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Breastfeeding

Diet Therapy of DiseasesWomen’s Health

CONSTIPATION IN EXCLUSIVELY BREASTFED KIDS

As a first time mother and a health practitioner, on being pregnant, I had already decided to exclusively breastfeed my baby for 6 months and continue thereafter with alongside complementary feeding because I was a nutritionist right? I had to ensure I practiced what I preached. Many experiences and drama trailed my journey to motherhood. My very first battle was with constipation.

Knowing that I was exclusively breastfeeding I became even more worried because there was little or nothing I could do to help my bundle of joy because she was to be on breast milk only for the next 6 months. Nope, maternal instinct kicked in and I knew I had to do something! Below is what I gathered from the experience.

constipation

What is Constipation?

Constipation could mean various things to different people. For some people, it means infrequent passage of stool (feces), to others; it means hard stools, difficulty in passing stool, or a sense of incomplete emptying after a bowel movement. According to the National Institute of Diabetes and Digestive and Kidney Diseases, constipation is one of the most common digestive problems in the United States, affecting around 42 million Americans and is not uncommon among infants.  Constipation is a common problem that affects both all ages irrespective of race.

Causes of Constipation        

Often when a child is constipating, there is infrequent bowel movement and most times the stool is hard, dry and painful to pass.

Causes of constipation in infants include:

  • Withholding stool: This happens when a child is trying to hold his bowel movement in, due to some reasons such as stress about potty training, or not wanting to use the rest rooms in certain places (like in school), or pains while stooling.
  • A low fiber diet.
  • Side effects of certain medications.

 

Signs and Symptoms

Understanding the signs of constipation can help you detect a potential issue before it becomes a big problem.

  • Infrequent bowel movements: The number of bowel movement of a child will reduce as to the normal frequency during constipation, sometimes during the period of trying new foods which the body seems to find different from the “usual”, sometimes may cause constipation
  • Blood in the stool: If you notice streaks of bright red blood in your child’s stool, it is likely a sign that the child is pushing too hard to have a bowel movement. Pushing and passing out a hard stool may cause tiny tears around the anal walls, which can result in blood in the stool.
  • Refusing to eat: Child may feel full quickly or refuse to eat while constipating.

What Can You Do?

If you notice signs of constipation, you can try several strategies to offer your baby relief. These strategies include:

A high-fiber diet: Your child’s plate should be teeming with fresh fruits and vegetables, high fiber cereals, whole grain breads and a variety of beans and other legumes can be very helpful. Foods containing probiotics like yogurt can also promote good digestive health. If your child does not like fresh fruits much, you could try pureeing/blending it or adding them to certain meals to encourage acceptance. Besides, adding fruits and vegetables to your child’s diet early in life helps build healthy eating habits later in life.

Switch up the milk: If your baby is breastfed, you can try adjusting YOUR diet. Baby may be sensitive to something you are eating, which could be causing the constipation, though this is uncommon. Bottle-fed babies may benefit from a different type of formula (which are rich in fiber), at least until the constipation clears. Sensitivity to certain ingredients can cause constipation.

Use solid foods: Although certain solid foods can cause constipation, but others could improve it. If you recently started feeding your baby solid foods, try adding a few high fiber alternatives, such as: broccoli, pears, prunes, peaches, skinless apple. Instead of refined cereals or puffed rice, offer cooked grains, such as barely or brown rice. Whole grain breads, crackers and bran cereals also add a lot of bulk to stool, which may help clear the constipation. Beans and other legumes provide soluble fiber which cause stool to move through the body faster.

Use pureed or mashed foods: if your baby is over 6 months and has not made the transition to solid foods yet, try some of the foods listed above in their pureed form. Keep in mind that fruits and vegetables have a lot of natural fiber that will add bulk to your child’s stool. Some are better than others at helping stimulate a bowel movement.

