What is infant diarrhea related to

Patient's question:

My baby is a premature child, and I was very worried about the child's condition from the beginning. Recently, the child has appeared with this series of conditions, and I am also very worried, afraid that the child will become worse. Please ask what is related to infant diarrhea

Doctor's answer:

The color of feces is related to the chemical changes of bile. In the upper small intestine, it appears yellow-green due to the effects of bilirubin and biliverdin. By the time it reaches the colon, biliverdin is reduced to bilirubin, turning the stool yellow. Breastfed infants have acidic stools, which can turn bilirubin into biliverdin under the action of oxidative bacteria, so their normal stools may appear slightly green. However, formula-fed infants have alkaline stools, which can be further reduced to colorless stercobilin, making the stool color lighter. If a formula-fed infant has green stools, it may indicate accelerated intestinal peristalsis or intestinal inflammation, a sign of diarrhea.
"Feeding Xiangfang Zhengqi Granules resulted in liver-like color" is because this traditional Chinese medicine preparation is naturally of this color. Based on your description, your child's diarrhea has already become migratory diarrhea. Have you given the child any antibiotics? If so, we need to consider whether the antibiotics killed some of the beneficial bacteria in the intestines, leading to dysbiosis and persistent diarrhea. In this case, it would be advisable to discontinue antibiotics and use probiotics such as Changle Kang, Peifeikang, or Mamiai to restore intestinal microbial balance. From a TCM perspective, prolonged diarrhea may be due to "sinking middle Qi," and taking Buzhong Yiqi Pills could help.
Below are some of my general observations on diarrhea, hoping you can find some help in them:
The most common causes of infant diarrhea are poor digestion and intestinal inflammation. Generally, if a child's stool contains bubbles, it often indicates poor digestion. Only when digestion is poor does food residue increase, and when fermented by intestinal bacteria, it produces gas, resulting in bubbly stools. Additionally, bubbly stools may also be related to excessive air swallowing due to prolonged crying.
If the child also has vomiting, with the vomit smelling sour or containing undigested milk curds, or if the child has abdominal distension (with the abdomen higher than the chest when lying flat), and the stool is bubbly but without mucus or pus, with increased frequency but still yellow or slightly green, or loose and watery, it is likely poor digestion. You can help by feeding digestive water or probiotics like Mamiai to adjust the intestinal flora, or using Smecta to stop diarrhea.
If the child also has severe vomiting, even vomiting immediately after eating, or intermittent crying that can be relieved on its own, with significantly changed stool consistency (e.g., resembling egg drop soup or watery, with mucus), it is more likely to be intestinal inflammation, which requires prompt medical attention. A stool test can help confirm the diagnosis.
If the child has persistent crying during diarrhea and appears lethargic, with tomato-juice-like stools, it could indicate intussusception. If the stool also has a very foul odor, it could be necrotizing enterocolitis. Some children may also develop diarrhea after drinking cold tea. If the child has indeed consumed cold tea before the diarrhea, this is more likely the cause. It is recommended to avoid excessive cold tea for the child in the future.
Improper complementary feeding, such as adding food too quickly, too much, or too early, can also cause diarrhea. The principles for adding complementary foods are provided below.
In terms of care, note the following: Since intestinal inflammation affects digestion, you can give the child pepsin or digestive water, such as "Shidele" digestive water. If the child is formula-fed, it is recommended to use diarrhea-specific formula. If you cannot obtain it temporarily, dilute the milk. If the child is breastfed, the lactating mother should follow a light but nutritious diet, avoiding greasy foods. The mother can also take probiotics like Changle Kang, Peifeikang, or Mamiai, which will benefit the child's recovery, as I advocate "treating mother and child together" for diarrhea.
Additionally, frequent bowel movements can cause discomfort to the child's bottom. It is advisable to avoid wrapping the child's bottom too tightly to prevent them from catching a cold. When cleaning the bottom, use water as much as possible. If using a cloth, avoid rubbing and instead gently press. This is to prevent the child's delicate skin from breaking, which could cause severe crying. If the child cries uncontrollably, check if the skin is red, as this indicates discomfort.
To prevent diaper rash, you can apply a layer of ointment, such as tetracycline ointment or eye ointment, after each cleaning.
Since you did not specify whether the child is breastfed or formula-fed, I answered based on general guidelines. I apologize for not providing a more targeted response. If the child is breastfed, it is recommended to start treatment with the lactating mother.
Complementary foods can be introduced when the child is four months old. Below are some resources I found online:
Infants aged four to six months not only need milk but also need to learn to eat. Initially, you can add scrambled egg yolk to the milk, starting with one-sixth, gradually increasing to one-quarter, one-third, and finally one whole. Rice water can replace warm water for mixing formula. Start with small amounts and gradually increase. Vegetable juice and fruit juice can also be provided in liquid form. Once the infant shows the ability to accept mashed foods, you can introduce banana puree, apple puree, carrot puree, tofu paste, egg yolk puree, fish puree, nutritional rice porridge, thickened milk porridge (for insufficient breast milk), milk congee, fruit lotus root powder, rice flour porridge, etc., using a small spoon.
For infants aged seven to nine months, you can add mashed vegetables, steamed egg custard, liver puree, shrimp and crab meat puree, fish puree, beef mince, pork mince, chicken congee, soft noodles, tender tofu, biscuits, and bread slices.
For infants aged ten to twelve months, you can add shrimp minced with cauliflower, steamed meat and tofu, soy products, fish, meat mince, noodles, soft rice, dumplings, won-ton, small cakes, and oatmeal porridge.
The principles for adding complementary foods are as follows:
(1) Start with small amounts and gradually increase: Whether breastfed or formula-fed, infants should be introduced to egg yolk at five months to supplement iron needs. However, do not feed the entire egg at once initially. It is best to start with one-sixth of an egg per day, observe for a few days, and if there are no digestive issues, gradually increase to one-quarter, then one-third, and finally one whole.
(2) From thin to thick, from refined to coarse: Formula-fed infants can be given juice and vegetable juice after one month. As digestion improves and development demands, you can introduce rice porridge, milk porridge, soft porridge, fruit puree, fish puree, and egg yolk at four months. By seven to nine months, you can try adding soft noodles, biscuits, and meat mince. After ten months, you can introduce soft rice, noodles, and chopped vegetables.
Infants generally transition from liquid to semi-liquid to solid foods, following this process.
(3) Introduce one type of food at a time: For example, if you introduce pork mince once, do not add fish mince the next time. Wait for the child to adapt to one food before introducing another. At least three days of adaptation time is recommended.
(4) Introduce new food types only when the infant is healthy: In hot weather, infants are more prone to digestive issues, so it is generally not advisable to introduce new complementary foods. Wait for cooler weather to gradually increase. If digestive issues arise during the introduction of complementary foods, pause and reintroduce in small amounts once digestion returns to normal.
I hope this explanation helps answer your question.