Adding complementary food causes constipation, what can be done more reasonably?

This is the 3668th article of Da Yi Xiao Hu

Parents often ask me during outpatient visits: Doctor, my 6-month-old baby's stool becomes dry after he started eating complementary foods. Sometimes it takes 3 days to defecate, and the baby cries a lot. What should I do? Can I use enema? Can I take lactulose for a long time? Will it be bad for the baby?

It is more important to keep calm when it comes to babies. Is it "real constipation" or "strange complementary food"? Let's recall the baby's usual defecation behavior and make a careful judgment:

1. Difficulty in defecation ≠ constipation

The difference between difficult defecation and constipation in babies is similar to the difference between adults being "overwhelmed when just taking on a job" and "unable to do a job". Difficult defecation means that the baby is not familiar with the "defecation" business, while constipation means that even after efforts such as bowel training, the baby is not able to face the workload of "defecation".

1. Difficulty in defecation

In addition to using many muscles when defecating, people also have to go through a complex and precise series of processes to expel feces from the body. After adding complementary foods, there are more food residues, the workload of the intestines increases, and it is more likely to have difficulty defecating. When the baby twists and turns during defecation, the little face turns red, and it seems very strenuous, but the stool is not dry, but soft. In this case, it can only be said that the defecation is difficult, because the baby's ability to mobilize various muscles and the physiological functions of coordination are not yet mature. The good news is that this kind of defecation difficulty can be relieved by itself as the baby continues to grow, just like facing a job that becomes handy after becoming more familiar with it, so we might as well give the baby more patience and "self-training" time, which will also help reduce our own anxiety.

2. Constipation

Do other people's babies also have constipation? Constipation is divided into many categories. 90-95% of infant constipation is "functional constipation". It is reported that the incidence of functional constipation in infants under 1 year old is 2.9%, and the incidence in children aged 1-2 years old is as high as 10.1%. Combined with the Rome IV standard for functional constipation in children announced in 2016, we can make some simple judgments in daily life: when the baby twists and turns during defecation, the little face turns red, and it not only looks very strenuous, but the stool is dry and hard, or granular, or even bloody. In severe cases, the baby may cry and refuse to defecate because of the pain of defecation, then it can be judged that the baby is constipated.

After determining whether the baby is constipated, let's determine whether the addition of complementary food is really reasonable:

2. Adding complementary food ≠ adding reasonable food

Many parents are able to add complementary foods to their children 4 to 6 months after birth. They have tried various big-name complementary foods, but the results are not ideal. Adding complementary foods should be like shopping - only "add" the right ones, not "add" the expensive ones:

1. Principles

The principle of gradual complementary food addition from less to more, from thin to thick, from one to many is familiar to all parents. If you encounter a situation where your baby is constipated even after enriching the types of complementary food, it may be:

2. Add fiber to your baby's diet because you're worried about constipation? You forgot to add "refueling"

When we adults have constipation, we immediately think of "eat more fiber-rich vegetables". Is it feasible to take adult measures for baby's functional constipation? Stop! This is not necessarily the right way of thinking. What if the baby's entire diet is mainly composed of plant paste, such as rice paste, potatoes, pumpkin, apples, broccoli, pears, etc., and fiber foods are added, but it still cannot effectively moisturize the intestines? Adults know to add oil when cooking, and don't forget to add 5 to 10 grams of vegetable oil rich in α-linolenic acid to baby's complementary food. It can not only directly moisturize the intestines, but also allow the decomposition products of oil to stimulate intestinal peristalsis, which can kill two birds with one stone. Flaxseed oil and walnut oil are both good choices. Don't wait until the baby's face turns red due to constipation to shout "Come on".

3. Don’t pay attention to hydration after adding complementary food? Don’t forget the power of “water army”

Calculate, the amount of liquid that babies over 6 months old need to consume every day = 150-200 ml/kg × baby weight (unit: kg), including the amount of liquid consumed from breast milk, formula milk and complementary food. Many parents think that the complementary food added by the baby contains water and ignore the additional water intake. In fact, in addition to the baby's daily needs for breast milk, formula milk and complementary food, the baby should also drink some boiled water to ensure that there is enough water to soften the stool.

3. Should I use enema, lactulose or honey?

1. Enema

It is recommended to use it only for a short period of time. Using enema is always a temporary solution, not a permanent solution, and dependence should be avoided. Parents can try using enema when the baby is severely constipated, or apply baby lotion on their fingers and stimulate the baby's anus to stimulate a defecation reaction.

2. Lactulose

Only short-term use is recommended. Lactulose is a safe and effective drug for treating constipation. It is a synthetic disaccharide. Like enema, it only treats the symptoms but not the root cause. It should be noted that taking lactulose directly has a bad taste and poor efficacy, or even no efficacy at all. The correct way should be: add an appropriate amount of lactulose to water or beverages, stir thoroughly to dissolve, and drink it on an empty stomach. It is best to drink plenty of water after drinking it.

3. Drink honey and eat bananas?

It is not recommended for babies under 1 year old to drink honey. The botulism spores in honey can easily cause food poisoning. It is also not recommended for children to drink honey to avoid premature development.

In addition, you may want to eat laxative fruits such as apples and pitaya instead. Unripe bananas contain tannic acid, which not only cannot promote defecation, but may also dry out the stool and aggravate constipation.

In the eyes of parents, eating, drinking, defecating, urinating and sleeping are all important to the baby. Pay attention to training the baby's bowel habits, pay attention to the addition of fat, water and fiber food in complementary food, urge the baby to exercise properly, or help the baby rub the abdomen clockwise, which will help the baby avoid defecation difficulties. When you are unsure, you should seek medical treatment in time and seek the judgment of professionals. Don't believe in folk remedies, so that the baby will suffer less and parents will feel more at ease.

Author: Yuan Ying, resident physician and master’s student at Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.

Editor-in-chief and tutor: Shen Jian, chief physician of the Department of Pediatrics, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. Doctor of Medicine, master's supervisor. National backbone talent of TCM innovation in the "Hundreds of Thousands" talent project of the Central Administration of Traditional Chinese Medicine Inheritance and Innovation. The popular science monograph "The Wisdom of Traditional Chinese Medicine that Good Mothers Should Know" won the 10th Healthy China Forum and the first annual outstanding popular science work award.

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