4 month old with chronic constipation

  1. I feel like a dunce, but my daughter needs help. I am a pedi psych nurse, and I am at a loss. My four month old granddaughter has such a problem with chronic constipation. She really suffers, poor thing. Her abd is so hard as she tries to relieve herself. I have talked to her pediatrician myself only to be told that all babies look like they are having a hard time. Not only is that insulting to me as a mother, but it is also insulting to me as a nurse. I gave my children water between feedings, and my son was put on a low iron dose formula, because he was chronically constipated. My granddaughters pediatrician says no water, just formula, or breast milk. My daughter does not produce enough breast milk to keep the baby satisfied so we need to supplement with formula. She has been advised to start cereal (rice). Well hello, I was told that rice is a nono when constipation was an issue. I will take any advice at this point. This child turns purple and screams with every BM it is so heartbreaking to be a nurse and not be able to help her or her mother . At one point I thought her bowels were folding in on themselves. Any advice will be appreciated. Thanks!
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  2. 16 Comments

  3. by   NRSKarenRN
    one of my sons had that problem. pediatrician recomended maltsupex powder. i also gave him 4 oz water extra/day per docs advice. worked like a charm.

    brat diet: bannas, rice, applesauce and teas are constipating foods recomended for children. making rice cereal on thin side will add aditional fluid content to stool. please followup with pediatrician second time---different partner in practice?
  4. by   prmenrs
    I think the baby needs a better work-up; one possible cause could be Hirschsprung's. If it is appropriate, consider changing pediatricians, or @ least ask for a referral to a peds gastroenterologist.

    Good luck.
  5. by   peds77
    My sons has constipation issues too I'm a peds nurse but this advice also comes from my pediatrician:
    Breast is best for some but didn't work for me
    1st formula to try is goodstart 2nd soy 3rd allimentum or nutramigen (one is similac one is enfamil) lastly is neocate. unfortunatly as u go down the line they get more and more expensive but it helps....each one is predigested a little to alot in the order I gave you....also glycerin suppositories are safe to use up to several times a day.....1oz of prune juice mixed with 3oz of formula does well to but it can cause loose stolls so you have to use your judgment on how much is too much but You can do that 3-4 times a day...do not give rice ceral is constipates which any idiot knows therfore I would definately look into a new peiatricain if anything give oatmeal......I started my son on fruit and veggies at 4mon old and he's pooped everyday since.....and also the BRAT diet is for diahrrea NOT CONSTIPATION..... last resort take him to a GI specialist just to make sure but I would not do that until I've exhausted all ideas above.......good luck
  6. by   rehab nurse
    sorry i am not a peds nurse, and i didn't have time to read the other replies. but i know there are very smart nurses here, so i'm sure you got good advice. my heart goes out to you as a mom myself, whose daughter did (still does) suffer from constipation. i have had to disimpact her just a couple times, when she was under a year old. she would just scream, and crawl into my lap. poor thing. it's unbearable to watch.
    what worked was giving her pear juice. prune juice was too yucky to her, and gerber made those nice 3-4oz small bottles of it. i would give her one every day. there were also times we had to try rx drugs, but we've been able to manage it with foods mostly.
    i hope your little granddaughter feels better soon. i also didn't produce enough breastmilk (cause of meds i was on) so had to supplement. ended up using plain enfamil. i was able to give her some breastmilk up until her sixth month bday.
  7. by   hcmanp
    I swear we used to use Karo syrup in the formula for constipation (in the olden days). Does anyone remember this? I think it worked, too.
  8. by   peds77
    I think people did use Karo syrup in

    "the old days" however Karo, Honey and Molasses should NEVER EVER be given to children under 1yr bc its been dirctly linked to causing infantile botulism...
  9. by   morte
    Hirschsprung's, would be one thought, also celiac and caesin sensitivity....does your daughter drink milk? try skipping that and make sure she (daughter) is well hydrated.....also new pedi sounds like a good idea!
  10. by   canoehead
    OK, so not to scare you but when my neice was diagnosed with neuroblastoma she was admitted to the hospital initially with constipation...she also had fever and loss of appetite though. IMO if you are a pediatric nurse and your gut is telling you it's important she needs a better workup. Don't be embarassed, and don't delay.
  11. by   BouBou
    I am not a nurse just a mother of two children. Pear juice is the best remedy I have ever found for constipation. My whole family uses it. Also, my sister swears by plain old yogurt. However, your granddaughter may be too young. They even have yogurt for babies now. The final suggestion I have is to put her on a soy formula.
  12. by   Pedi-ER-RN
    our docs recommend dark kayro syrup in each bottle. but...i do think this child needs a better workup and referral to a peds GI ASAP! If you dont get anything out of your primary pedi..move on and get in with a specialist.
  13. by   nurs4kids
    Lord, we will scare you to death, eh? Okay, I admit my first thought was hirschsprungs, but I seriously doubt it's that serious. We ARE talking about a forumula fed infant, so some constipation is not doom. Before I fired my pediatrician, I would probably try juice and water in between. I used glycerine supps a few times with mine around that age and also used the karo syrup thing. The botulism thing was never proven as the source, however the way it was manufactured was changed because of the concern and karo syrup no longer contains botulism http://www.drgreene.org/body.cfm?id=...etail&ref=1953
    BEFORE I would put my infant through tireless test (pain), I would try some of these other remedies. If it IS hirschsprungs, it will not go away. I doubt it is anything serious, probably an immature GI system.
  14. by   kidznurse
    As both a paeds nurse and a mother whose fully breast fed (until 6months) infant son was constipated from 4months until 3years I haven't a definitive answer. Some would say mixed breast and bottle feeding encourages constipation but I wasn't doing that.

    Fact: Some children have delayed gut motility some have fast guts . In such cases adding a sugar that increases the osmolar water retention and softens the stool helps. Whether that's brown sugar in water( 1tsp to 100ml) pear juice, prune juice, peach juice, orange juice, kiwifruit juice or lactulose/duphalac depends on preference and trial and error. Honey is definately contraindicated in infants as described by someone else

    I considered both Hirschsprungs and a tumour but consulting a paed surgeon ruled that out.

    It's very frustrating having a child with constipation because everyone is an expert. I felt that if one more well wisher asked if I'd tried prune juice I'd scream!! A dairy free diet and wheat free diets were trialled both by me when I fully breast fed and later when he started solids and neither helped. Too much roughage as he got older made the stools too bulky and difficult to pass. Pain from anal tearing during hard passage added a psychological holding back behaviour. At one stage around 20months he was up to 3-4 20ml doses of lactulose a day. Glycerine suppositories and creams to the anal area to reduce pain and ease passage were used.To keep high levels of fluid intake I allowed a feeding bottle for water until a much later age than I would have wished.I used abdominal massage following the direction of the bowel , rosemary oil, accupressure to the feet,kept breast feeding until 16months, sitting on the potty with a book at regular times, making star charts and poo songs you name it.

    Then at around 3 1/2 he got through it. His abdominal muscles seemed to tighten as a develpmental progression ,and no more lactulose. No more straining . Bingo! his bowel grew up. He still passes rather large stool but has otherwise had no further issues and is now 15. In testing the gut motility I measured the length of time it took for sweetcorn to pass through the stools of everyone in our family ...sick what nurses do for family entertainment huh!! 26hours for eldest son, 18hours for youngest son, my husband was 13 hours and I was 32 hours so guess where the slower gut came from... and yes my mother confirms I was prone to constipation in infancy too.

    If I hadn't been vigilant though I fear he may have ended up with encopresis which I have subsequently been involved in community programmes- retraining older children with stretched bowels. Hope this helps .

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