Is My Baby's Milk Intake Too Low? Urinary Tract Infections

Is the milk supply too low? Urinary tract infection?

Hello Doctor,
I would like to ask you about my son, who has just turned 5 months old.
Since he was 2 months old, he hasn't been eating much.
At 4 months, he weighed 5.5 kg, and now he is 6.5 kg.
Is this growth too slow? Currently, he is bottle-fed with breast milk, taking about 100 cc per feeding, sometimes less, every 3 hours.
He sleeps heavily, so sometimes he misses a feeding, resulting in a total daily intake of around 450 cc or even less.
I read that for children under 10 kg, the recommendation is to consume 100 cc per kg, but he just won't eat more, and if I try to make him eat more, he will vomit.

I have a few questions:
1.
Is his milk intake too low, and will this be harmful to his growth?
2.
Should he drink more water? Recently, he had a urinary tract infection caused by E.
coli, and despite my frequent diaper changes, it still happened.
It's really frustrating because he often has a little stool at the anal area, which causes redness.
The doctor mentioned that his anal sphincter hasn't fully developed yet, and that breastfeeding might be related, but I'm still unsure what to do.
With the urinary tract infection and a diagnosis of hydronephrosis, with one side measuring 10.5 mm, I'm really worried.
Is this due to him drinking very little water? Should he drink more or less water?
3.
Will the hydronephrosis cause problems in the future, and how can we reduce it?
4.
The doctor advised me to retract the foreskin daily for cleaning.
However, after retracting the foreskin, it often has tears when returned to its original position.
Should I continue to do this? But if I don't retract it, there is a white substance inside.
What is the best approach?
Thank you, Doctor.
I really need your advice.
Thank you.

Meizi, 30~39 year old female. Ask Date: 2006/04/12

Dr. Lin Huizhen reply Pediatrics

Dear Dr.
Lin Huizhen of the Pediatrics Department at Tainan Hospital, Ministry of Health and Welfare:
1.
Based on your child's age and weight, they are approximately at the 25th percentile on the growth curve.
Generally speaking, the milk intake is indeed slightly lower, but the required amount is not as much as you mentioned.
Sometimes, children may exhibit a phenomenon of milk aversion.
I suggest introducing solid foods to increase caloric intake.
2.
There are many causes of urinary tract infections (UTIs).
Drinking plenty of water can indeed reduce the chances of UTIs; however, it is important to remember that milk and juice also contain a significant amount of water, not just plain water.
The degree of hydronephrosis should be assessed based on the extent of renal pelvis dilation, not the size of the kidneys.
Therefore, the conditions you pointed out cannot determine the severity of hydronephrosis, and I recommend regular follow-up.
The severity of hydronephrosis is somewhat related to urinary tract infections, and simply drinking more water is not a solution.
3.
Hydronephrosis can vary in severity; if it is mild, regular follow-up is sufficient.
4.
The foreskin should be naturally retracted.
Some children may experience phimosis, which can make retraction difficult.
It is sufficient to clean the urethral area.
If there is a foreskin infection, circumcision may be recommended.
Wishing you good health and all the best from Tainan Hospital!

Reply Date: 2006/04/12

More Info

When it comes to your concerns about your 5-month-old son's milk intake and urinary tract infections (UTIs), it's important to address each of your questions with care and provide some additional context.

1. Is My Baby's Milk Intake Too Low?
Based on the information you've provided, your son is currently consuming about 450cc of milk per day, which is on the lower side for his age and weight. The general guideline suggests that infants should consume about 100-150cc of milk per kilogram of body weight. At 6.5 kg, your son should ideally be consuming between 650cc to 975cc of milk daily. However, every baby is different, and some may naturally consume less. If he is gaining weight, albeit slowly, it may not be an immediate concern, but it is essential to monitor his growth closely. If he continues to gain weight at a slower rate, it may be beneficial to consult a pediatrician or a lactation consultant to explore ways to encourage more feeding or to introduce complementary foods, as he is now at an age where solids can be introduced.

2. Hydration and Urinary Tract Infections:
Regarding hydration, it is crucial for infants to stay hydrated, especially if they have experienced a UTI. While breast milk provides hydration, if your son is not drinking enough, it could contribute to concentrated urine, which may lead to crystal formation and potentially increase the risk of UTIs. The presence of E. coli in his urine indicates a bacterial infection, which can be exacerbated by dehydration. It's essential to ensure he is getting enough fluids, which can include breast milk and, if appropriate, small amounts of water or diluted fruit juice as he begins to eat solids.
3. Understanding Hydronephrosis:
The mention of "water kidney" or hydronephrosis, where one kidney appears enlarged, can be concerning. Hydronephrosis can occur due to various reasons, including urinary obstruction or reflux. The degree of concern depends on the severity and the underlying cause. Regular follow-ups with a pediatric urologist or nephrologist are essential to monitor the condition. Increasing fluid intake can help dilute the urine and may reduce the risk of further complications, but it is not a guaranteed solution.
4. Care for the Foreskin:
Regarding the care of your son's foreskin, it is common for infants to have some degree of phimosis (where the foreskin cannot be easily retracted). Gentle cleaning of the area is important, but if you notice cracks or irritation, it may be best to avoid excessive retraction. Instead, focus on cleaning the external area with mild soap and water during baths. If there are persistent issues with irritation or infection, consulting a pediatrician for advice on proper care or potential treatment options is advisable.

In summary, while your son's milk intake is lower than recommended, it is essential to monitor his growth and consider introducing complementary foods. Ensuring adequate hydration is crucial, especially in the context of his urinary tract infection. Regular follow-ups for his hydronephrosis are necessary to prevent complications. Lastly, gentle care of the foreskin is important, and if issues persist, seeking medical advice is the best course of action. Always consult with your pediatrician for personalized guidance tailored to your son's specific health needs.

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