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Dr. Stoll,
I have attempted to do my "homework", before posting this message, by reading the links/archives. My situation and questions...
My 9-month old daughter is suffering from fairly severe constipation. She is eating breastmilk, soy formula, and solids (oatmeal, prune, apple/prune juice, applesauce, carrots, squash, green beans). Each in roughly equal portions.
She began getting constipated a few months ago when we introduced solids. At the time, our pediatrician advised us to use rice cereal, as it is the least likely to be an allergen, and my daughter suffers from eczema. The rice cereal made her constipated, so we switched to oatmeal made with apple/prune juice, prunes and applesauce. She had infrequent (every few days) stools. Now, her constipation is worsening. Yesterday, she was crying/screaming from the pain of an anal fissure which has developed. So bad, that she woke up screaming in pain last night. Her stools are formed, but not hard. Should her transit time be 18 hours, or less?
Our pediatrician recommends mineral oil. Have also read your recommendation of this, as well. Can MO be continued long-term? The bottle says "no". Are there any side effects that we should look for? Muscle tone issue? Pediatrician also suggests Neosporin topically, as it will help with the pain. If this is insufficient, we are advised to use 1% hydrocortisone topically for it's anti-inflammatory properties. Your thoughts??
In terms of sugar-free Metamucil... ...is this appropriate for a 9-month old girl? Why sugar-free, as these contain aspartame, which I thought was bad? If it is appropriate, then how can I get her to ingest it? She does not currently drink fruit juices, and is a very finicky eater.
A friend suggested flaxseed oil. Does this help constipation? I have read many postings on this site suggesting it for eczema, so it may be advised for my daughter? If so, what form, and how to administer?
Thank you in advance for your suggestions.
Thayer
In Reply to: Infant Constipation & Anal Fissure posted by Thayer on August 29, 2000 at 14:44:20:
Hi, Thayer.
POOR LITTLE TYKE!
First of all she has to have LGS and C-RS to have both the constipation and the eczema.
Next, I will bet that the rice cereal was white rice. Refined foods always make C-RS worse. Your health food store has brown rice cereal. You need Beth Loiselle's book (call [800] 870-5378). A knowledgable physician would have her on oral Nystatin. The essential oils would help the eczema while you were dealing with the C-RS.
Remember, the same stuff contributing to this is true of the mother's diet as well so long as the child is breastfeeding.
The fissure complicates this since, even at this age the child quickly learns to withold at the first sign of needing to evacuate. You do not have much time to TOTALLY avoid the pain & prevent the problem of stool witholding!
The mineral oil lubricates and the metamucil makes the bulk softer. The only really safe metamucil is the plain and at this age probably the best. It will take on the taste of whatever you mix it with. HOWEVER, remember that you are treating a serious problem here and if you have to expose the little tyke to aspartame for a while to resolve it so be it. The sugar would encourage the C-Rs so must NOT be used.
About the only thing that will help the pain of the fissure is an anesthetic OINTMENT applied inside her rectum at least a few minutes before a bowel movement. Americaine is the usual one used for rectal problems--available without a prescription. The only problem is that there are a few people who have an allergic reaction to it so watch for a rash around the rectum. The things you have had recommended are basically worthless for what they have been recommended.
Hope this helps.
Let us know what happens.
Walt
In Reply to: Re: Infant Constipation & Anal Fissure (Archive in constipation.) posted by Walt Stoll on August 31, 2000 at 08:55:28:
Dr. Stoll,
Thank you for your insightful reply. I will do more research on your site regarding LGS and CR-S.
I will also look at my local health food store for brown rice cereal. And, since I have not heard of it before, I will also investigate your suggestion of Nystatin. Is this for the constipation, eczema, LGS or CR-S?
My wife and I gave our daughter mineral oil (1 tbsp daily)all of last week. It helped, but I became concerned with it negatively impacting her ability to absorb nutrients. We have discontinued, and now feed her Metamucil (1/4 tsp daily). This seems to have helped a lot, as her stools are much softer and less formed. She is also going more frequently, about every 24-36 hours.
Before I read your thoughts on aspartame vs. sugar, I spoke to our pediatrician. She opinion was that the sugar would be preferable to the aspartame, which is contrary to your suggestion. How does the sugar worsen the CR-S?
Will keep you apprised. Thanks again for your suggestions.
Thayer
In Reply to: Re: Infant Constipation & Anal Fissure (Archive in constipation.) posted by Thayer on September 12, 2000 at 14:41:00:
Hi, Thayer
Dr. Stoll really is expert at this subject. You are very fortunate you found his assistance - sorry for your little one's troubles.
Since I did know the answer to a little of what you asked, I thought I'd write you. The Nystatin is for the Candida. Not using sugar is because of the candida too. Just as sugar will feed the yeast in baking bread, so with the candida. The Aspartame instead of the sugar in this case is probably one of the few times the benefits outweight the risks (not that sugar isn't something we should probably all cut out anyway).
Why would the mineral oil keep her from absorbing nutrients? (I'm just curious)
I hope her LGS will soon be a thing of the past. Best wishes.
June
In Reply to: Re: Infant Constipation & Anal Fissure (Archive in constipation.) posted by Thayer on September 12, 2000 at 14:41:00:
Hi, Thayer.
Listen to June (Thanks, June!)
It would take a year or so for mineral oil to absorb enough fat soluble vitamins from her diet to make a difference. IF she has NO painful stools this problem will be over in 6 months.
Your doc would be more honest to tell you he does not know than to give you an opinion about something he obviously has not studied. We are taught in medical school to never admit to a patient that we do not know something. This is supposed to foster confidence in the doc by the patient. I have not found it honest but most docs do it routinely.
Walt
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