Up the fluids:  Proper hydration is essential for regular bowel movement. While focusing on fiber, don’t forget fluids. Water is great for keeping your baby hydrated. If your child is eating plenty of high fiber food but not getting enough fluid to help flush it through the digestive tract, it could make matters worse. There should liberal intake of water, soda and sugary drinks should be limited. Usually breastfed babies get enough fluid from the breast milk. However, infants from 7-12 months need about 0.8 L/day of fluid and children of ages 1-3 require 1.3L/day.

Encourage exercise: Movement speeds up digestion, which can help move things through the body more quickly. If your child is not walking yet, bicycles and play dates would be helpful.

Massage: Gentle stomach and lower-abdominal massage stimulate the bowel to pass a bowel movement. Do several massages throughout the day, until your child has a bowel movement.

Regular Toilet Time: Encourage your growing child to use the toilet first thing in the morning. Particularly for a younger child, you may get better results by telling, not asking. Instead of suggesting, “Do you need to go to the bathroom?” Simply say, “Time to go to the bathroom”.

Conclusion

Because breast milk is quite nutritious, sometimes a baby’s body absorbs almost all of it, leaving little or nothing to move through the digestive tract. Your baby may poop only once in a while—it is perfectly normal for breastfed infants to have a bowel movement once a week. Other infants just have a slower (but completely normal) gut, so they don’t go very often. But if your baby seems to be in pain, or you have any complain, call your doctor or dietitian. In rare cases, a medical problem could cause lasting, severe constipation. For kids that have progressed to eating solid foods very well, encourage them to consume more of high fiber foods and to take enough water.

 

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CHALLENGES OF INFANT FORMULA FEEDING

Formula Feeding Challenges

There are some challenges to consider when deciding whether to feed. Okay this is purely to inform and not to castigate or dissuade. So please do read with an open mind.

Lack of antibodies:

None of the antibodies found in breast milk are in manufactured infant formula. The abundant immunoglobulins which are essential for building baby’s immunity are absent in formula. So formula can’t provide a baby with the added protection against infection and illness that breast milk does.

Can’t match the complexity of breast milk:

Manufactured formulas have yet to replicate the complexity of breast milk, which changes as the baby’s needs change.

Planning and organization:

Unlike breast milk — which is always available, unlimited, and served at the right temperature — formula feeding baby requires planning and organization to make sure that you have what you need when you need it. Parents must buy formula and make sure it’s always on hand to avoid late-night runs to the store. Also it’s important to always have the necessary supplies (like bottles and nipples) sterile, easily accessible, and ready to go — otherwis, you will have a very hungry, very fussy baby to answer to. With 8-10 feedings in a 24-hour period, parents can quickly get overwhelmed if they’re not prepared and organized.

Expense: Formula can be costly.

Powdered formula is the least expensive, followed by concentrates, with ready-to-feed being the most expensive. And specialty formulas (such as soy and hypoallergenic) costing more — sometimes far more — than the basic formulas. During the first year of life, the cost of basic formula can run into tens of thousands of Naira.

Possibility of producing gas and constipation:

Formula-fed babies may have more gas and firmer bowel movements than breastfed babies.

How do you make up for this?

Well, if you absolutely have to formula feed, here are some guidelines to making sure your child is getting the most available. Formula feeding poses immune and neurological drawbacks but there are strategies you can take now to improve your formula-fed baby’s health. These factors can have a life-long impact on your child’s overall health.

Consider hydrolyzed milk formula:

The best choice for a first formula may be a hydrolyzed milk formula, especially if any kind of allergies exist in the family. Cow’s milk proteins are large and difficult for young babies to digest, and are highly allergenic. In hydrolyzed formulas, the proteins are broken down into smaller, more tolerable pieces (lysis).
Many of the potential problems with milk intolerance can be avoided by using one of these hypoallergenic formulas from the beginning. Often, small but regular intestinal bleeding occurs in formula-fed infants (or breastfed infants not tolerating cow’s milk proteins in mother’s diet), even when dairy intolerance is not suspected. This common occurrence is usually undetected but can lead to anemia. It may be preventable by simply beginning with hydrolyzed formula for the first months of life, when formula is necessary.

