Patient's question:
One and a half months description of the problem: The baby has always been drinking formula milk, but recently, they don't like to eat as much, especially during the day. Originally, they could eat 120ML at a time, but now they only eat 40-50ML, and the number of meals has also decreased. During the day, they can only drink more water and be fed with porridge. They often cry and fuss. They also drool a lot and sometimes vomit.Doctor's answer:
The factors or causes of a baby drooling are numerous. Parents can analyze the reasons for their baby drooling from the following points:◎ Teething. During teething, babies may feel uncomfortable due to swollen and itchy gums, which can worsen drooling.
◎ Mouth ulcers. If blisters appear on the baby's lips, corners of the mouth, or around the mouth, it could be mouth ulcers or stomatitis, making the baby reluctant to swallow due to pain.
◎ Throat inflammation. If the baby drools excessively and also has symptoms like fever and a runny nose, it may be a cold or throat inflammation, tonsillitis, etc., leading to poor swallowing.
◎ Pharyngolaryngeal mucositis. The baby may frequently feel pain in the mouth or tongue or have ulcers in the mouth.
◎ Viral infections. Conditions like hand, foot, and mouth disease or chickenpox can cause ulcers in the mouth and around the tongue, leading to pain and difficulty swallowing.
◎ Bites. If the baby accidentally bites its skin, causing broken skin in the mouth, it may experience pain and be reluctant to swallow saliva.
◎ Neurological disorders. Conditions like intellectual disability, coma, facial nerve palsy, medullary paralysis, or postmeningitis sequelae can lead to excessive saliva production and drooling.
Why does a baby refuse to breastfeed? There are two main reasons: physiological refusal and pathological refusal. The clinical characteristics and parental coping methods for these two situations are detailed as follows.
### Physiological Refusal
Normal newborns are usually very focused on feeding in the first two months after birth. They cry when hungry and sleep when full, with rapid weight gain. Parents see their beloved baby grow like a balloon, which is truly rewarding! However, after three months, most babies start to breastfeed intermittently instead of continuously, sometimes making gurgling sounds. Some curious babies stop breastfeeding as soon as there is any noise or movement around them, clearly finding other activities more interesting than feeding. Therefore, in medicine, this temporary refusal to breastfeed in babies aged four to five months is called the "physiological anorexia period." Its characteristics are normal development and high energy, with only a temporary decrease in milk intake, which usually returns naturally after about a month. Although babies eat less during this stage, most can still maintain normal growth, and there is no evidence that it affects intellectual development. Therefore, parents can assess the baby's growth based on the growth curve. If there is no significant deviation from the expected growth curve, it is best to let nature take its course. However, if some babies experience a prolonged refusal to breastfeed, it is not advisable to simply wait for them to recover naturally. The human stomach is a flexible bag, and if it is not stretched regularly, it gradually becomes accustomed to not feeling hungry. Some children who initially had physiological anorexia gradually stop gaining weight appropriately. If their weight percentile drops by two curves on the growth chart or falls below the 3rd percentile, it is called "growth retardation," which is already considered pathological anorexia and requires medical evaluation and active nutritional supplementation.
### Pathological Refusal
We often say that housewives have seven daily tasks: "firewood, rice, oil, salt, vinegar, tea." The life of an infant is "eating, drinking, defecating, urinating, sleeping, playing, and moving." If a child's health problems arise, it will affect these seven tasks, showing reduced appetite, poor sleep, and low energy. Refusal to breastfeed is a common symptom accompanying acute and chronic diseases. Chronic diseases such as congenital heart disease, metabolic disorders, and tumors consume a lot of energy but lead to reduced appetite due to anemia or insufficient oxygen in the blood. These infants cannot describe their discomfort, and parents can only observe poor complexion and reduced energy and appetite. These children require long-term medical care, not only for the underlying disease but also to improve nutrition for normal development.
#### Acute Infections
Acute pharyngitis, thrush, and oral pain can cause sudden reductions in appetite. Acute respiratory infections can lead to nasal congestion, making it difficult for the baby to breathe while breastfeeding, also causing refusal to breastfeed. Additionally, acute gastroenteritis and urinary tract infections can cause abdominal pain and fever, leading to crying and restlessness.
