Baby's Digestive Issues: Formula and Bowel Movements

Infant formula and bowel movement issues?

Hello Doctor: My son is now 8 months old and weighs 8 kg.
He was exclusively breastfed until 6.5 months, after which we transitioned to Nestlé HA2 hydrolyzed protein formula, mixing 4 scoops with 1 scoop of rice cereal and 180 cc of water, feeding him every 4 hours, 4-5 meals a day.
For solid foods, he has been eating brown rice porridge, apple puree, grape juice, etc., for about a month.
His stools have not been formed; sometimes they are loose and watery, and at times they have a strong sour odor, somewhat similar to stinky tofu.
Throughout the week, he has bowel movements about 2-3 days where he has a large stool in the morning, and for the other 2-3 days, he has a bowel movement after each meal.
I am unsure if this constitutes diarrhea.
I have tried adding probiotics to his formula in the morning and evening, but the situation has not improved.
Could this be lactose intolerance? Should I consider switching to a different brand of formula? Thank you!

Zhe Ma, 0~9 year old female. Ask Date: 2005/04/11

Dr. Lin Wenxian reply Pediatrics

Dear Mother Zhe,
Hello! Based on your description in the letter, your baby's weight is within the standard range, and the milk intake is adequate.
Your concern is about the frequency, consistency, and odor of the stools.
In fact, regarding bowel movements in infants, there is a wide variation; it can range from once every couple of days to several times a day.
The consistency can vary from slightly firm to soft, and even somewhat mushy or watery, all of which are acceptable.
It is typically not until around two or three years of age that bowel movement frequency and consistency begin to resemble that of adults.
As long as your baby is healthy, gaining weight, and developing well, you can continue to monitor the situation.
If you are still very concerned, you may bring a sample of your baby's stool to a pediatrician for evaluation.
Wishing you good health and all the best from Tainan Hospital!

Reply Date: 2005/04/11

More Info

When it comes to understanding your baby's digestive issues, particularly regarding formula and bowel movements, there are several factors to consider. Your son, now 8 months old, has transitioned from exclusive breastfeeding to a combination of formula and solid foods. This change can significantly impact his digestive health and bowel habits.

Firstly, the consistency and odor of your baby's stools can vary widely, especially during the transition from breast milk to formula and solid foods. Breast milk is easily digestible, leading to softer stools, while formula can sometimes result in firmer, more formed stools. The fact that your baby's stools are sometimes watery and have a strong odor could indicate a few things.

1. Stool Consistency: The presence of loose stools or watery stools does not automatically mean your baby has diarrhea. Diarrhea is typically defined as having more than three watery stools in a day. Since you mentioned that your baby has a mix of stool types, it may be a normal variation as his digestive system adjusts to the new diet. However, if the stools are consistently watery and accompanied by other symptoms like fever, irritability, or dehydration, it would be wise to consult your pediatrician.

2. Dietary Factors: The introduction of solid foods, such as rice cereal and fruit purees, can also affect stool consistency. Foods high in fiber, like apples and certain grains, can lead to softer stools, while others may cause firmer stools. The strong odor you described, similar to fermented foods, could be due to the breakdown of certain components in the formula or the introduction of new foods.
3. Lactose Intolerance: Given that your baby is on a hydrolyzed formula (Nestlé HA2), which is designed for babies with a higher risk of allergies, lactose intolerance is less likely but not impossible. If you suspect lactose intolerance, look for signs such as excessive gas, bloating, or discomfort after feeding. If these symptoms persist, it may be worth discussing with your pediatrician whether a lactose-free formula might be appropriate.

4. Probiotics: You mentioned trying probiotics without improvement. Probiotics can help balance gut flora, but their effectiveness can vary. It may take time for the benefits to manifest, and not all strains are equally effective for every baby. If you continue to see no improvement, consider consulting your healthcare provider for recommendations on specific strains or dosages.

5. Formula Change: If you are considering changing formulas, it is essential to do so gradually to avoid further digestive upset. Transitioning to a new formula can take time, and it’s best to introduce it slowly, mixing it with the current formula to allow your baby's digestive system to adjust.

6. Hydration: Ensure your baby is adequately hydrated, especially if there are any signs of diarrhea. While babies typically get enough hydration from breast milk or formula, introducing small amounts of water or electrolyte solutions can be beneficial if stools are loose.

In conclusion, while your baby's stool patterns and odors may be concerning, they can often be attributed to dietary changes and the adjustment of his digestive system. Monitoring his overall health, including weight gain, hydration status, and behavior, is crucial. If you have ongoing concerns or if his symptoms worsen, do not hesitate to reach out to your pediatrician for further evaluation and guidance. They can provide tailored advice based on your baby's specific needs and health history.

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