Slightly losing my mind - 6 month old constantly straining to poo

[bibette]

Hi all - has anyone experienced similar with their baby? DD is six months old, EBF, and still has around 6 dirty nappies a day. A lot of the time she seems to have to work really hard to pass them.

In the day she tends to make out like she wants to feed, but when it comes to it she will just wriggle around latching on and off until she's filled her nappy, then she relaxes and comes off. Similarly at night, unless she's fast asleep, as soon as I put her down, she'll start whining/straining (not crying as such) and is only placated if I pick her up and put her on the breast. There she seems to fall asleep within minutes but wakes up again if I put her down and starts the straining/whining noises. At some point around 7/8am she might fill her nappy and then settle a bit more easily.

I really want to get to the bottom of it to stop any unnecessary discomfort to her. Also, on a selfish level, the lack of sleep is getting to me. Except for an inexplicably great period between around 3-4 months where she would get a solid 5-7h stretch in each night, the best I'm getting is a few slots of 30mins to 1.5h per night where I don't have to hold/feed her.

GP wondered about CMPA but I went dairy free about 3/4 months ago and whilst the nappies seemed to get a bit less foul smelling/green, the discomfort is still there.

As we speak we're stuck in another cycle of her having fallen asleep at the breast, only to start whining/straining the second I put her down.

Thanks for any thoughts/experiences!

Could she have worms?

How long has this been going on for?
What is her poo like? Little rabbit droppings, soft poo, runny?
Is she on any solid food yet and has that made things worse/better?

Thanks for your replies, both.

@user1492757084 - that's a really interesting suggestion. I think because it's been from the very early days that never even occurred to me. Anything in particular that makes you say it?

@ghostbusters to answer your questions:

When it started

Hard to pinpoint exactly when, but we first went to the GP a couple of weeks after birth because she had odd days where she seemed to spit up all the time to the point that it seemed to be affecting her weight (she was slightly prem and v. small anyway). That seemed to get better after I went dairy free, but meanwhile the straining/squirming kicked in. All symptoms got worse for a while after each rotavirus vaccine.

What it's like

Her poo is never hard - normally runny or at least soft, sometimes mucusy. A browny-orange colour with the odd green one. Haven't had the yellow American mustard ones since the very beginning. Often will fill a nappy, even with her having perhaps about 6 a day.

Solids

Started some vegetable purees in the last few days (peas, cauliflower and broccoli). No obvious change either way, although for the first couple of days she only ate very little.

More recently the GP referred us to the paediatric dietitians but so far that's just consisted of an online information session re CMPA. The dieticians said if additionally going soy free (which I did just after Christmas) didn't obviously improve things then it might not be CMPA and we should go back to the GP. Said it could be "soft stool constipation" but I appreciate that's probably more of a description of the symptoms rather than a diagnosis. Not getting much when I search for it online.

Have you tried a cranial osteopath? My daughter suffered terribly with pop constipation and straining but they fixed her in one session.

How long did you go dairy free for?

Did you also go soya free?

I wasn't sure if the solids made her constipated. Both my kids were EBF and solids definitely bunged them up.

Both mine always had runny nappies. But I don't remember them squirming or straining until they started food and until their gut adjsted.

Has anyone considered reflux? That sprung to mind when you mentioned you can't lie her in bed. I think they find feeding soothing and the pain starts when they stop and lie down.

Thanks, all. Really appreciate your thoughts.

@AperolWhore - amazing! Glad your DD is doing better. I came across it early on but read mixed reviews. Will have another look.

@Sofabum - it's been about 3 or 4 months now of dairy free. I've tried dairy again twice in that time and had particularly bad days straight after but could just be coincidence, as there are bad days even without dairy. I went soya free just after Christmas as I noticed that I was eating a fair bit of it and read about the potential cross-reactivity with dairy.

