Patient's question:
Please ask if my baby just turned three months old, and I bathe his little bottom with warm water 4-5 times a day. However, there is still diaper rash (using traditional diapers, not disposable ones like those). His bottom is red every day, and sometimes there are small bumps. Why is this happening, and how can it be resolved? Also, at three months, he still keeps leaking bowel movements. When he strains, a little bit comes out, and I have to change many diapers daily. Is this normal? How many months until he can have regular bowel movements?Doctor's answer:
Children who are breastfed: Their stools are golden yellow, soft, and have a uniform consistency, resembling soft butter. Occasionally, they may be slightly thin and greenish, with an acidic odor but no strong smell, and they are excreted once or twice daily on average. If a child normally has four to five bowel movements, or even seven to eight, but is otherwise in good health and gaining weight, this should not be considered pathological.Children who are formula-fed: Their stools are pale yellow, drier, and more abundant, with a faint and sometimes mixed with curds. If they have only one to two bowel movements daily, they may be prone to constipation.
The above information is referenced from Dr. Xu Jide's Pediatric Internal Medicine (3rd Edition). The color of stool is related to the chemical changes of bile. In the upper small intestine, bilirubin and biliverdin cause it to appear yellow-green; in the colon, biliverdin is reduced to bilirubin, turning the stool yellow. Breastfed infants' stools are slightly acidic, which can turn bilirubin into biliverdin due to oxidative bacteria, so their normal stools may appear slightly green. However, formula-fed infants' stools are alkaline, 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 motility or intestinal inflammation, a sign of diarrhea. This condition may indicate that the child has infant diarrhea.
The following are my summaries and suggestions regarding diarrhea, with the last paragraph likely addressing your concerns:
Diarrhea is characterized by an increase in bowel movement frequency and changes in stool consistency (e.g., loose, watery, mucous, or bloody stools; color changes). Even if a child's original stools were ribbon-like and now become pasty, this is also diarrhea. The most common causes of infant diarrhea are indigestion and intestinal inflammation.
Generally, if a child's stools are frothy, it often indicates indigestion. Only when digestion is poor and food residue increases can fermentation by intestinal bacteria produce gas, leading to frothy stools. Additionally, frothy stools may also be due to excessive air swallowed if the child cries for a long time.
If the child also vomits, with vomit having an acidic odor or containing undigested milk curds, or if they have abdominal distension (where the abdomen is higher than the chest when lying down), and their stools are frothy without mucus or blood, but the stool consistency remains yellow or slightly greenish and watery, this is likely indigestion. In such cases, digestive water can be given to aid digestion, or probiotics like Mama's Love and Smecta can be used to regulate intestinal flora and stop diarrhea.
If the child also vomits severely, even vomits immediately after eating, or has intermittent crying that subsides on its own, with significantly altered stool consistency (e.g., resembling egg soup or watery, with mucus), intestinal inflammation is more likely. This requires prompt medical attention, and a stool test can help diagnose it.
If the child has persistent crying during diarrhea, poor spirits, and tomato-juice-like stools, intestinal intussusception should be suspected. If the stool also has a very foul odor, necrotizing enteritis should be. Some children may also develop diarrhea after drinking cold tea. If they have indeed consumed cold tea before the diarrhea, this is more likely the cause. It is recommended to avoid giving them excessive cold tea in the future.
Additionally, improper complementary feeding can also cause diarrhea, such as adding food too quickly, too much, or too early.
Care tips:
When intestinal inflammation affects digestion, enzyme supplements like pepsin and digestive water (e.g., Shidele) can be given. If the child is formula-fed, it is recommended to use diarrhea-specific formula. If unavailable, the milk can be diluted. If the child is breastfed, the lactating parent should follow a light but nutritious diet, avoiding greasy foods, and can take Changlekang to aid recovery, as I advocate "treating mother and child together" for diarrhea.
Furthermore, frequent bowel movements can cause discomfort to the child's buttocks. It is advisable to avoid wrapping the buttocks too tightly to prevent chills while cleaning. When cleaning, use water instead of cloth, pressing gently to avoid irritating the delicate skin, which may cause severe crying. If the child cries uncontrollably, check if their buttocks are red, as this indicates discomfort.
To prevent diaper rash, apply a cream like tetracycline ointment or eye ointment after each cleaning. Change diapers frequently and let them air out to prevent the ammonia released from urine and feces from irritating the skin.
Complementary feeding:
Complementary foods can be introduced when the child is four months old. Below are some online references:
Infants aged four to six months not only need milk but also need to learn to eat. Initially, egg yolk can be added to milk, starting with one-sixth, gradually increasing to one-quarter, one-third, and finally one whole. Rice porridge can be used instead of warm water to mix formula, starting with small amounts and gradually increasing. Vegetable juice and fruit juice can also be provided in liquid form. Once the infant shows the ability to accept mashed foods, foods like banana puree, apple puree, carrot puree, tofu puree, egg yolk puree, fish puree, nutritional rice porridge, thickened milk porridge (for insufficient breast milk), milk congee, fruit lotus root powder, and rice porridge can be introduced, using a small spoon.
From seven to nine months, infants can be given crushed vegetables, steamed egg custard, liver puree, crab and shrimp puree, fish puree, beef puree, pork puree, chicken congee, soft noodles, tender tofu, biscuits, and bread slices. From ten to twelve months, they can be given shrimp puree with cauliflower, steamed meat and tofu, soy products, fish, meat puree, noodles, soft rice, dumplings, won tons, small cakes, and oatmeal porridge.
Principles for introducing complementary foods:
(1) Start with small amounts and gradually increase: Whether breastfed or formula-fed, infants should receive egg yolk at five months to supplement iron needs. However, do not feed the entire egg at once initially. Start with one-sixth of an egg daily, 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: After one month of formula feeding, infants can be given juice and vegetable juice. As digestion improves and development demands, at four months, add rice porridge, milk porridge, soft congee, fruit puree, fish puree, and egg yolk. From seven to nine months, try adding soft noodles, biscuits, and meat puree. After ten months, introduce soft rice, vermicelli, and chopped vegetables. Infants generally progress from liquid to semi-liquid to solid foods.
(3) Introduce one food type at a time: If pork puree is introduced for one meal, do not add fish puree the next time. Wait for the child to adapt to one food before introducing another, with at least three days of adaptation time.
(4) Introduce new foods when the infant is healthy: In hot weather, when infants are prone to indigestion, it is generally not advisable to introduce new foods. Wait for cooler weather to gradually add them. If indigestion occurs during introduction, pause and reintroduce the food in small amounts once digestion returns to normal.
I hope my answer helps you.