Patient's question:
My baby is a premature child. 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 get worse. Please ask what is related to infant diarrheaDoctor's answer:
The color of feces is related to the chemical changes of bile. In the upper small intestine, it appears yellowish-green due to the effects of bilirubin and biliverdin. When it reaches the colon, biliverdin is reduced to bilirubin, turning the feces yellow. Breastfed infants have acidic stools, which can turn bilirubin into biliverdin under the action of oxidative bacteria, so their normal stools are 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 should 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 stop using antibiotics and use probiotics such as Changle Kang, Peifeikang, or Mamiai to restore intestinal flora balance.
From a traditional Chinese medicine perspective, prolonged diarrhea may be caused by "sinking middle Qi," and it may help to try taking Buzhong Yiqi Pills. Below is a summary of my insights on diarrhea, hoping it will provide some assistance:
The most common causes of infant diarrhea are poor digestion and intestinal inflammation. Generally, if a child's stools contain bubbles, it often indicates poor digestion. Only when digestion is poor does food residue increase, and when fermented by intestinal bacteria, it produces gas, leading to bubbly stools. Additionally, bubbly stools may also be related to excessive crying, causing the child to swallow more air.
If the child also has vomiting, and the vomit has an acidic odor or undigested milk clumps, or if there is abdominal distension (the child's abdomen is higher than their chest when lying down), with bubbly stools but no mucus or blood, and the stool frequency increases but the consistency remains yellow or slightly greenish, or loose and mushy, 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 subsides on its own, with significantly altered 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 and poor spirits during diarrhea, with tomato-juice-like stools, it could indicate intussusception. If the stool also has a very foul odor, it may suggest 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 a strong possibility, and it is recommended to avoid giving them excessive cold tea 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, it is important to note that when a child has intestinal inflammation, digestive function is affected. You can help by feeding pepsin or digestive water, such as "Shidele" digestive water. If the child is formula-fed, it is recommended to use a diarrhea-specific formula. If you cannot obtain it temporarily, dilute the milk slightly. If the child is breastfed, the lactating parent should follow a light but nutritious diet and avoid greasy foods. The lactating parent can also take probiotics like Changle Kang, Peifeikang, or Mamiai, which will benefit the child's recovery, as I advocate "treating both mother and child" for diarrhea.
Additionally, 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 as much as possible. If using a cloth, avoid rubbing and instead gently press, as the child's delicate skin is prone to tearing, which can cause severe crying. If the child cries uncontrollably, check if the buttocks are red, as this may indicate 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 have 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 parent.
Complementary foods can be introduced when the child is four months old. Below are some resources I found online regarding complementary feeding:
Infants aged four to six months should not only drink milk but also learn to eat. Initially, you can add scrambled egg yolk to the milk, starting with one-fourth of an egg, gradually increasing to half, then one-quarter, one-half, and finally one whole egg. Rice porridge can be mixed with warm water instead of milk, starting with a small amount and gradually increasing. Vegetable juice and fruit juice can also be provided in liquid form. Once it is determined that the infant can accept mashed foods, you can introduce banana puree, apple puree, carrot puree, tofu paste, egg yolk puree, fish puree, nutritional rice porridge, thick milk cakes (for those with insufficient breast milk), milk congee, fruit vermicelli, rice porridge, etc. At this stage, feed with 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 tons, 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 at the start. It is best to start with one-fourth of an egg per day, observe for a few days, and if there are no digestive issues, gradually increase to half, then one whole egg.
(2) From thin to thick, from refined to coarse: Formula-fed infants can be given juice and vegetable juice after one month. As digestive ability improves and developmental needs increase, you can add rice porridge, milk cakes, soft porridge, fruit puree, fish puree, and egg yolk at four months. Between seven to nine months, you can try adding soft noodles, biscuits, and meat mince. After ten months, you can introduce soft rice, vermicelli, and chopped vegetables. Infants generally progress from liquid to semi-liquid to solid foods.
(3) Introduce one type of food at a time: For example, if you introduce pork mince, do not add fish mince 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 food types only when the infant is healthy: During hot seasons, infants are more prone to digestive issues, so it is generally not advisable to start introducing new foods. Wait for cooler weather to gradually increase. If digestive issues arise during complementary feeding, pause and reintroduce the food in small amounts once digestion returns to normal.
I hope this explanation addresses your concerns.