Fairly urgent help needed re: 6 month old bf baby weaning and constipation - HV useless. Very very long post!

[IlanaK]

Hi all,

I am in need of some advice as I tried my hv and she was useless. I can't really go and see the GP now until it reopens next week as this is not an emergency as such.

Here goes.... my ds2 is 6.5 months old (will be 7 months in about a weeks time). He was exclusively bf until 6 months and 1 week old. When I weaned him to solid food, he took to it very well. The problem is with his pooing.

He has gone from liquid explosive bf poo to more normal formed poos. But he is really struggling with going. At first I thought it was just because the sensation was different for him. He would strain and strain and cry and scream when going. SOmetimes he would produce nothing and sometimes just a tiny amount and sometimes a whole poo. I did not think he was constipated as they were normal brown formed and soft - nothing hard.

I cut back on his solids for a few days thinking this may be it. Things got a little better so I reintroduced them again and the same thing happened. I spoke to the hv yestrerday on the phone who said that it didn't appear that he was constipated and that it did not seem like a food intolreance as he would have runny poo.

However, last night when I changed him after a feed in the night there was a very hard poo in his nappy. He is straining this mornign to no avail. I would definately describe him as constipated now.

As to what he is eating..... I always make sure to offer bf first and then solids. HE has a bf on waking in the morning, and then breakfast of organix oat and fruit flakes mixed with breastmilk and additional fruit (banana or pureed other fruit). He has another bf around 11am ish or whenever he is ready for it. Then some lunch around 12 ish. This is a pureed veg and also some minced up turkey. He has another bf in the afternoon (3 ish or whenever he wants it) and then tea at 5. This is a pureed fruit (apple and pear usually) and some rice. He has another bf before bed and then again at 10pm before we go to bed. He wakes once in the night for a bf too.

The HV suggested giving him cool boiled water which I did do yesterday. HE has taken to it well from a beaker, but I do not want him cutting down on bf (although the hv didn't feel this was a problem, I disagree with her) so I am only offering the water after he has had a milk feed and his solids.

Anyway, he really enjoys his solids and I am reluctant to cut back on them again. I am being very careful about introducing foods as we are an allergic family. No dairy or wheat before 1 year old, no potato or tomatoes yet (deadly nightshade veg), etc etc. I am also conscious of not giving too much baby rice as it could bung him up - in fact, I have started giving real brown rice instead with his fruit puree as it has more fibre.

Sorry this is so long, but I am not sure what to do. I am not convinced GP will have any good advice either. It is quite distressing seeing him like this. I did not have any problems with my first ds (he was weaned at 4.5 months as guidlelines were different then). Also, ds2 is quite underweight. HE fell off the bottom of the charts just before I started weaning him. I stuck firm against hv advice and pressure until 6 months, but even GP felt that as he was so incredible active he was burning up the calories from my milk and really needed weaning. I was feeding him every 2 hours daily and 3 hours nightly before weaning and he was still not gaining weight fast enough. I am soooo reluctant to go back to that and do feel he needs and wants the solids. HE almost ripped my arm off to get the food the first time I gave him any! And he is still very keen now!

One last thing.....LLL website says that if you always offer milk first, you can be reassured they will not take more solids than they need which is what I am doing.

Sorry sooooooooo long!

Sounds like he is eating quite a lot of solids and I feel it is quite a big jump to go from no solids at all to 3 meals a day in just two weeks. I started dd (at 6 months) very slowly onto solids just giving one type of fruit for a few days, then trying a veg and only one meal for several weeks. I think she was about 9 months before she was on 3 meals a day. HOwever I appreciate you have concerns about weight gain.

If you are worreid about fluid intake and also calorie intake - what about expressing some milk and mixing it with his food. That way he gets the calories from the breastmilk and also the fluid too which should easy the constipation. Also maybe try mashed advocado with a little olive oil to ease things.

Have you considered millet and other non wheat cereals and also pulses eg lentils etc?

I was quite surprised how hard dd's poos went - she was even doing fairly solid ones before she even started eating solids.

Thanks - I had been mixing about 2 ounces of expressed milk with his cereal when I was doing cereal for his breakfast. I had bought Millet flakes just before I cut out grain and was mixing them half and half with the oat based cereal.

