Note: Questions for individualized care advice cannot be answered in this forum. For individualized help with your baby’s reflux, bowel habits, feeding or growth, make an appointment so I can give the support you and your baby deserve. You can also learn more on how to help your baby in my book Special Needs Kids Go Pharm Free. Get a copy today if you need step by step instructions that you can try at home. Lastly, if you’re new to my blog or practice, get an intro to integrative whole health for kids here – along with a freebie for joining my list! Thanks for stopping by!
Babies, like everybody else, need to move their bowels daily. Stool that sits in the intestine and colon for too long permits toxins to flow back into circulation, can feel painful or uncomfortable, and can diminish your baby’s appetite. Stool that passes too fast will carry too much fluid out with it, and nutrients and energy won’t be adequately absorbed. More than anyone else, babies are quite sensitive to these dilemmas. Occasional changes in this pattern are of no consequence; persisting patterns are. This is common sense as much as it is sensible nutrition science!
Many things disrupt stooling for babies. Teething, stress, immunizations, antibiotics, badly tolerated foods, and infections or illnesses can all cause changes in stooling pattern, but the changes should be temporary for your baby. Even if your baby has special needs or circumstances, make restoration of comfortable digestion a priority. On balance, your baby should comfortably pass one or two formed soft stools every day (possibly more if exclusively breast-feeding), and it shouldn’t smell terrible. Breast-fed infants have softer, mushier, wetter stools that look more seedy and light brown or gold, and these babies may pass stools more often. Younger babies may also have more frequent stools. But if any of the following signs persist for more than two or three weeks with no explanation, consider it a flag for distressed digestion and absorption. Think about making a plan to correct it, so your baby can absorb all the nutrition he needs to grow and thrive:
- More than four stools per day
- Liquid, runny, or watery stools
- Mucus in stools
- Undigested food in stools
- Stools that are explosive or overflow onto your baby’s back or neck
- Yellow, gold, tan, pale gray, black, or green stools (dark mustard colored stools are normal for breast fed infants)
- Blood in stools
- No stools passed for more than three days on a regular basis
- Hard, dry, pebble-like stool that appears painful or difficult to pass
- Plugs of hard stool followed by explosive loose stool
- Unusually foul-smelling stools
Probiotics are one of the corrections you may want to use to restore a healthy stool pattern. Generally, these guidelines can help. Check with your doctor. If he or she isn’t sure about how to dose and use these, you can always schedule time with me to get targeted help.
- Place 1/8 teaspoon of bifidobacterium blend probiotic powder in your baby’s feeding once a day. If this is tolerated and no improvements ensue, increase to ¼ teaspoon.
- Stop if you notice explosive diarrhea, hives, fever, or sudden rashes.
- Look for Bifido strains such as B. breve, B. infantis, B. longum, and B, bifidum in the product, and a potency of at least 8 billion CFUs per dose.
- Safe Lactobacillus strains that can be added for babies nearing their first birthday or for toddlers are L. rhamnosus, L. casei, L. paracasei, L. gasseri, L. reuteri, and L. salvarius.
- Don’t use L. acidophilus in babies, premies, or infants with NEC. The form of lactic acid made by this species appears to be tolerated poorly in babies. In fact, one study showed that it actually increased allergy (noted as skin rashes) in babies.
- Probiotic powder can be blended with soft food, breast milk, or formula. You can also dust some on the nipple of the bottle or the breast.
- Infants should avoid probiotic strains and blends that are intended for adults.
- Don’t give probiotics at the same time as an antibiotic. The antibiotic will kill the probiotic. Wait until the course of antibiotic is completed, then begin using a probiotic daily.
- If your baby must use antibiotics for longer than two weeks or indefinitely, you can add probiotics at the opposite end of the day. For example, if an antibiotic is given in the morning, give the probiotics in the afternoon or evening.