@ghostbusters - thank you! I'm still hopeful that solids could change things up for her, as at least it introduced something different to the equation. Yes interesting re reflux - the GP we saw when she was a couple of weeks old suspected that. But I think if she did have it she's perhaps grown out of it. She rarely spits up (most days doesn't at all) and back then would make a sort of raspy sound when she was put down. Now it's more that she's straining - you can feel her belly is rock hard when she's making the sound. She'll also say "mama" every so often until she's picked up, so seems distressed.

Sounds like your baby has cmpa then. With weaning you should then follow the allergy protocol of one new food every 3 days.

Thanks, @Sofabum . One new allergen every three days, right (as opposed to trying every food for three days)? Interestingly the dieticians at the hospital seemed to think I would have seen a better improvement if it were CMPA, as she's still having days/nights where she spends the whole time straining. But they said to wait and see with eliminating soya before going back to the GP.

@bibette do your research and have a phone consultation with one to see if they can help first. I recommend them to everyone, they can help little ones so much. Good luck!

Sorry I meant food. I treat all foods as potential allergens as I had a TED baby. I would suspect things like egg and wheat and at least keep a solid food diary with symptoms.

Thank you! I do have a recommendation for a local one so will get researching.

As part of this, does anyone have any thoughts on when to pick baby up when they're fussing vs when to leave them to it? She's not crying as such when she makes the straining sound but she does sound unhappy - like a moan. Her eyes are also open. If I just pat her or hold her hand while she does it she seems to get louder. On the other hand, I let her carry on for a minute or so just now before picking her up and she managed to get a fart out.

Poor thing is going to be absolutely knackered again today. She's so far only managed to get one stretch of about two hours in her bassinet and otherwise it's just been bits and pieces here and there when I'm holding her.

Try removing egg from your diet. I recognise a lot of this, and my eldest had an egg allergy. You could also try a prebiotic to help balance the gut.

Oooh interesting - thank you! I stopped eating eggs on their own a couple of months back as they seemed to coincide with some bad days, but haven't completely eliminated it as an ingredient. Sounds like that's worth a try. Perhaps if I do another 2-4 weeks of very strict no dairy, soy or egg and then take stock. I hope the allergy wasn't/hasn't been too tough on your child.

It sounds like grunting baby syndrome to me. DD had this (along with CMPA!) and honestly, the best thing I ever did was move her into her own room. She got on with learning how to poo and I only woke up when she was genuinely distressed and needed me, rather than waking every time she made a noise and fussing over her (which only makes it take longer for them to learn how to poo because they get used to only doing it upright when you’re holding them!).

Thanks, @peachgreen! Silly question but how did you decide when to pick her up/comfort her and when she could be left to it? I'd say she's in discomfort - she's frowning and eyes wide open while moaning, but she's not crying as such. If I leave it for a minute or so she starts saying "mama", which currently seems to mean she wants milk!

If you suspect that your baby has food intolerances/allergies I would only introduce 1 new food a week, and I would give it 3 days running in generous amounts. Also keep a food diary: one page for her and opposite one page for you.
Sounds very difficult to have a baby that is uncomfortable in her body. I hope she improves soon.

I only comforted her when she was actually crying. Mostly she was just grunting and straining and making frustrated noises. She sounded like a farm!

Around 50% of babies with cmpa are also allergic to soya.

I would think it's time to cut down on comforting with the breast and/or feeding to settle. It's what she wants because it's most babies favourite thing in the whole world but it's not sustainable for you and she's not getting her sleep either. It's not easy because she will be upset but she'll get used to it quite quickly if you're consistent

Hi! No need to cut down on giving her breastmilk for comfort; BF is a tool in your mum tool bag and is bringing her comfort/reassurance - she has learnt to say mama for milk - which is excellent communication skills and as you're responding, some wonderful brain building is going on. I assure you once she is mobile/around 1y she will want feeding a lot less anyway. So if it helps her & you; go for it!

Sounds like it'll all settle down when she gets used to the solids foods in her diet, give it a few weeks, monitor for any triggering foods; keep a diary. Regarding allergies, any other 'symptoms' besides strain BO? Have you introduced anti-inflammatory foods? Fruits to help her 'go'? Although it doesn't sound like hard stools.