I agree that he moved onto 3 mealas a day very quickly, but this was following his lead. He took to solids so immediately and ravenously that I felt he wanted/needed it. Some days if he has got up late and had his mornign bf late, we have not bothered with breaskfast at all so it is not 3 meals everyday.

I have just had a similar experience with dd - what got things moving was dried fruit compote morning noon and night for a couple of days. Looks horrible, but tastes nice and she loved it. Stew dried apricots, figs, prunes etc etc and then puree. I think it's from the Annabel Karmel book. HTH

I can also recommend fennel tea instead of water helped ds a treat

Sorry, havent' read this all, so maybe repeating, but:

Ds suffered dreadfully from consitpation, every advice was to give him more fibre. My instinct was that he had too much fibre. I replaced wholemeal bread with white (but good quality, not sandwich bread), cut down severley on wheat, and increased non-milk drinks. Within days he had improved enormously.

So, keep a detailed food-diary including drinks and bowel-movements so that you can see any patterns that emerge. Sometimes foods only cause a reaction if they've been eated several days in succession, or several days later.

Herb teas are very good if you don't want to give juice. Juice isn't habit-forming, at this age you can control how much he gets and how strong, and can wean him off them if you so choose.

Avoid apples, bananas and rice in any form (think of the BRAT diet for diarrhoea! ).

If you're concerned about gluten, try buckwheat (it's not wheat, despite its name). You can get it whole (get the roast or toasted sort, much tastier) but at this age the flour is probably better for making porridge or thickening foods.

Ds did better on less red meat as well.

This may sound awful, but if he's straining and distressed, take his nappy off (you will be able to see the poo bulging his anus if he's actually pooing) and to help the poo out put a little margarine on your finger and gently rub it into his anus. Don't push obviously!

Update - saw the HV at clinic today. I am really worried as I did not think the advice she gave was good at all. She said constipation is perfectly normal and I should not be cutting anything frmo his diet. She said we should worry more about weight gain and I should be giving him way more solids - as much as he will take. She said I need to get him drinking more water - at least 2 beaker fulls a day. When I said that he is still bf and gets plenty of fluid from that, she said "milk is milk" whether it is brast milk or formula makes no difference. I know this is not true and that breastmilk is made up of a fluid thirst quenchy part and then the fattier part. I asked her at what point I should worry about the constipation and she said only once he had not been for 4 days! I am going back to my GP on Thursday to try and get some better advice, but really have no idea what to do now. I cut the protein from his diet today so all he has had is pureed fruit. And tomorow I will do the same until I see the GP. I really disagree that constipation is a normal part of weaning

unfortunately I think for some babies it can be as their guts get used to eating real food .. my friend's DS2 was like that for a month or so, seemed to be in pain, really grunted hard, passed small pellets .. her GP told her he would 'grow out of it' and he did ..

I am the first person to slate HVs but she's not that far out

However as he's only 6.5 months I wouldn't worry about putting him on total milk and starting again in a month or 2 with weaning

HTH

The problem with puttin ghim back to bf only is that he was not gaining enough weight. HE was slipping off the charts. Today, he was up the centiles having had solids for 3 weeks.

Maybe it is just a question of him getting used to solids, but it leaves me unsure what solids to be giving him.

Your HV is TOTALLY wrong that milk is milk whether it's formula or breastmilk (well, obviously it's milk, but the two are definitely different!). As for two beakerfuls of water, that's far too much IMO and will fill him up without helping his weight gain (if you can get him to drink that much!).

Breastfeed as much as you want (as much as he wants) - he'll take what he needs and soon push you away if he doesn't want any more. You might find he has more shorter feeds as he's only wanting the thirst-quenching foremilk, but it's still full of vitamins and better for him than two beakers of water!

By all means offer water too with meals, but do not believe that breastmilk is solely food.

Can you try putting a selection of fruit and veg on his tray and letting him play with it? Lots will end up on the floor to begin with, but he'll soon get the hang of picking it up and some will go in his mouth.

DS is 9mo and eats anything I put in front of him (throws a lot on the floor too...) - except broccoli and cauliflower. He does strain to poo a lot more now he's eating solids and often they're quite dry, but still soft.

HTH a bit - I don't go and see my HV any more as she's useless - might as well stay at home and answer my own questions with 'up to you really' - saves putting DS in the buggy and waiting at the clinic

Ilana - sorry no time to read whole thread but have you seen this old thread here - lots of useful advice and other people's experiences re constipation.

