Patient's question:
Please ask if my baby just turned three months old. I bathe the little bottom 4-5 times a day with warm water, but the diaper rash (baby uses diapers, not disposable ones like that) is still there. It's red every day and sometimes has small bumps. Why is this happening and how can it be solved? Also, at three months, the baby still keeps pushing out poop. When the baby strains, a little bit comes out. I have to change many diapers every day. Is this normal? How many months until the baby can have normal bowel movements?Doctor's answer:
Breastfed babies: Stools are golden yellow, soft, uniform in consistency, resembling soft butter, occasionally slightly thin and greenish, with an acidic odor but no strong smell, and are excreted one to four times daily on average. If the baby normally has four to five bowel movements, or even seven to eight, but is generally in good health and gaining weight, this should not be considered pathological.Formula-fed babies: Stools are light yellow, drier, and more abundant, with a faint ( refers to decomposition, not necessarily rotten), sometimes mixed with curds. If the baby only has one to two bowel movements daily, there may be a tendency toward 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, due to the effects of bilirubin and biliverdin, the stool appears yellow-green. As it reaches the colon, biliverdin is reduced to bilirubin, turning the stool yellow. Breastfed babies' stools are slightly acidic, which can cause oxidative bacteria to convert bilirubin to biliverdin, so their normal stools may appear slightly green. However, formula-fed babies' stools are alkaline, which can further reduce them to colorless stercobilin, making the stool lighter in color. If a formula-fed baby has green stools, it may indicate accelerated intestinal motility or intestinal inflammation, a sign of diarrhea. The baby in this case may have diarrhea.
The following are my summaries and suggestions on diarrhea, with the last section likely addressing your concerns:
Diarrhea: It is characterized by an increase in bowel movement frequency and changes in stool consistency (e.g., loose stools, watery stools, mucous stools, or bloody stools; color changes). If the baby's original stools were ribbon-like and now are pasty, it is still diarrhea.
The most common causes of diarrhea in babies are indigestion and intestinal inflammation. If the baby's stools are frothy, it often indicates indigestion. Only when the baby's digestion is poor and food residue increases can the intestines ferment it, producing gas and frothy stools. Additionally, frothy stools may also be related to the baby swallowing excessive air due to prolonged crying.
If the baby also has vomiting, with the vomit having an acidic odor or containing undigested milk curds, or if the baby has abdominal distension (the abdomen is higher than the chest when lying flat), with frothy stools but no mucus or blood, and the stool is still yellow or slightly greenish and watery, it is likely indigestion. In this case, you can give the baby digestive water to help, or probiotics like Mama’s Love to adjust the intestinal flora, or Smecta to stop diarrhea.
If the baby also has severe vomiting, even vomiting immediately after eating, or has 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 diagnose this.
If the baby has persistent crying during diarrhea and appears lethargic, with tomato-juice-like stools, it may indicate intussusception, and if the stool has a very foul odor, it may suggest necrotizing enterocolitis. Some babies may also develop diarrhea after drinking cold tea. If the baby drank cold tea before the diarrhea, this is more likely the cause, and it is recommended to avoid giving the baby excessive cold tea in the future. Additionally, improper complementary feeding (e.g., adding food too quickly, too much, or too early) can also cause diarrhea.
Care tips:
- When the baby has intestinal inflammation, digestion may be affected, so you can give digestive enzymes or digestive water, such as "Shidele" digestive water.
- If the baby is formula-fed, it is recommended to use diarrhea-specific formula. If it is not available, dilute the milk slightly.
- If the baby is breastfed, the lactating parent should follow a light, nutritious diet and avoid greasy foods. The lactating parent can also take "Changlekang" to help the baby recover, as I advocate "treating mother and child together" for diarrhea.
- Since frequent bowel movements can cause discomfort to the baby's bottom, avoid wrapping it too tightly to prevent chills. When cleaning the diaper, use water instead of cloth and gently press rather than rub to avoid irritating the baby's delicate skin, which may cause severe crying.
- If the baby cries excessively without apparent reason, check if the skin is red, as it may be uncomfortable.
- To prevent diaper rash, apply a cream like tetracycline ointment or eye ointment after each diaper change. Also, change the diaper frequently and let the diaper air out to prevent the ammonia released from urine and feces from irritating the baby's sensitive skin.
Complementary feeding: Babies can start complementary feeding around four months. Below are some online references:
Babies 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-fourth, gradually increasing to one-half, then one-quarter, and finally one whole. You can replace warm water with rice soup to mix the formula. Start with a small amount and gradually increase. Vegetable juice and fruit juice can also be provided in liquid form. Once you determine the baby can accept mashed food, you can add banana puree, apple puree, carrot puree, tofu paste, egg yolk puree, fish puree, nutritional rice porridge, thickened milk porridge (for those with insufficient breast milk), milk congee, fruit lotus root powder, rice porridge, etc., and feed with a small spoon.
Babies aged seven to nine months can be introduced to mashed 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.
Babies aged ten to twelve months can be introduced to shrimp puree with cauliflower, steamed meat and tofu, soy products, fish, meat puree, noodles, soft rice, dumplings, won tons, small cakes, and oatmeal porridge.
The principles for introducing complementary feeding are:
(1) Start with a small amount and gradually increase: Whether breastfed or formula-fed, by five months, the baby should be introduced to egg yolk to supplement iron needs. However, do not feed the entire egg at once when starting. It is best to start with one-quarter of an egg per day, observe for a few days, and if there are no signs of indigestion, gradually increase to one-half, then one whole.
(2) From thin to thick, from refined to coarse: Formula-fed babies can be given juice and vegetable juice after one month. As digestion improves and developmental needs increase, you can add rice porridge, milk porridge, soft porridge, fruit puree, fish puree, and egg yolk around four months. By seven to nine months, you can try adding soft noodles, biscuits, and meat puree. After ten months, you can introduce soft rice, vermicelli, and chopped vegetables.
Babies generally transition from liquid to semi-liquid to solid foods, with a gradual process.
(3) Introduce one type of food at a time: For example, if you introduce pork puree once, do not add fish puree the next time. Wait for the baby to adapt to one food before introducing another, with at least three days of adaptation time.
(4) Introduce new food types only when the baby is healthy: In hot weather, when babies 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 the introduction of complementary foods, pause and reintroduce the food in small amounts once digestion returns to normal.
I hope my answer helps you.