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

@rasnos Thank you for replying. The healthcare professionals I refer to are her pediatrician, my midwife etc. However, I’m a bit wary of their advice and want to do my own research. Could you please add more about what else we can try,
other than medication and water? So far we’ve also tried: different formula, bicycling the legs, massage.
 
@holy_venom95 Try a warm bath before the massage, it will help get the bowels moving. You can achieve the same with a warm compress on baby's abdomen.

You can also try rectal stimulation, but only do that as a last resort as you don't want baby to require it in order to have a bowel movement. But for my second kid (who also had constipation issues) we had to do it a few times when she was around that age.
 
@holy_venom95 Per the CDC website:

Use the amount of water listed on the instructions of the infant formula container. Always measure the water first and then add the powder.

Too much water may not meet the nutritional needs of your baby.

Too little water may cause your baby’s kidneys and digestive system to work too hard and may cause your baby to become dehydrated
Click to expand...
 
@holy_venom95 Also, just another school of thought, go ahead and try other formulas but my ebf had allot of digestion issues / constipation at they age. Our ped advised its super common because babies intestines and system are still developing out. We had some gas tubes to help but it got much better around 3 mths.
 
@holy_venom95 Formula is hydrating. Baby kidneys are immature and it is very easy for a baby to develop water intoxication. Generally speaking, formula should only be mixed according to the instructions on the can, unless directed otherwise by a health professional. But you are being directed by a health professional, so it's worth looking into.

I think it depends on how much dilution is being recommended and for how long. So far the research I have found is very old. The most recent information I'm finding is case studies from the 1990's. Other research is from the 1960's and 1970's and unfortunately is not available online as far as I can tell. So it looks like water intoxication in infants is pretty rare.

https://pubmed.ncbi.nlm.nih.gov/3563573/

I retrospectively describe 20 episodes of water intoxication in 19 infants, with hypothermia, seizures, and hyponatremia. Overdilution of formula or aggressive supplementation with water or clear juices were documented in 16 of the 20 episodes. Seizures and respiratory distress were severe enough in six cases to require intubation and ventilatory support.
Click to expand...

It is important to note that this information is from 1987. The use of "overdilution" and "aggressive supplementation" leads me to believe that a little dilution is probably okay. But again, this is very old research and the full paper did not appear to be available so it's difficult to determine what is considered overdilution.

Edit for clarity.
 
@fernandosn As kindly as I can possibly say this, I would not necessarily take an NP's word at face value for subspecialties. While there is training available for them, they do not require further education to do things like pediatrics, psychiatry, derm, etc.
 
@holy_venom95 So the reason against adding extra water is due to immature kidneys, if you prepare formula with extra water baby is not as able to compensate and balance fluid and electrolytes as you or I can. When you say you are consulting with healthcare professionals, is this your pediatric care providers?
 
@vanessamarsden Thank you for replying. I’m indeed referring to pediatric professionals, with the caveat that the country where I currently live has what I consider sub-par healthcare so I’m wary of their advice and try to double-check before doing anything.

The impact on the kidneys is also what I was most worried about. From your reply I get that the concern is actually dehydration (is that the balancing of electrolytes that you refer to?).
 
@holy_venom95 Well, the risk is more that the baby's blood could become too dilute from an improper formula ratio, which could make the blood's sodium level to drop for instance. The kidneys filter out waste and keep an appropriate balance or ratio of water to electrolytes in the body, but with the baby's kidneys not at maturity yet they are less able to "fix" the blood after an improper ratio of formula to water. The effect of having low sodium from dilution can actually cause the brain to swell and lead to seizures. Does that make sense? (I work in NICU)
 
@vanessamarsden Definitely makes sense, thank you for taking the time to explain so clearly.

It’s also put the fear into me about how I currently prepare formula. It feels like even an 0.3pz deviation (smallest unit my bottle tracks) can be harmful
 
@holy_venom95 I’m in the UK and was advised by my midwife to give very small amounts of cooled boiled water between feeds (a sip or 2) to help with constipation. I wouldn’t water down the formula.
 
@holy_venom95 Yeah sorry, I mean't the idea wasn't bad but I couldn't compare to a 2 month old. Makes me wonder what babies were drinking before formula? especially the ones who couldn't produce breast milk.
 
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