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

[greenie123]

@deborahallen This does make more sense to me. I’ll admit I (obviously) have no idea how much the parents were diluting the bottles, so I could definitely be off on my assumption that adding any amount of water to a bottle is fatally dangerous.

 

[deborahallen]

@greenie123 I don't know what happened with my formatting above!

This is unfortunately another example of a type of fear mongering from medical professionals and the government. I see it often, where instead of proper guidance and education on reasonable things, parents are told to not do it at all. (Sort of like abstinence only sex-ed).They think we're too stupid to understand the nuance of weighing risks associated with parenting choices. So instead of saying" limit added water intake to 1 ounce per month of age per day" (a very reasonable guideline), we're told no water at all. There are multiple examples of this, including no bedsharing, not sleeping in car seats or swings, no walkers or jumpers, no sunscreen until 6 months, etc. It's something that occurs with guidance for adults, too. As a NICU nurse, I really wish the focus would be on education and risk management.

 

[caowen]

@deborahallen I understand your frustration, but maybe it helps to remember that guidelines and recommendations are often worded in a way that even someone with almost zero common sense can look at them and understand them and have a safe outcome following that recommendation. No baby should suffer because their caregiver did not, in fact, understand a guideline that allowed for nuance.

 

[deborahallen]

@caowen Thanks. I do understand that and also realize that unfortunately many us adults can't read very well. I recall hearing the average reading level is around 8th grade, I think. But it is frustrating for parents and adult patients to be given an absolute like this and perhaps not even knowing there is wiggle room.

 

[gizmorazaar]

@holy_venom95 This may indeed be the right answer, though you should not do this. The guidelines are for typically developing healthy kids. Your kid is a little bit “off balance” in some way, and if he is either a little dehydrated or having some gastric motility problems, intervention is called for.

But at 7 weeks this requires the guidance of a pediatrician. The nurse may be correct - experienced pediatric nurses see a lot and know a lot. But she still cannot make this call.

FWIW my son had this issue and it was easily resolved with a supplement of prune juice, home brewed by an experienced grandma (not his). But he was 6 months old so we did not need to wait for medical clearance to try this. I would not have dosed him on my own at 7 weeks, or before 4 months.

 

[fiollent]

@gizmorazaar all of this.

Also, depending on the area you practice, that standards of doctors can differ.

Nurses have a lot of experience, often times more than the doc, but the doctor makes the final call.

do not change anything like increasing water intake on a newborn without further consultation if you're not knowledgable.

 

[bel13]

@holy_venom95 Are you preparing formula from powder? If so, you might want to try preparing from weight instead of volume. We found that a scoop of formula usually had more formula in it than it was supposed to and the markings on our bottles were too small. After weighing everything we realized we needed to use what looked like an ounce more water per 8 oz bottle to get the actually correct dilution, and figuring that out really helped our baby. Our pediatrician had given the same advice yours had (with an older baby, though), so I guess they were technically right.

 

[jesusreigns777]

@bel13 This is a great response! Definitely weigh the formula and the water to make sure the proportions are right and baby is getting enough water per scoop of formula.

I also always mention enfamil reguline to parents with formula fed babies struggling with constipation. We added 1 scoop per bottle for our daughter who has always been prone to constipation and it helped a lot. It comes in a green container.

 

[gizmorazaar]

@bel13 This is an important point. If you carefully measure the powder, add it to then bottle, then add water to the X ounce line, you will get a higher concentration (less water) than if you measure the powder then add X ounces of water.

So OP should first go back and reread the directions carefully. It’s so easy for sleep deprived parents to take things for granted out of habit, and not realize that they’ve slipped.

 

[mutters1]

@bel13 100% - the measurement marks on baby bottles vary wildly and so can the amount of formula packed into a scooper.
(Kinda like measuring flour for baking...compressed cups vs sifted cups - always best to just measure by weight)

 

[mobai]

@holy_venom95 I don't have any medical training but my wife is a doctor and said I should never under any circumstances give our kid anything other than formula or breast milk before he starts eating solids. If I recall correctly she said it can cause water intoxication and/or cause problems with electrolytes. I'm not 100% positive on the second part but the first part is definitely true.

 

[seeker1231]

@mobai Water intoxication is a type of problem with electrolytes. Basically the water dilutes the sodium (an electrolyte) in the blood too much and the kidneys cant keep up to filter out the excess water. Sodium levels are extremely important and when they are too low, organs especially your brain cannot function properly.

Unlike other electrolyte imbalances, sodium levels need to be corrected very slowly because if done too quickly, can cause permanent brain damage. Sometimes the kidneys by themselves can correct it too quickly, so very low sodium levels always need to be monitored carefully and corrected slowly in hospital.

 

[mobai]

@seeker1231 Holy shit I already knew it was dangerous but I had no idea it was that much of an imminent life threatening emergency.

Thank you for the explanation.

 

[deborahallen]

@mobai This doesn't happen with tiny amounts of water. Electrolyte imbalance would not be caused by 1 ounce of extra water daily. A parent diluting every bottle by 50% would be a medical emergency. 5 ml in each bottle would not.