Wow - thanks phatcat for posting that link, but my god I found it depressing. It seems that not only could this turn out to be a long term problem, but that no GP or health professional willt take it seriously. Not a happy thought.

Ilana, are you usin the normal centile charts or the breast from birth ones. The latter show a typical tailing off of weight as compared with formula fed babies. My ds is underneath the charts too but I have a very clued up, laid back HV luckily.

That amount of water is way too much imo. As someone else said, it will just fill him up without giving him any nutrition.

Have you considered weaning the babyfriendly way. The basic assumption is you follow the babies lead and skip the puree stage, just allowing baby to eat what he wants of fingerfoods. It didn't work for me as ds refused to eat fingerfoods for a while but screamed until I spoon fed him but I have seen it work for many babies.

You could also try asking for advice on the BreastfeedingUK and Ireland yahoo group. Somone on muddlepuddle will give you the proper url. We have been discussing weaning breastfed babies recently.

I really feel that whilst some of what your HV is saying is true, she does not know enough about breastfed babies. She is also probably struggling to come to terms with the new 6months guidelines.

I also have a 6.5month DS2 who was suffering a bit of constipation. He's been alright since I started giving him a little water with his 'meals'. Thankfully he likes drinking water from a cup, DD can still be constipated at 3yo because she won't drink enough fluids.

Like his big sister, DS2 took very eagerly to solids. I know it's some kind of standard mantra in the breastfeeding community that "breastfed babies don't need extra fluids" when they start solids. It just doesn't make sense to me; if breastmilk is perfectly balanced, how can it become slightly unbalanced to being more watery, to adjust for a sudden big intake of solids? DS1 never was constipated, but I just let him have as much water as he wanted (didn't know I wasn't "supposed to").

As for the LL advice, my baby would rather skip having his milk if anything is happening in the room, and certainly if he thinks other 'food' might be on offer! I have to supervise other children & can't sneak off and lie down for a quiet, undistracted feed with DS2 before every meal. We have to hide whatever we're eating from DS2. When I feed him (he's teething, too, so very keen on chewing), I try to fob him off with slowly giving him little bits, actively limit how much he gets.

Anyway, I just know my babies do seem to need water when they start having lots of solids.

Both of mine got a bit constipated when they started solids. With ds it was actual constipation, he had had bowel trouble from a very early age, before solids, and still has occasional difficulties (it's not exactly constipation really, but leads to constipation). Dd, on the other hand, had brief bouts as she got used to solids (just as that rather dubious-sounding HV of your's says) and adjusting what she ate always sorted it out.

More water is certainly necessary when a baby starts solids, but 2 beakers a day is way too much. Not just that it will fill him up, but so much so often could well be a strain on the kidneys.

Have a look at this book . I found her advice invaluable.

My hv was also pants when my dd was constipated. I was going between dr and hv for weeks and weeks. It finally took me rushing up to the surgery with a nappy full of blood and poo before they did anything. DD was then referred to hospital where a bowel biopsy was carried out and the discovered dd had a crack in her bowel. They cut it out and rejoined it and to my amazment dd pooed that night and has been fine since. Hope I'm not scaring you but I know exactly what you mean I went through months and months of the hv and dr telling me constipation in babies is perfectly normal. Yeah right, is it right for an 11 month old baby to be squeezing my hand that hard that she hurt me???? Have you tried lactulose for your ds?? It softens the poo. It didn't work for my dd but I know alot of people who have used it for constipated babies and swear by it.

Thanks everyone.

Prettycandles - that is actually the book I have been using. I used it with my first ds and thought it was fabulous.

The update is that today since this morning, he has pooed 3 times and they have all been normal! I don't know if it was the protein (But I had only cut it out yesterday so that seems too fast), or just things finally moving through.

Anyway, today I have added back some cereal this morning for breakfast and I will keep the rest of the day just puree fruit and veg for a few days. Hopefully this is it solved now!

Julie - I have tried finger foods with ds - pieces of apple, etc. He is not interested. He is really happy with spoon feeding. And I am happy too. I have read about going straight onto finger foods with babies weaned later, but am happy to do purees (though not so smooth ones) for now.