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Newborn and Infant Care

Infant pain before bowel movement or feedings

02/02/2007

Question:

Any help you could offer would be greatly appreciated. I`m having a very difficult time getting help from our pediatrician. I`m really deperate for some sound advice from an expert because it`s very hard to see my infant in pain. If you could offer any assistance I would greatly appreciate it. My daughter is 6 weeks old and here is what is going on:

For her first two weeks she was fine and drinking Enfamil Lipal with DHA ARA. At around two weeks old she started fussing really bad and crying (almost in a scream and sometimes tears :( before a bowel movement. This would usually last for less than 5 minutes and she would pass a soft stool. But this happens every time she has a bowel movement. The Dr. tested her stool for blood and it was negative. She tells me that maybe she is just afraid to go. It seems like its more than that though. Sometimes the fussiness and pain occurs after an ounce of milk too and she will fuss for usually five minutes then calm down. Under her doctor`s advice we switched formulas from the Enfamil LIPAL to SOY and soy seemed to cause more discomfort. Now she is on Nestle Good Start Supreme. For the first week it seemed to really help, but now a week later she is still having the pain before a soft stool. So this has been going on for about four weeks. The symptoms are similar to Infant Dyschezia, but I wasn`t sure since they have lasted longer than a week.

Again, please, if you could offer any advice or suggestions I really would appreciate it. I just want my baby to be comfortable again. Perhaps I should try another formula or get additional tests.

Thank you so much for taking the time to read this!

Answer:

I do appreciate how distressing this situation is for you and the whole family. None of us wants to see our tiny baby in such distress.

The symptoms you describe certainly do suggest dyschezia. While it seldom lasts more than 2 weeks, it does occasionally last longer in individual infants. It is extremely reassuring that there is no blood in your baby's stool. This makes it very unlikely that your child has stomach ulcers, diverticula (outpouchings of the bowel that can twist or become infected), as well as common problems of twisting or telescoping bowel.

If your baby was not already taking Good Start, that is the formula I would have suggested. If lactose intolerance runs in your family or severe food allergies, you could try a lactose free formula.

It is definitely not a good idea to resort to oral laxatives or rectal stimulation with suppositories or rectal thermometer insertion to encourage stooling. This results in dependency on external stimulation.

If irritable bowel syndrome, ulcerative colitis, Crohn's disease, or bowel motility disorders run in your family, it is likely a good idea to seek consultation with a pediatric gastroenterologist.  If serious food allergies are prevalent in your family, this usually requires comanagement by a pediatric allergist and gastroenterologist. This really is your next step even if these disorders are not in your family's history.

My best guess is that the problem will resolve on it's own, especially if your baby is growing well, not spitting up a lot, sleeping well (4-6 hours of sleep at night), and developmentally normal. At this age, you should note longer periods of alertness, social smiling, improving head control, and great delight in interacting with others.

However, for your peace of mind, seeking a referral to a specialist would be my suggestion. If the problem does resolve, you can always cancel the appointment.

I hope things are better soon.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University