 

[katrina2017]

@holy_venom95 https://www.aafp.org/pubs/afp/issues/2006/0201/p469.html

Infante DD, Segarra OO, Redecillas SS, Alvarez MM, Miserachs MM. Modification of stool's water content in constipated infants: management with an adapted infant formula. Nutr J. 2011 May 19;10:55. doi: 10.1186/1475-2891-10-55. PMID: 21595890; PMCID: PMC3112405.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3112405/

Benninga MA; MENA Infant Constipation Study Group; Vandenplas Y. The Magnesium-Rich Formula for Functional Constipation in Infants: a Randomized Comparator-Controlled Study. Pediatr Gastroenterol Hepatol Nutr. 2019 May;22(3):270-281. doi: 10.5223/pghn.2019.22.3.270. Epub 2019 Apr 18. PMID: 31110960; PMCID: PMC6506425.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506425/

Fabrizio Veronica, Harris Cheryl L., Walsh Kelly R., Wampler Jennifer L., Zhuang Weihong, Wu Steven S.

Softer More Frequent Stools in Infants With Difficult Stooling Fed Hydrolyzed Protein Formula With Added Prebiotics: Randomized Controlled Trial

Frontiers in Pediatrics

VOLUME 10 2022

https://www.frontiersin.org/articles/10.3389/fped.2022.894626

The following are just a few tips & trucks from a few pediatric groups; check in with your pediatrician before doing anything.

-For infants over 1 month old only on breast milk or formula, you may add fruit juices 1 ounce per month of age per day (e.g., 3 months old = 3 ounces a day). Limit amount to 4 ounces per day. Pear, prune and apple juice are good choices. After 3 months, you can also use prune juice - no more than 2oz in 24hrs.

-A gentle tummy massage can relax the stomach muscles.

-Try switching to a ready-to-use formula, as baby’s stools will be softer.

-Bottle-fed babies may be given cooled boiled water – the amount is calculated upon a baby’s weight and is usually given following feeds; it is important to not dilute the formula feeds. Stipulation: never do this without consulting with your doctor on the calculation, and never exceed the advised amount. Don't let more than one person give water to avoid duplication. Talk to your doctor.

-Try gently moving the baby’s legs in a bicycling motion; gentle massage of the stomach may also help to stimulate the bowels

-a warm bath

 

[rhemajoy]

@holy_venom95 Our doctor told us to do this with our baby but not every bottle and only an extra 10 ml or one third of an ounce. It did work but I think you should talk to an actual doctor about it!

When she was older (like 6 months plus) we added quite a bit of water to her formula (about 20-30 ml every other bottle) and that also worked for constipation (again doctor ordered). But at that age you can give prune puree which causes a poo explosion.

 

[virgoprincess_alicia21]

@holy_venom95 Just to add to this whole mess of contradicting advice...

Nurses are trained medical professionals who work closely with physicians. It is more than safe to assume that this nurse knows what the physicians at the practice recommend for this extremely common situation. It is even likely that physicians have told the nurses explicitly to answer this extremely common question with the exact advice you have received.

I am a healthcare provider (APC) and I have even told our front desk (not even nurses), "If the patient's only concern is X, please tell them to try Y and call us back if it doesn't work." It is hardly fair to me or to the patient to wait for them to leave a voicemail, wait until I am available, wait until I call them back (and they likely won't answer in the middle of the day if they're employed), and then deliver the advice when it can just be told to them at the time of the initial call.

 

[gell]

@holy_venom95 A few things.

The water restriction is one of those blanket rules that are more complex. So instead of trying to educate, they issue a No.

It is easy to over hydrate and can be dangerous to give a newborn water. Plus their little kidneys are working so hard just learning to process the milk/ formula, and balance blood pressure in this new gravity world.

Plus plus, the viscosity of just water is very thin and can easily cause choking on the throat that is still learning and developing the muscles.

All this to say, your nurse may be right. But i would get a confirmation from a second professional in your area/ climate, that knows your baby.

First i would try using oil like avocado oil, or olive oil to give a belly rub with bicycle kicks. In clockwise motion. Put some drops of oil on your hands, and just gently with the weight of your hand, no pressure. Rub in a spiral from near the belly button around, working your way out to the hips and under the ribs. Then work it back again. This may look like just finger tips of one hand. While the other hand gently cradles the back of the head and upper back. Depending on how small your babe is. This can be done day one to help relieve colic, gas, and stimulate peristalsis to get the bowels moving. Remember direction matters. Up the right side and down the left side.

You can also take a little oil and put it on your finger and gently rub the anus, from the exterior, no need to go in. Just lightly touch and rub clockwise.

 

[megshumayt]

@gell I wanted to tag on here to say that a warm bath followed by clockwise stomach massage, bicycle legs and knees to tummy really helped when my son was struggling to poop in the first few months

 

[virkambhatt]

@gell Midwife and lactation consultant here. Please avoid all food based oils for massages on babies (eg coconut, oil, macadamia oils). This is more likely to cause food allergies later. Foods should be introduced via the mouth (not skin) when a baby is developmentally read (around 6 months of age). Massage is great! Just use a non food baby oil to do it