#### Septicemia
The most severe form of refusal to breastfeed is sepsis in infants. Before the age of two, the immune system is not fully developed, and any infection, such as in the lungs, middle ear, or kidneys, can spread to other parts of the body due to poor white blood cell function, leading to systemic infection. At this time, the child may be agitated, drowsy, inactive, have rapid or labored breathing, and a temperature that may be high or even lower than normal. Milk intake may decrease sharply or vomiting and abdominal distension may occur. If pathological refusal to breastfeed is suspected, it is essential to seek medical attention immediately for diagnosis and treatment.
### Seven Tips to Deal with Physiological Refusal
When a baby refuses to breastfeed, parents often become anxious, hoping this challenging period ends soon. "Do everything possible to get the baby to eat" is a common approach for many parents. The following suggestions can provide practical reference for parents struggling with their baby's refusal to breastfeed:
1. Create an Ideal Feeding Environment
Observe the best conditions for feeding and create an appropriate environment. Most babies find it easier to focus on feeding in a quiet, less distracting place.
2. Maintain a Relaxed and Happy Mood
Babies can sense the tension of the feeder, which may affect their appetite.
3. Offer Timely Care and Encouragement
This helps create the best feeding mood for the baby.
4. Avoid Forcing or Losing Temper
Forcing the baby or losing your temper can lead to crying and worsen the situation. This is the least effective method and often backfires.
5. Try Solid Foods
Babies around 4–6 months old can start trying solid foods. Sometimes, using a spoon to feed simple foods like juice, rice porridge, or oatmeal can help the baby adapt to food sources other than the bottle. This can also train their oral muscles for better acceptance of solid foods in the future.
6. Use Appetite-Boosting Medications
If necessary, doctors may use medications to stimulate appetite, which can help some children.
7. Supplement with Vitamins
For babies who consume very little milk, this is also an important factor.
### How to Supplement Calcium
First, I wish your little baby good health and intelligence! Next, only needs to be supplemented with medication when there is a calcium deficiency. If there is no deficiency, it is recommended to obtain calcium primarily from food.
Calcium is the most abundant element in the human body, accounting for about 1,200 grams, and is also one of the easiest elements to be deficient in. 99% of it forms bones, while 1% is found in blood and soft tissues. Whether the body is deficient in calcium depends on two factors:
1. Peak Bone Mass
This refers to the calcium content when bone mass reaches its peak in the body around the age of 35. It is mainly determined by genetic factors, calcium supplementation, and exercise.
2. Calcium Loss
This is influenced by calcium intake, loss, and lifestyle habits, such as excessive smoking, alcohol, coffee, tea, cola, or salt consumption, as well as eating too little or too much meat, all of which can lead to calcium loss.
### Symptoms of Calcium Deficiency
As a parent, observe your child carefully for signs of calcium deficiency. If your child shows the following symptoms, it is best to have their blood calcium levels checked at the hospital to determine if they are deficient in calcium.
1. Difficulty falling asleep and entering a deep sleep.
2. Excessive sweating, crying, and frequent waking after falling asleep.
3. Irritability and restlessness during the day.
4. Delayed teething or irregularly arranged teeth.
5. Delayed walking.
6. Episodic abdominal pain without identifiable parasites, poor digestion, or intestinal inflammation.
7. Picky eating or refusal to eat.
8. Prominent finger joints, weak and slender fingers.
9. Frequent convulsions.
10. Greyish or white nails with white streaks.
#### (1) Infants
Six-month-old Mao Mao is, but recently he has been crying frequently at night and is less active than before. His mother brought him to the hospital for a checkup, and the doctor determined that Mao Mao is calcium-deficient. Why? Due to rapid growth and limited outdoor activities and sun exposure, calcium absorption may be insufficient, leading to various symptoms of calcium deficiency. Whether a child is deficient in calcium can be judged from the following aspects:
① Excessive sweating unrelated to temperature, especially head sweating after falling asleep, causing the child's head to rub against the pillow, leading to a bald patch on the back of the head over time.
② Irritability and lack of interest in the surrounding environment. Parents may notice that the child is less active than usual.
③ Night terrors, with sudden waking and crying at night.
④ After the age of one, children may have delayed teething. Some may still not have teeth at 1.5 years old, with delayed closure of the anterior fontanelle, which may not close until after 1.5 years old.
⑤ High forehead, forming a square skull.
⑥, due to the proliferation of costal cartilage due to vitamin D deficiency, the cartilage of each rib joins together like a string, often compressing the lungs and making it difficult to breathe, increasing the risk of tracheitis and pneumonia. When calcium deficiency is severe, muscles and tendons become loose. If the abdominal muscles or intestinal wall muscles are loose, it can lead to gas accumulation in the intestinal cavity, causing abdominal distension like a frog's belly. If the muscles and tendons of the spine are loose, it can result in hunchback. After the age of one, if a child walks and is calcium-deficient, the bones may soften, and the body weight may cause the lower limbs to bend, resulting in "X" or "O" shaped legs and an increased risk of fractures.
