Brief Answer:
Kindly give few more details

Detailed Answer:
Hi XXXXXXX
Welcome to Ask A Doctor service
This is Dr Aslam, pediatrician, to assist you.
I understand your concern

To have a more clear picture of her condition, kindly give me few more details:

1. On Similac, how was her bowel- how frequently she used to pass motion, was there any need for suppositories, was it too hard or painful to cause crying?

2. Was there any abdominal distension, frequent vomiting(some spitting up is normal in thins age) or excessive crying from constipation?

3. How many days you have been trying with the new formulas? Is that she is not at all accepting, or takes but vomits after sometime?

4. What about breast feeding- any feasibility issue or inadequate milk output?

Kindly get back with details, so that I can guide you better
Regards, Dr Aslam

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Brief Answer:
Kindly give few more details

Detailed Answer:
Hi XXXXXXX
Welcome to Ask A Doctor service
This is Dr Aslam, pediatrician, to assist you.
I understand your concern

To have a more clear picture of her condition, kindly give me few more details:

1. On Similac, how was her bowel- how frequently she used to pass motion, was there any need for suppositories, was it too hard or painful to cause crying?

2. Was there any abdominal distension, frequent vomiting(some spitting up is normal in thins age) or excessive crying from constipation?

3. How many days you have been trying with the new formulas? Is that she is not at all accepting, or takes but vomits after sometime?

4. What about breast feeding- any feasibility issue or inadequate milk output?

Kindly get back with details, so that I can guide you better
Regards, Dr Aslam

---

Brief Answer:
Need not worry

Detailed Answer:
Hi dear,
Thanks for the details given.

Going through all details, I feel there is no reason to worry much. I will explain why:

Both infrequent stools and some vomiting can be normal in young babies. We have to differentiate this from pathological constipation and pathological reflux.

1. On Similac: She is having a stool once in 3 days.

It is common for young infants to have infrequent stools. Upto one motion in 7-8 days can be considered normal in this age, provided it is not too hard and painful or cause fissures with blood streaking of stools. Some straining and crying in the beginning can be normal, and need not be worried about. If she cries in pain throughout the process, we need to loosen it by laxatives. For this, we can use Prune juice once in a while. Suppository is better avoided for repeated uses. If pain/crying is not severe, and present only at the starting, we can weight 7-8 days before intervening.
Abdominal distension is significant only if it is progressive, and the abdomen is firm/tender to touch. This is very unlikely in an otherwise happy kid. Avoid Omega 3, 6, 9 in formulas.

2. With new formulas: she vomits after feeds.

See, some vomiting/spitting up is also quite common after feeds in young infants. This may not necessarily suggest formula intolerance. We consider this pathological only if she is vomiting more than half of the feed given at a time, or not gaining weight as expected.

The usual regurgitation happens from physiological immaturity of esophageal sphincter, and will gradually resolve by 6-8 months. Few things can be done to minimise regurgitation: Give feeds in sitting position as far as possible, Do burping for 10-15 min after each feeds, and avoid laying her down soon after feeds.

Regarding changing formula, some babies tolerates some brands/formulas better, which we can not generalise. It is found out by trial and error. Changing may help to improve vomiting/regurgitation, but stool frequency may not improve much. Both Nutramigen and Alimentum are lactose free formulas and better tolerated by most infants. This will be especially useful if there is history of atopy or milk allergy in baby's family/parents.

In short, we need not worry about stool frequency if baby is not in severe pain through out defecation and no progressive abdominal distension. Similac can be continued. We can give Prune juice once in a while. On new formulas also, if vomiting is only occasional & low volume, and baby remains otherwise happy, we need not consider this as feed intolerance.

I hope this answer will help
If you need further clarification, I will be happy to help
Take care

---

Brief Answer:
Need not worry

Detailed Answer:
Hi dear,
Thanks for the details given.

Going through all details, I feel there is no reason to worry much. I will explain why:

Both infrequent stools and some vomiting can be normal in young babies. We have to differentiate this from pathological constipation and pathological reflux.

1. On Similac: She is having a stool once in 3 days.

It is common for young infants to have infrequent stools. Upto one motion in 7-8 days can be considered normal in this age, provided it is not too hard and painful or cause fissures with blood streaking of stools. Some straining and crying in the beginning can be normal, and need not be worried about. If she cries in pain throughout the process, we need to loosen it by laxatives. For this, we can use Prune juice once in a while. Suppository is better avoided for repeated uses. If pain/crying is not severe, and present only at the starting, we can weight 7-8 days before intervening.
Abdominal distension is significant only if it is progressive, and the abdomen is firm/tender to touch. This is very unlikely in an otherwise happy kid. Avoid Omega 3, 6, 9 in formulas.

2. With new formulas: she vomits after feeds.

See, some vomiting/spitting up is also quite common after feeds in young infants. This may not necessarily suggest formula intolerance. We consider this pathological only if she is vomiting more than half of the feed given at a time, or not gaining weight as expected.

The usual regurgitation happens from physiological immaturity of esophageal sphincter, and will gradually resolve by 6-8 months. Few things can be done to minimise regurgitation: Give feeds in sitting position as far as possible, Do burping for 10-15 min after each feeds, and avoid laying her down soon after feeds.

Regarding changing formula, some babies tolerates some brands/formulas better, which we can not generalise. It is found out by trial and error. Changing may help to improve vomiting/regurgitation, but stool frequency may not improve much. Both Nutramigen and Alimentum are lactose free formulas and better tolerated by most infants. This will be especially useful if there is history of atopy or milk allergy in baby's family/parents.

In short, we need not worry about stool frequency if baby is not in severe pain through out defecation and no progressive abdominal distension. Similac can be continued. We can give Prune juice once in a while. On new formulas also, if vomiting is only occasional & low volume, and baby remains otherwise happy, we need not consider this as feed intolerance.

I hope this answer will help
If you need further clarification, I will be happy to help
Take care

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