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Pediatrics/My 5month 11 days old son doesnt poop regularly

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Hello Doctor,

 Pleaseeeeeeeee help..

I am working mother of 7.5 kg baby boy ...his birth weight was 3.5 kg...i lil worried about his weight gain ...but as per my local pedictrician he is healthy and weigh satisfactory.

As i started working when he was 2.5 months...i still kept him on exclusive brestfeed for 3 months (I express milk). but as per doctor i consult, she asked me to start introducing some liquid and semisolid from 3rd month onwards. i followed her instruction and started with Orange juice and rice porridge and alternate day baby banana only ONce in day and other meals were breatmilk. I have reservation towards formula feed.my doc also supports me . as I have enough milk supply never bothered aboutformula feed. My son loves to eat external homemade healthy fod as mentioned above. Banana is his favraite. but as v started within a week he started pooping almost after 2-3 days (he was regular whn exclusive on beartfee.One more thing he have gas problem right from birth as v need to burp him well and he passes gas too.). my nights became sleepless as he was experiencing stomach ache and gas was not escaping fine. his poop became green color. after seeing his pain . i stopped external food completely and put him exclsively on breast milk again for another month. after that I started with one meal of moong dal (with astiphoide, termeric, salt) and rice water (with temeric and salt) alternate day respectively( No juice) when he was 4.5 momths, and regularly giving him grip water 2 ml morning and evening (suits him well), 20 ml water and breat milk. He was pooing good, only once in week used to laps for a day but used to poop good next day. No sever gas problem. but rcently when he turned 5 moth my mom in law started giving him one meal of lil moong mashed with dal water and rice ticker one, the consistency of food became thicer and thicker as he do not like too watery food, around 30 -50 ml water as per his need, orange juce around 20 ml (with sugar) or banana ( 1/3 to 1/2 baby banana) everyday. he used to poop but I noticed his poops are no longer watery . they became  like paste (less watery) and he started exerting pressure to poop. he started lapsing a day twice in week. still he used to poop good amount and was at ease.  but since from last 2 days he dd not poop. and saw him exerting lot of pressure to poop but nothing happening. his urine became yellow and frequency of passing became less (he is peeing at long interval in large quantity). he is passing gas but no poop.

I am worried about less frequent urination and poop as he is experiencing stomach pain today.

Please help.

Answer
Hi Daks,


It is so good that you are continuing breastfeeding inspite of being a working mother! Congratulations!


And pleeease Relax! There is nothing to worry!!

His weight is good for age. Trust your pediatrician.

"Gas" is NOT a problem in babies It is NORMAL.

Avoid Gripe water: It is of no use; will make stools hard.

Don't worry about frequency of stools. Just avoid gripe water. Even if baby passes normal stools once in 5-6 days, it is NORMAL.

Following write-up would be of help in deciding about "complementary feeding" that you need to give in addition to breast milk.


Following are the general guidelines on infant feeding in addition to milk (complementary feeding):

1. There is no doubt that breast milk is the best for a baby and one should not switch to any other milk. Complementary feeding is started, while continuing breastfeeding as before.

For preparing cereals like suji-kheer etc, you can use small amount of toned milk. However, make sure that the final consistency is paste-like and not liquid (see below for details).

2. Whatever is given has to be semi solid (thick paste consistency), rich in fat (ghee/ oil) and very little added sugar and salt and almost no spices. The idea is to give condensed food: small in volume (as baby's stomach capacity is small) but high in calories (since baby has to grow fast). Liquids like daal paani, fruit juices, soups etc. fill baby's stomach easily but do not provide enough calories. Instead, baby should be given thick dal (with added ghee/butter), mashed fruits and vegetable puree.