#### (2) Children
When a child shows the following symptoms, calcium deficiency should be diagnosed:
- Difficulty falling asleep, difficulty entering deep sleep, crying after falling asleep, frequent waking after falling asleep, excessive sweating after falling asleep.
- Episodic abdominal pain, diarrhea, cramps, chest pain, "X" or "O" shaped legs, pigeon chest, greyish or white nails with white streaks.
- Picky eating or refusal to eat.
- Irritability and restlessness during the day.
- Delayed intellectual development, late speech.
- Delayed walking, not starting to walk until after 13 months.
- Delayed teething, not getting teeth until after 10 months. Irregularly arranged, sparse, and loose teeth, with black or sawtooth-shaped teeth.
- Sparse hair.
- Poor health, frequent colds.
### Calcium Supplementation Recommendations
1. Don't Follow Advertisements
Increase your health knowledge and understand calcium supplementation correctly. Calcium supplement manufacturers often use celebrities to attract consumers. However, based on your own needs, make choices rather than being swayed by loud product names. Remember that such commercial terms are purely and do not exist in the field of nutrition.
2. Don't Believe Exaggerated Advertising
Some advertisements claim "good deposition and fast absorption," making it seem like calcium absorption is a simple process. In reality, calcium must first enter the bloodstream, then form calcium-containing cells, and finally undergo complex changes to penetrate the outer layer of bones and fixate in the inner bone tissue. Another advertisement claims that their product has "particles several times smaller than ordinary products," but particle size is only a physical change and does not fundamentally improve the body's absorption rate of calcium. Currently, the body's absorption rate of calcium from calcium supplements is only about 30%, and there is no such thing as a 95% absorption rate.
3. Improve Your Diet to Obtain Calcium Naturally
In daily household food, foods rich in calcium include milk, cheese, eggs, soy products, kelp, wakame, shrimp skin, sesame, hawthorn, seafood, and vegetables. Especially milk, 100 grams of fresh milk contains 120 milligrams of calcium. If you drink 250 grams of milk daily, it can provide 300 milligrams of calcium; if you drink 500 grams of milk daily, it can supply 600 milligrams of calcium. Combined with other foods in the diet, which provide about 300 milligrams of calcium, it can fully meet the body's need for calcium. It is worth noting that when consuming these calcium-rich foods, avoid excessive consumption of foods rich in phosphates, oxalates, or proteins to prevent affecting calcium absorption.
4. Test Calcium Levels at a Regular Hospital
The "monochromatic bone density tester" available in pharmacies can only measure the ulna and radius of the arm and is not accurate, as calcium loss mainly affects the lumbar and hip bones. Additionally, these instruments are radiation sources, and their radiation can affect the body.
5. Calcium Supplements Are Not Necessarily Better the More Expensive
Currently, the quality of calcium supplements circulating in the market is not significantly different. Moreover, different calcium products are suitable for different populations. Calcium carbonate has a high net calcium content and high absorption rate and is a traditional calcium supplement. However, it is not suitable for those with low stomach acid. Phosphorus calcium has high phosphorus content but is not suitable for those with chronic kidney disease.
6. Calcium Supplements Are Not the More, the Better
The key is to focus on absorption. If the elemental calcium intake exceeds 200 milligrams per time, it will reduce the absorption rate.
7. Children Should Prioritize Food Supplementation When Taking Calcium Supplements
Children have weaker gastrointestinal functions and should avoid choosing calcium products with strong alkalinity, such as calcium carbonate or active calcium. They should also avoid drinking soda or carbonated drinks while taking calcium supplements to prevent reduced absorption.
To supplement calcium for your child, first increase the amount of calcium-rich foods on the dinner table. Milk is the best source of calcium for children, containing about 120 milligrams of calcium per 100 grams, which is three times more than breast milk. Next, eel vertebrae not only have high calcium content but also have a calcium-phosphorus ratio very close to that of human bones, with a higher bioavailability than ordinary calcium sources, making it easy for the body to absorb. Additionally, various beans (especially soy and its products), lean meat, fruits, vegetables, and seafood (such as small fish, fish bones, small shrimp shells, and kelp) are all good sources of calcium. In addition to giving calcium tablets to your child, encourage them to spend more time in the sun and participate in outdoor sports to promote the body's full absorption and utilization of calcium. It is important to note that during calcium supplementation, regularly check blood calcium levels at the hospital to avoid excessive supplementation, which can lead to adverse consequences. Additionally, excessive calcium supplementation in children can inhibit the absorption of zinc, so for children with zinc deficiency, dietary supplementation should be the primary approach:
1. Drink more milk and soy milk. Japanese people used to be short but are now taller, which is said to be related to young people drinking more milk.