What does this have to do with reflux? Probiotics can help digestion a lot when used correctly. Digestion, when normal, permits the baby’s stomach contents to move along. When this isn’t happening, food sits for too long in the baby’s stomach. This feels like heartburn, and your baby will cry and be miserable. This can be avoided without medication in many cases. Changing formula, changing diet when breastfeeding to avoid trigger foods, or using various herbs have all proven effective, without the side effects from using reflux medicine for too long. Note: Reflux is not the same as spit up, which happens to babies who are doing just fine. Your baby does not have to lose feedings on your shoulder to be experiencing reflux! Signs can include misery, crying, hiccups, burps, arching with crying, pulling away from feedings, and weak growth pattern.
Reflux, diarrhea, constipation, and colic are not necessarily benign for a baby. They can signal malabsorption, imbalanced bowel microflora, inflammation, infection, milk protein intolerance or allergy, or any combination of these, especially when they persist for weeks on end. These problems can worsen reflux if a baby already has it, or trigger it to begin with. Giving reflux medication can give a quick reprieve from symptoms, but using it longer than a few weeks may set a downward spiral in motion. Work on the causes of the reflux if you can, rather than medicating it away. Reflux medications alter pH of the GI tract, and make digesting and absorbing food harder. They also shift your baby’s gut micro-biome away from ideal species of bacteria that help the immune system “learn”, protect from viruses, and digest food. Instead, reflux medicines favor fungal microbes and detrimental bacteria such as klebsiella or clostridia. These microbes produce toxins of their own that further alter the gut’s pH. They can injure the gut wall, and circulate to your baby’s brain to alter behavior or even trigger seizures.
Some babies whom I’ve encountered in my practice came to me “stuck” on reflux medication, and this is a scenario to avoid. In these cases, the baby will need increasingly higher doses that become less and less effective. One child I worked with was given reflux medication daily for the first three years of his life. Though he had been off this medication for three years by the time I met him at age six, he was stunted with delayed bone age and poor bone mineralization, growth failure, developmental and learning problems, and was unable to eat enough to sustain normal growth since eating was so uncomfortable. He’d had chronic infections as an infant and toddler, needed antibiotics often, and became asthmatic as well. Another youngster who came in for nutrition care at age three was also stuck on it, had fallen into growth failure, and showed the same pattern of not being able to achieve a typical food intake to support growth and gain. Many other toddlers I have met show this pattern of growth failure owing to picky, weak appetites after using reflux medications for a long time (more than a month or two). Reflux medications are intended for short-term symptomatic treatment, not as a long-term strategy. You may have more success by trying the corrections described here first instead, so discuss them with your provider. Your baby will be healthier, and will grow and feel better , when digestion can evolve normally rather than with the digestive down-regulation from the medication strategy.
When unhappy poop patterns persist for weeks and months, nutrients and energy are not being optimally absorbed by your baby. Medicaitons for reflux or constipation may ease the symptoms, but won’t do much to improve the malabsorption. Toxins from this addled gut can be absorbed more easily too. Babies with weak growth amid these symptoms are sending a clear signal that it’s time to intervene. Don’t wait for your baby to slide into a failure to thrive (FTT) diagnosis, which means less than the 5th percentile in weight for age. Babies in growth failure need two to three times more calories per pound per day to recover a normal growth pattern, and this is even more challenging to accomplish when a baby has reflux or other GI issues. Intervene as soon as you notice a “dropping off channel”—that is, if your baby’s weight for age or length for age percentile drops more than fifteen points, it’s time to intervene.
This blog is an updated excerpt from the first chapter in my book, Special Needs Kids Go Pharm-Free. Get more strategies on kicking reflux naturally there – including which herbs are gentle and effective, how to avoid allergy or intolerance to milk, breast milk, or other feedings and formulas, what commercial formulas to avoid and what to try, and tips on breastfeeding a colicky baby. There are many options before going to Zantac that your doctor may not know about!