3.Commercial infant formulae like “Cerelac” provide only one advantage: that they are easy and quick to prepare. They are ideal when baby suddenly demands food or during travel etc. Otherwise home-cooked food is much better: it has no preservatives, and baby does not need transition from "infant food" to home food at a later age and is used to all that you eat from a very early age. Still, if one wishes to use infant formula, it comes in various stages, as you know: stage-1, 2, 3 and 4. You have to stat from stage-1 and gradually move to stage 4 over several months. In stage 1, usually there are 2 variants: Rice and Wheat-Apple. One needs to start from Rice and then move to Wheat-Apple.

4. The food items which are usually started are: Moong-dhuli Dal with added ghee (NOT daal paani), Moong-dhuli daal  and rice gruel (khichri) with added ghee, suji-halwa (sweet or saline) rich in ghee, mashed banana, other fruits in mashed form (mango, papaya, melon, water-melon: practically any fruit without seeds in mashed form (NOT juices). After a few days, roti( mashed) can also be started. Move to paratha in next few days. add vegetables in paratha/ rice gruel/ suji. Jaggery (Gur) can often be used in place of sugar, as it is rich in iron.

5. Amount and mode of administration: Breast feeding is continued as before. In between two feeds, small amount (1/2 to 1 spoon only) of above food items are offered. gradually amount is increased as the baby's acceptance improves. As baby's solid diet increases, the interval between breast feeds automatically increases.

6. All babies require iron supplement from 6 months to 12 months of age. Please consult your doctor regarding the brand and dose according to weight.


Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India

www.KumarChildClinic.com

+91-9818356846

Pediatrics

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Dr. Puneet Kumar

Expertise

I would be happy to answer general queries on prevention and treatment of ailments in newborn, infant, toddler, child or an adolescent. Needless to say, it will not be possible to answer any query requiring specific diagnosis of a particular subject.

Experience

I have worked in various capacities (medical officer, resident, senior resident, consultant) in public as well as private sector in Pediatrics and Neonatology. Today, I have over 15 years of experience in the field.

Organizations
Currently, I am running my own clinic (Kumar Child Clinic) in Dwarka, New Delhi and am attached to Lifeline Hospital, Dwarka as consultant pediatrics and neonatology. I am also developing my clinic website into a comprehensive child health/ parenting website (http://www.kumarchildclinic.com)

Publications
(a) Chapter "National Immunization Schedule" in Frontiers of Social Pediatrics, Jaypee Publishers: 2nd edition, 2016. (b) Article, "All about Pertussis vaccines" in special issue of Indian Journal of Practical Pediatrics, July-Sept 2015 (c) Three chapters (DTP vaccines, Pneumococcal vaccines and Poliovirus vaccines) in "Textbook of Pediatrics for Post-graduates" First edition: 2015. (c) Chapter: "Alternative delivery methods of vaccines" in IAP textbook of Vaccines, First edition, 2014 (published by IAP/ Jaypee Brothers) (d) Special Article: "50 years of Immunization in India: Progress and Future" in January 2013 issue of Indian Pediatrics (e) Four chapters in "FAQ: Book on Vaccines and Immunization Practices" First edition, 2011 AND 2nd edition, 2015 published by Jaypee Brothers. (f) Three articles in special issue of Journal of Pediatric Sciences on “Controversies and Challenges in Pediatric Vaccination Today" in Sept, 2010. Co-edited the series also. http://www.pediatricsciences.com/issue/view/1050000010 (f) Regular column, “How do I treat” in Pediascene (www.pediascene.com) (g) Review article, “Role of Anti-Poliovirus Agents in Polio eradication and beyond” in Polio Pulse, April, 2008. (h) Chapter on “Acute Infectious Diarrhea” in Textbook of Infectious Diseases in Children. (An IAP Publication), 2007. 2nd edition in 2011. (i) Book-Review (IAP Pediatric Drug Formulary, 2004) in Pediascene, March 2005 (http://www.pediascene.com/page.php?cid=6&catid=9&id=132 ) (j) Case-report on Osteopetrosis. Jharkhand Journal of Pediatrics, Dec-2002.

Education/Credentials
After MBBS, I have done DNB residency in Pediatrics.

Awards and Honors
Winner of IAP practising pediatrician's quiz in 2001.

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