2. Maintain a regular lifestyle with sufficient sleep, timed sleep, and guaranteed sleep duration, which are essential conditions for growing taller.
3. Shrimp skin has high calcium content, and carrots are rich in vitamin A and D. Often use soybeans and pork trotters to make soup (add some vinegar when boiling bones, so the calcium in the bones can be released), and add shrimp skin when cooking. Carrots are fat-soluble and require more oil for cooking.
4. Pay attention to personal health, prevent diseases, and seek early treatment if sick. Maintain physical and mental health, enrich cultural and entertainment life, and keep a stable mood and to promote growth.
5. Eat snails and animal blood.
6. Eat more soy and its products (tofu, soy milk, etc.).
Note: Eat less and more frequently. If possible, add a meal when the child wakes up in the middle of the night; cook the porridge with a few drops of fish liver oil.
7. Let the baby spend more time outdoors and get more sun. Exercise can strengthen muscles and bones and promote bone growth. Sunlight can convert cholesterol in the body into vitamin D, which helps absorb calcium and promotes the baby's growth.
### Precautions When Taking Calcium Supplements with Vitamin D
Many consumers believe that calcium supplements must be chosen with vitamin D, which is a misconception. Due to individual differences, not everyone is deficient in both calcium and vitamin D. Long-term use of vitamin D may actually inhibit the body's own formation of vitamin D or lead to vitamin D toxicity due to excessive intake. Toxicity symptoms include liver and kidney damage and soft tissue calcification caused by hypercalcemia,,,,,,,.
### Do Not Take Active Calcium Long-Term
Active calcium is a calcium mixture extracted from aquatic shells like oysters through high-temperature, low-heat processing, mainly composed of calcium hydroxide. It has high heavy metal indicators and strong corrosiveness. Experiments have shown that administering active calcium to mice can cause death, with post-mortem findings of intestinal congestion. Therefore, taking large doses of active calcium can often cause nausea, vomiting, and stomach pain. Long-term use of active calcium can also impair the normal function of the stomach.
### The Best Time to Take Calcium Supplements
It is best to take calcium supplements between meals. Generally, plant-based foods contain more fatty acids and oxalates, which can combine with calcium ions to form insoluble calcium salts that cannot be utilized by the body and are excreted. Animal-based foods contain large amounts of fat, and excessive fatty acids can combine with calcium ions to form calcium soaps, which also cannot be utilized by the body. Due to these two factors, taking calcium supplements during meals reduces the body's absorption rate of calcium and leads to waste. Therefore, taking calcium supplements only between meals ensures better utilization of calcium.
### Food Supplementation Is Better Than Medication
The following are the calcium content of some foods for daily consumption:
1. Milk
250 grams of milk contains 300 milligrams of calcium, along with various amino acids, lactic acid, minerals, and vitamins, promoting calcium digestion and absorption. Moreover, the calcium in milk is more easily absorbed by the body, making milk the primary food for daily calcium supplementation. Other dairy products like yogurt, cheese, and milk snacks are also good sources of calcium.
Health Tip: When drinking milk in summer, it is important to choose carefully.
2. Kelp and Shrimp Skin
Kelp and shrimp skin are high-calcium seafood. Eating 25 grams daily can provide 300 milligrams of calcium. Additionally, they can lower blood fat and prevent atherosclerosis. Kelp can be cooked with meat or served as a salad, both of which are delicious dishes. Shrimp skin has an even higher calcium content, with 25 grams containing 500 milligrams of calcium, making it a great choice for soups or fillings for daily calcium supplementation.
Friendly Reminder: People who are allergic to seafood should be cautious when consuming these products.
3. Soy Products
Soy is a high-protein food and also rich in calcium. 500 grams of soy milk contains 120 milligrams of calcium, while 150 grams of tofu contains as much as 500 milligrams of calcium. Other soy products are also excellent sources of calcium.
