Nurse suggested diluting formula as measure against constipation in 7-week old - is this as bad of an idea as I think?

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holy_venom95

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Our 7-week old baby is exclusively formula-fed and has been low-key struggling with constipation from birth. We’re consulting with healthcare providers to find ways to make it better for her. One nurse has suggested adding a small amount of extra water to every formula bottle, so as to “ensure baby is hydrated and that dehydration is not the reason for the constipation”.

As far as I know, you’re not supposed to give babies water before they start solids/ before they turn 6 months old. However, baby is struggling enough that I’d be willing to try anything that doesn’t directly jeopardise her health.

Is the suggestion endangering our baby in any way? I’m keen to receive data-driven answers, but anecdotes are also welcome.
 
@holy_venom95 Pediatrician here. This is a terrible suggestion, and I'd be very concerned that that nurse gave you this idea. Do not do this - you would put your infant at risk for hyponatremia.

Generally for constipation (if true constipation with hard stools), I start out by suggesting giving prune juice 5-10ml once a day. You can mix it into formula or give it on its own.
 
@chhow I think many new parents see their newborn struggling and straining to poop and assume it's constipation. When in reality it's normal because NBs are learning to coordinate the muscles to poop.
 
@chhow Many parents see their infant grunting and straining and assume it's constipation when it's more likely normal infant dyzchezia. If the stools are coming out soft in an infant, even if straining and turning red, it likely isn't constipation.

Another concern comes up when an infant (often exclusively breastfeeding) doesn't stool for a long period of time. Still not necessarily constipation and not pathologic. Some breastfed infants just don't need to stool frequently because it's such a low-residue diet. I've seen them go up to 2 weeks.
 
@chhow I do not know if the worry is common but constipation can be real and serious. My son didn’t poop for a few days and his hardened stool had to be manually removed; the doc was clear that this needed to be considered urgent.

Sure, breastmilk/formula should be perfect. (Though not relevant in our case since he was beginning solids.) But the truth is that not every infant functions perfectly straight out of the box. That’s why they get so many well baby visits.
 
@holy_venom95 No matter the answers you receive here, you should only take the advice of a licensed healthcare provider. MD/DO/NP/PA only. 7 weeks old is far too young to not see a provider.

Your child could have motility or anatomical issues, or it could be as simple as needed a bit more water. A nurse is not qualified to diagnose or determine this.
 
@holy_venom95 When my 2-month old was constipated her pediatrician recommended some constipation-specific formula and that was it. if you dilute formula baby will feel full with less nutrients and beyond what other have mentioned you would be underfeeding them on top. In my country, where summers can be quite hot, pediatricians do not recommend giving water to babies as it makes them full and they will feed less, and formula and breastmilk should be more than enough to ensure hydration. So while increased water makes sense to address constipation in non-babies, for babies is a terrible idea and your instinct is right.
 
@tony212 I switched pediatricians when at her first appointment I was handed a feeding pamphlet from the 70s that suggested I could give my infant tea and orange juice starting at 2 weeks.
 
@lprymus Yeah I'm no baby expert or anything but I knew that was wrong and I just couldn't. I had only taken my older kids to him for their school physicals and stuff after moving to the area so I had no idea how outdated his practice was. I pulled my kids out of there so fast and the new pediatrician apparently was aware of this guy and while they didn't badmouth him they said they understood why I left. And they complained that he would never send over paperwork via email or fax or whatever. That they had to wait for someone to bring over paper copies of my kids medical files.

I just can't help but wonder how many people took his advice and had catastrophic results.
 
@holy_venom95 My doctor recommended this around the 2month mark and it worked out just fine. Just an extra ounce of water, not a whole bottle or anything. People like to put a lot of fear into mixing formula correctly (and for good reason) but I promise you the situation is not as sensitive as you’d think. You won’t be doing it for long.

But try switching to soy formulas first. Regular can be hard on babies stomachs sometimes
 
@holy_venom95 Do not do this. When I worked in a hospital we had two twins came in two weeks apart, both dead due to nutritional issues from the parents diluting their formula. I would seriously question the credibility of any medical profession who told me to do this.
 
@greenie123 It depends how much she was talking about. An extra ounce in each bottle is too much. 5-10 ml in a 4 oz bottle is negligible. So I would hope the nurse gave specific amounts and cautioned the mother on the risks of giving more than instructed.
 
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