Hydrolyzed formulas do not taste as good to infants who have tasted other formulas. Therefore, it’s sometimes difficult to switch to a hydrolyzed formula once you’ve begun with regular formula.

Some babies still react to the traces of intact proteins in these. There are alternative formulas made with only amino acids (the protein building blocks), but they’re very expensive. These formulas (Neocate AA, Nutramigen AA) are even more hypoallergenic and are good choices for the very allergic, formula-fed baby (although they still contain trace corn proteins).

Some mothers are erroneously told they should feed hydrolyzed or amino acid formula to their infant who is breastfeeding and is intolerant of dietary proteins in mother’s milk. This advice is absolutely wrong. A food-intolerant baby will fare far better on mother’s milk while mother avoids dairy and any other problematic foods in her own diet.

Don’t avoid lactose:

Many are mistaken about lactose tolerance when it comes to babies. Lactose is baby sugar. It’s available only in the milks of mammals to provide for their offspring and it provides valuable immune-protective properties and more importantly energy.

A baby born with the extremely rare defect causing total inability to digest lactose quickly suffers brain damage and would not survive prior the rather recent development of lactose-free infant feeds. It is, however, common for an infant reacting to cow’s milk proteins or recovering from some other intestinal irritation to suffer a temporary reduction in lactase enzyme, needed for lactose digestion. This may cause some babies to test positively for lactose intolerance via laboratory assessments. While these babies may appear to fare slightly better with lactose-free formula, this condition will reverse as soon as a child recovers from illness or is given a feed without cow’s milk proteins or other problematic proteins in it.

Use acidophilus:

Formula-fed infants develop adult-type flora in their intestines. These flora are part of the cause of formula-fed babies’ increased incidence of intestinal illnesses. Providing a daily dose of friendly bacteria (the kind found in yogurt) may help to maintain a gentler flora for baby. Don’t give your young infant yogurt though. Instead, provide a twice-daily dose of a good quality powdered or liquid combination of Lactobacillus acidophilus, Bifidobacterium, and some other good bacteria. You can add the powder directly to the formula when preparing it (after warming), or place drops of the liquid directly in baby’s mouth. Store these friendly bacteria, known as probiotics, in the refrigerator.

Formula companies are currently studying the addition of probiotics to store formulas. They have been found to be safe for infants and to possibly reduce colic and diarrhea, although occasional constipation has been reported with probiotic-fortified formulas. Daily use of probiotics may reduce your baby’s potential for developing allergies, as formula-fed babies have a greater risk.

Consider DHA and ARA:

There has been much research lately in regards to certain fatty acids known as DHA (docosahexaenoic acid) and ARA (arachidonic acid), important nutrients for brain and vision development. These long-chain polyunsaturated fatty acids found in breast milk have traditionally been very low in infant formulas. It is known that babies are able to make their own DHA and ARA, but it has been found that they are unable to create optimal amounts. This discrepancy explains in part the slight neurological and visual deficits linked with formula feeding. Studies show some possible visual and cognitive benefits when these fatty acids are supplemented in formula-fed infants. Several recently released studies and ongoing studies are working to find the optimal levels and forms of these to add to infant formulas.
Study results so far are mixed but mostly positive. Oxidation of these fatty acids during storage may be a problem and may account for some of the mixed results. Some infants experience diarrhea from these formulas. The chemicals used in the extraction process are under scrutiny today. Fresh forms of these fatty acids might be more beneficial to infants. Some consultants are recommending adding these directly to infants’ diets. Cod liver oil is an excellent source of DHA and ARA, as well as EPA, another important fatty acid. An eighth to a quarter teaspoon per day may be appropriate for a small infant. Vegan DHA supplements are available as well.

