician!  I have so much more empathy and answers for the mothers I see in my practise.

My prayer is that I will continue to grow closer to God as I continue to learn and grow as a mother, and that I will be able to raise this little boy to become a man who loves and chooses to walk with Him. I look forward to the next 18 years of learning and loving and laughing!

 

*** This is not a sponsored post. See the links below to the books I spoke about above:

Pregnancy Sense

Baby Sense

Weaning Sense

** Pictures taken by my husband!

When your baby wants to be Peter Pan – weight gain problems

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Since our little baby was born I have been acutely aware of his weight. Initially we went for weekly weight checks at our baby-clinic to determine whether he was gaining well. It is one of the few ways to determine if he was getting enough breast milk. I even went to buy a bathroom scale (something we never had), so I could get an estimate of what his weight was. Over the last 7 months I have realised I am not alone. Many of my friends struggled with babies that did not gain weight appropriately, causing stress on different levels. Every mom wants to know that her baby is healthy and GROWING, and if it all depends on milk that you cannot even see, it is easy to fall into a negative cycle of slow weight gain – anxiety – decreased breast milk production – slower weight gain – add-on feeds – decreased breast milk production – insufficient weight gain and finally changing over to formula feeding all together.

* In the end I agree it is more important that you have a healthy, GROWING baby, and if formula is necessary to achieve that then please give it, but I am at heart a big breastfeeding-fan, so I would like to help you get over this hurdle without giving up on breast milk! 😉

“Growth is never by mere chance; it is the result of forces working together” –  James Cash Penney

So what is normal weight gain and when should you worry?

During the first few days of life it is normal for your baby to lose weight. This is due to all the excess fluids that you and baby retain during the last few weeks of pregnancy and can be exaggerated if you had an epidural / spinal with extra intravenous fluids during the delivery.  Another contributing factor is the volume of colostrum. This liquid gold is very concentrated specifically to give your baby’s kidneys time to get used to working with larger volumes of fluid. It is however important to make sure your baby does not lose more than 10% of his birth weight, and that he starts gaining weight again after a few days. A term baby should reach at least his birth weight by 7-10days of age, a premature baby can take up to 14days to get back to birth weight.

There-after the general rule of thumb for a healthy weight gain is 20-30grams per day (140-200g/week) for the first 4months.  From 4-6months breastfed babies tend to gain 90-120g/week and 50-80g/week from 6-12months. It is important to understand that these numbers are calculated from the average weights of a large number of healthy babies. This means that there were babies who gained more or less than these suggested weights and were still healthy. 1,2

 

“All children, except one, grow up.” ― J.M. Barrie, Peter Pan

 

Peter PanBefore you start weighing daily or weekly for the rest of your baby’s life… remember that growth over time is more important than one good or bad weight. That is why we use growth charts to keep track of your baby’s weight gain over time. We want your baby to follow the shape of the curve (whether he is above or below the “middle” line). This allows your individual baby (who might have very tall or petite parents) to grow within a healthy margin. We as health care practitioners start to worry when your child drops from the line where he used to grow to a lower curve (percentile), or if the weight stands still, causing a flat line on your curve. Once again this should be seen in context. Your little one might have had a bout of gastro just before the weight was taken, or he might have a chronic disease or syndrome where we expect him to grow slower.

If you are worried that your baby is not gaining weight, take a step back and look at some of the other indicators that your baby is getting enough milk and is growing. Is your baby having 4-6 wet nappies per day? How many dirty nappies per day? (The stool frequency can change after 6 weeks, but before that there is usually a minimum of one stool per day). Is the length- and head-circumference measurements increasing? I have seen many babies have a growth spurt in length before the weight catches up. If your baby’s head is growing in circumference, it means his brain is getting enough calories to grow. Is it the same scale that was used previously? Is the scale calibrated?

If your health care provider is also worried about your baby’s weight gain, they should ask a thorough history, do a good clinical examination and appropriate special investigations to understand why baby is not growing well. The underlying cause is usually due to a lack of provided nutrients (baby is not latching well or has started sleeping through the night and is now missing out on calories previously provided by the night feeds), or due to a problem in the absorption of the nutrients provided (severe reflux and vomiting, allergies, certain metabolic diseases), or due to an increased use of the nutrients (acute or chronic diseases, congenital abnormalities).

It is important to understand the cause so that the treatment can be directed in the right direction. It does not help to only give supplemental feeds when the problem is that the baby is not absorbing any of his feeds. Regular follow-ups with your health care provider is very important until your baby gains weight sufficiently again.

Weight is an indicator of wellness over the last few weeks, while length shows us the wellness over months and years. If a baby does not grow well for a prolonged period of time, it may lead to him not reaching his full potential in height and other areas of his development.  There might be complications of specific vitamin and mineral deficiencies and ultimately permanent damage to the brain. Early identification and treatment may help to prevent long-term complications.3

There is a handy app that you can download to your tablet or cellphone to keep track of your baby’s growth. It helps you keep track of the weight, height and head circumference, and will also show you the child’s weight-for-length (a handy measurement that shows overall wellness).

http://get.growthapp.net/ for Iphones

https://play.google.com/store/apps/details?id=com.abqappsource.childgrowthtracker for Android.

