Increased Bowel Movements in Infants: Causes and Concerns

Sudden increase in bowel movements?

The baby is now over seven months old and is exclusively breastfed.
The growth curve is normal (8.9 kg, height 70.9 cm).
On August 27, the baby suddenly had five to six bowel movements, but they were only small amounts, so I decided to observe (similar to breastfed stools).
Some people suggested it might be due to too much fiber in her diet, and that it would improve in a few days.
However, the situation remained the same, so I stopped introducing solid foods for a few days, but the bowel movement frequency was still about 3-4 times a day.
After a week, I took her to the doctor, who prescribed probiotics, anti-nausea medication (which she did not take), and anti-diarrheal medication (which she took for two days).
There was still no improvement, so we continued to observe.
By September 14, the bowel movement frequency was about 3-4 times, but the stool volume was still low.
On September 15, the baby seemed uncomfortable and cried a bit.
I helped her with abdominal massage and anal stimulation, which resulted in a larger bowel movement that was mushy, but then she had several more bowel movements that seemed to have an unusual color (white-yellow) and no odor.
Before bed, she had a large bowel movement that was dark green and also odorless.
On September 16, we visited a large hospital where the doctor examined the stool and thought it looked acceptable, mainly because the baby's growth curve was fine, and her energy and appetite were good, so we could continue to observe and also do blood tests and stool analysis.
The blood test results are unknown, but the stool sample showed 2-5 red blood cells, 10-20 white blood cells, and 3+ occult blood.

I would like to ask:
1.
Could the baby's situation be related to the fact that I did not puree the solid foods? (I have been cutting them into small pieces for her.
After the increase in bowel movements, I started cooking rice into porridge and making the vegetables even finer, but there has been no improvement?)
2.
What could the results of the stool sample indicate? Inflammation? Active bleeding? Is it necessary to return to the doctor for further evaluation and treatment soon? The doctor scheduled a follow-up appointment for next week.
Thank you!

CY, 30~39 year old female. Ask Date: 2019/09/16

Dr. Xiao Kaiwen reply Pediatrics

1.
It's okay; the complementary foods can be chopped into small pieces.
However, you can also try mashing them a bit (it doesn't have to be pureed).
2.
Based on the stool report, there may be a suspicion of bacterial gastroenteritis, such as Salmonella.
Be aware of some warning signs: including a high fever lasting several days, decreased energy, severe abdominal bloating and pain, reduced appetite, severe diarrhea leading to decreased urine output and dehydration, etc.
If there are none of these warning signs and the child is active and has no fever, you can follow up with the doctor for further discussion.
If any of these warning signs are present, please go to the emergency department of a major hospital immediately.

Reply Date: 2019/09/16

More Info

Increased bowel movements in infants can be a source of concern for many parents, especially when accompanied by changes in stool consistency, color, and frequency. Your baby, at seven months old, is experiencing a notable increase in bowel movements, which you have observed to be frequent but with small amounts of stool. This situation raises several questions regarding potential causes and implications for your baby's health.

1. Dietary Factors: You mentioned that your baby is exclusively breastfed, and you have recently introduced solid foods. The transition to solids can often lead to changes in bowel habits. If your baby is consuming a higher fiber diet, this could contribute to increased bowel movements. However, since you are providing finely chopped foods and have switched to a more porridge-like consistency, it may not be the sole factor. It is essential to ensure that the introduction of solids is gradual and that the foods are appropriate for your baby's age and digestive capabilities.
2. Stool Characteristics: The characteristics of your baby's stool, including color and odor, can provide insights into their digestive health. The presence of white-yellow stools with no foul odor may indicate a change in digestion or absorption. The fact that you noted a change to a darker green stool could be related to the types of foods being introduced or even a sign of bile in the stool, which is normal in certain contexts.
3. Laboratory Results: The lab results you provided show a range of red and white blood cells, as well as a positive test for occult blood. The presence of white blood cells can indicate inflammation, while the presence of occult blood may suggest irritation or bleeding in the gastrointestinal tract. These findings warrant careful consideration. While the doctor suggested observation, the presence of blood in the stool, even if it is not visible, should be taken seriously.
4. Next Steps: Given the ongoing changes in your baby's bowel habits and the lab results, it would be prudent to follow up with your pediatrician sooner rather than later. They may recommend further testing or a more detailed examination to rule out any underlying conditions, such as infections, allergies, or gastrointestinal disorders.
5. Monitoring Symptoms: Keep a close eye on your baby's overall health, including their appetite, energy levels, and any signs of discomfort. If your baby shows signs of distress, such as excessive crying, refusal to eat, or any other concerning symptoms, do not hesitate to seek medical attention.

In summary, while some changes in bowel habits can be normal as infants transition to solid foods, the combination of increased frequency, changes in stool characteristics, and lab results should prompt further evaluation. It is essential to maintain open communication with your healthcare provider and to advocate for your baby's health. Regular monitoring and timely follow-ups can help ensure that any potential issues are addressed promptly.

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