ARA, DHA and EPA are found only in animal sources.Egg yolk is an excellent source for babies, but it’s not something to give newborns. Some nutrition consultants suggest providing one rinsed yolk plus a teaspoon of cod liver oil daily after 4 months. Since egg white is the part of eggs that can cause allergy, you should avoid using them with infants. Cod liver oil may loosen the stools.

Keep formula in the diet for 18 months :

Studies show that children fare even better when infant formula is continued in the diet for 18 months or more, rather than switching to straight cow’s or goat’s milk, or other drinks at one year. “Follow-on” formulas are just cheaper versions of infant formulas. They contain more calcium only because they have not replaced as many cow’s milk ingredients with the more-balanced nutrients put into infant formulas.

Consider avoiding the vitamin K injection:

Babies are purposely born with low levels of vitamin K, which is meant to increase gradually through feedings of breast milk, which is deliberately “low” in vitamin K. This tightly managed vitamin K level controls the rate of cellular reproduction. When infants are injected with the huge amount of vitamin K routinely given at birth, cellular reproduction may be allowed to get out of hand. Some very slight increase in leukemia cases is associated with these injections, and there are other very rare complications as well.

On the other hand, serious damage from a rare bleeding problem may be prevented by vitamin K injections at birth. A baby born with an undetected liver disorder can suffer damaging or fatal bleeding into the brain, and the clotting action of added vitamin K can reduce this bleeding.

Studies have shown that breastfed babies can be supplemented in smaller oral doses spread out over the first weeks of life and still safely avoid this rare but dangerous bleeding complication. Formulas are already supplemented with much higher levels of vitamin K than are natural or proper. Studies suggest that this gradually supplemented amount of vitamin K is adequate to prevent bleeding problems, negating the need for routine injection at birth in formula-fed babies. All babies need to be watched for signs of liver disorders, including advanced jaundice, or pale colored stools.

Take immuno-protective measures:

Because formula-fed infants miss out on the daily provisions of immunities and chemical defenses from mother’s milk, you should do all you can to assure your baby gets the best possible dose of antibodies from your body before birth. The greatest portion of these immunoglobulins are pumped into the newborn’s body during labor. A child born via scheduled cesarean section misses out on labor and its last-minute provisions unfortunately. Even when a C-section is recommended, natural labor can often be allowed to happen first, giving your baby a big, important immunity boost.

A maternal diet high in antioxidants from fruits, vegetables, and nuts, can provide baby with good stores of antioxidants before birth. These stores can help for a while with some of the oxidizing effects of infant formula. A little liquid vitamin C may be added to formula to provide some extra antioxidant protection to formula-fed babies.

Newborns are more susceptible to illness when not receiving an exclusively breastmilk diet. The first weeks of life are the most dangerous. Simply keeping your baby close to home and screening visitors for any illnesses can help a great deal. Visitors should wear a snug mask if they’ve recovered from a virus less than 3 days prior to their visit.

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Premature Milk:

Mothers of premature babies produce breast milk that is slightly different in composition, at least for the first several weeks, and this difference is designed to meet your baby’s particular needs. The premature milk is higher in protein and minerals, such as salt, and contains different types of fat that she can more easily digest and absorb. The fat in human milk helps to enhance the development of the baby’s brain and neurologic tissues, which is especially important for premature infants. Human milk is easier for her to digest than formula and avoids exposing her immature intestinal lining to the cow’s milk proteins found in premature infant formula. Premature babies who are breastfed are less likely to develop intestinal infections than are babies who are formula-fed. The milk you produce in the first few days contain high concentrations of antibodies to help your baby fight infection. Even if your baby cannot breastfeed yet, expressing breast milk from the beginning will ensure that your milk supply is maintained until your baby is able to nurse.

Where possible please stick to the natural breast milk.. Its benefits far outweigh formula.

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