Friendly Reminder: Soy milk needs to be boiled repeatedly seven times before consumption. Tofu should not be cooked with certain vegetables, such as spinach, which contains oxalates that can combine with calcium to form calcium oxalate, hindering calcium absorption. Therefore, tofu and other soy products should not be cooked with spinach together. However, soy products cooked with meat are both tasty and nutritious.
4. Animal Bones
More than 80% of animal bones are calcium, but they are not soluble in water and are difficult to absorb. Therefore, when making food, they can be crushed first, cooked slowly with vinegar. Remove the floating fat and add some vegetables to make a delicious soup.
Friendly Reminder: Fish bones can also supplement calcium, but attention should be paid to choosing the right cooking method. Dry-fried fish and braised fish can make the bones tender and easier to absorb calcium, and they can be eaten directly.
5. Vegetables
Many vegetables are also high in calcium. For example, 100 grams of napa cabbage contains 230 milligrams of calcium; 100 grams of small, rapeseed, fennel, coriander, and celery contain about 150 milligrams of calcium.
### How to Choose a Calcium Supplement
Currently, there are more than 400 types of calcium supplements in China, including both domestic and imported products. The specific choice of calcium supplement depends on the individual.
1. Calcium Carbonate
High calcium content, low side effects, cheap, high absorption rate (up to 40%), similar to milk, and is a widely used calcium supplement that is easily accepted by the Chinese people.
2. Lactic Acid Calcium
One of China's traditional calcium supplements, easy to dissolve, but with low calcium content. Examples include:
- Lactic acid calcium, containing 13% calcium.
- Gluconate calcium, containing 9% calcium, with even lower content when made into tablets, requiring too many tablets to reach the daily calcium intake of 1,000 milligrams for adults, which is not practical for most people.
3. Ammonium Phosphate Calcium
A commonly used calcium supplement in Japan, with a relatively high calcium content (23.3%), produced by Chengdu Pharmaceutical Factory in China, with 70 milligrams of calcium per tablet, moderate price, but its drawbacks are slow disintegration and absorption, and high phosphorus content, which is harmful to those with kidney dysfunction. Therefore, it is used less frequently.
4. Citrate Calcium
Contains 21.1% calcium, good water solubility, and better bioavailability than phosphate calcium. Its absorption does not depend on stomach acid, and it comes in effervescent tablets, making it more suitable for the elderly.
5. Active Calcium
A calcium mixture formed by high-temperature calcination of biological calcium (shells), with high calcium content but a strongly alkaline aqueous solution, which is irritating to the stomach and intestines and is not suitable for the elderly with low stomach acid. It can reduce gastrointestinal irritation when taken with food.
6. Organic Calcium
Amino acid calcium and protein-bound calcium have begun to be used in China.
#### Calcium Brand Analysis
(1) Haya System Calcium Supplements
Three and from Haya Group account for half of the 30 billion calcium supplement market and are currently the leading brands in the calcium supplement market. oral liquid targets the children's market, while high targets the elderly market, making them the leading brands in the calcium supplement market.
(2) Calcium Baby D
Produced by Suzhou Lida, it has the highest market share in the professional market (hospital channel), providing strong momentum for retail market sales. Currently, its OTC market advertising targets mainly women.
(3) Leverve
Produced by the U.S. Minevit Company, it entered the Chinese market in 1996 and currently has annual sales of 500 million yuan. Its good efficacy has built strong product strength, earning a good reputation and repeat purchases from consumers.
(4) Jin Neng Calcium
Beijing Jin Neng Company was one of the earlier players in the calcium supplement market after . Its product, Jin Neng Calcium oral liquid, is a third-generation calcium supplement made primarily from L-sorbitol calcium, a deep-processed product of vitamin C.
(5) Long Mu Zang Gu Granules
Produced by Wuhan Jian Min, the product is a Chinese and Western compound, the top brand in the calcium supplement market in the mid-1990s. It targets children and also has the effect of regulating the stomach and intestines, making it favored by some professionals. Due to its long market presence, it has a high market penetration and a loyal consumer base.
(6) Gai Tian Li
Made from animal shells, it was a pioneer in the Chinese calcium supplement market and targets the children's market.
(7) Ai Er Calcium
Produced by Shanghai Huahong Biopharmaceutical Co., Ltd., it is made from marine biological materials, free from pollution, with good absorption and no side effects. L-lactic acid calcium is safe and non-toxic, with a left-handed structure that is compatible with the human body. It contains multiple beneficial trace elements for the body; its calcium supplementation effect is better than calcium carbonate.