I hope your baby will grow and GROW and GROW! 😉

We continually ask God to fill you with the knowledge of his will through all the wisdom and understanding that the Spirit gives,[a] 10 so that you may live a life worthy of the Lord and please him in every way: bearing fruit in every good work, growing in the knowledge of God, 11 being strengthened with all power according to his glorious might so that you may have great endurance and patience. – Col 1:9-11

 

Photo’s from Google Images

  1. https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/infant-growth/faq-20058037
  2. World Health Organization Child Growth Standards, 2006
  3. Perrin E, Frank D, Cole C, et al. Criteria for Determining Disability in Infants and Children: Failure to Thrive. Evidence Report/Technology Assessment No. 72. AHRQ Publication NO. 03-E026. Agency for Healthcare Research and Quality, Rockville, MD, March 2003.

The oral thrush episode…

One of my biggest mom-fails/pediatrician-fails to date must be the episode with the oral thrush…

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‘Love never fails’ 1 Cor 13:8

I still feel really red-in-the-face when I tell this story, but it is important to share. I think we all try our very best as moms to do only what is best for baby, but sometimes the sleepless nights and hormones overwhelm us and then we need our support system to keep us on track. It is also important to know that as a pediatrician I also want what is best for your child, but we are only human and can make mistakes.

At about 3 weeks old I noticed that our baby boy’s tongue had a white patch on the middle of his tongue. I did not think much of it as we have been giving him white, crushed “Magnesium Phosphate” tablets for cramps before each feed and that left a white residue everywhere. I did not notice that the white patch became thicker and larger. At our next weigh-in the sister asked me if I saw that my baby has oral thrush… I immediately objected and told her about the tablets, but she was wise enough to show me that you cannot remove this patch with a tongue-spatula, and that it was indeed oral thrush. I was very upset, not only because my poor baby had a problem, but also because I realised that the pediatrician-me missed a very easy diagnosis! Luckily I have a very supportive husband who quickly calmed me down and reminded me that I am Eran’s mother, not his pediatrician, and as such I do not need to make diagnoses on him, I only need to love him and care for him.

Let me tell you a little bit more about oral thrush:

oral thrushIt is caused by a fungal organism (mostly Candida Albicans)1 and presents as white patches on your baby’s  tongue, cheeks and palate. This white patch cannot be easily wiped off with a washcloth as a milk-patch would be, and if it is removed it might bleed. It can be asymptomatic, but it can also cause a burning sensation in your baby’s mouth or be painful and prevent baby from drinking well.

 

It is very common in babies under one month of age, and can also affect children/adults with a defective immune system. Candida is a fungus that normally resides in your mouth/other mucosal areas together with other organisms we call “flora”, and that all form part of your microbiome. When the balance between these organisms are disrupted, then you get an overgrowth of the Candida which then causes thrush. We started washing Eran’s dummies in Milton when he was 2 weeks old, and I think this wiped out all the “good” flora in his mouth, leaving ample space for the Candida to thrive.

The infection can spread to the mother’s nipples (presenting as very red, tender or a burning sensation of the nipples, or it can cause a red ring to form around the areola), and then can spread back to the baby, so it is very important to treat both the mother and the baby. The baby also swallows the spores, and thus the infection can easily spread to the buttocks where it presents as a red rash that does not improve only by using barrier creams, affects the skinfolds and scrotum, and may have red satellite lesions.

Specific treatment with an antifungal (usually Nystatin drops or Miconazole oral gel) aims to kill the overgrowth of Candida in baby’s mouth and on the mother’s nipples. There are many more “natural” ways to regain the balance in your baby’s mouth, but these should only be used in mild cases, and if it does not resolve, rather get an antifungal. We used a mixture of 1 cup cooled boiled water, ½ teaspoon salt and ¼ teaspoon Bicarbonate of Soda to create a more alkaline environment in which the Candida cannot grow, and then we applied Miconazole gel after every feed. Within 3 days the patches improved dramatically, and within 5 days it was totally cleared up. It is important to continue using the medication for 7-10 days to make sure the Candida does not take over again.

Other measures to ensure there are no more infective spores around baby, is to wash your bras / pajamas in hot water and to properly boil / sterilize his dummies / bottle teats.

Hopefully you will do better in noticing this condition in your baby than I did… Luckily it is not a very serious condition, but we don’t want anything making breastfeeding harder than it already is in the beginning, so rather sort it out asap!

“Even on the days you feel like you are failing, look around, I promise your kids still think you are the best mom in the whole UNIVERSE.” Julie Clark, Motivating Mother

 

 

Photo’s courtesy of Pixabay and Google Images

  1. https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html