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News from Baby Medical Q&A, Issue #026
November 01, 2008

New Questions and Answers

Question: My daughter was born with Jaundice. She has had problems with her bowel movements from day one. But now she's 2, and she still constantly has bowel problems, to the point that she crys every time she gets blocked up. She is a very healthy eater, eating lots of fruits and veggies, and she drinks plenty of water and milk.

I've been through all the steps that her doctor has directed me to do; I've tried the fruits, and the laxatives, and I'm starting to get concerned that it may be something with her intestine...and i'm not possitive in how to go about addressing it with her doctor.

I was hoping that maybe you could give me a little advice as to what MAY or MAY not be ailing my daughter with this problem, so that I could address it properly at a well check visit. I dont know enough to present technical information to the doctor to explain what kind of tests I'd like him to run on her to make sure that everythings okay...if there's anything you could do to help me figure out a way to get this taken care of for her that would be wonderful thank you.

Answer: Most children with constipation do not have a medical problem but have had a bad experience of passing a hard painful stool and then they try to withhold stool leading to constipation - it can take a while to clear.

If you are having no luck with laxatives, either you need to change the type or increase the dose. I often give an agent to disimpact (empty) the bowel to start with.

See Toddler Constipation and related pages.

If your daughter passed meconium (black stool) within 24 hours of birth, then a bowel problem is extremely unlikely. If your daughter had delayed passage of meconium beyond 24 hours of age, then your daughter may have an obstruction due to Hirschsprung's disease and review by a pediatric surgeon is warranted.

I don't think the jaundice your baby had after birth is relevant to the constipation if she is now developing normally. If your daughter seems slow in development, a thyroid function test would be appropriate.

Question: My 3 yr old has bright red bloody stool and dark purple blood clots. He has more blood in his stool than poo. What could this be? I need help and answers.

Answer: If the blood is just new and your son has been crying with abdominal pain, this could be intussusception and you need urgent medical care.

If this is not an acute problem (ie/ it has been going on for a while), then I would first want to know that your son didn't have a bleeding disorder (you can find out with a blood test). The other thing that I would want investigated is whether your son has a Meckel's diverticulum which might need surgery. Ask to see a pediatric surgeon.

Question: My understanding is that 4 month olds generally sleep 9hrs to a full night. Is this true for breastfed babies and what can i do to encourage my baby girl to sleep longer hours? at the moment, she is waking up approx. every 3 hrs!!!

Answer: Every baby is different and so it's not unusual for a 4 month old baby to wake every 3 hours, although it could be quite exhausting for you.

I would try and encourage a longer feed before bed so your daughter sleeps a bit longer. You could encourage a longer feed by making her wait for a short while before the last feed before bed, so she's a bit hungrier and drinks more.

It sounds as if your baby is only taking 3 hours worth of feed - she could probably manage at least 4 hours worth of feed but she is in the habit of 3 hourly feeds. You need to try and make her used to waiting a little longer - as long as you have good milk supply and she is growing well.

Question: My infant son(7wks old) was just diagnosed with thrush in the mouth. Nothing in his diaper area. He has had a hoarse cry sporadically for the past couple of weeks. Is it a possibility that this hoarse cry could be an indication that he has thrush on his esphagus? and if yes, does it mean that he could have a weakened immune system?

Answer: It would be unusual for a baby to have thrush in the esophagus is there is a normal immune system. It is likely that, if your baby is otherwise well and growing normally, that the hoarse cry is just related to a virus or even a floppy larynx that will sort itself out.

See your doctor if your baby isn't thriving or there are other problems but if there aren't then I think the most likely thing is that your baby has normal immunity and does not have thrush of the esophagus.

Thrush in the mouth and diaper (nappy) area in young babies is common and is not an indication of poor immunity.

News and Updates

Umbilical Granuloma

For those of you who have missed ezine questions on this topic, here is my latest update on treatment on umbilical granulomas.

An umbilical granuloma is a bright red moist swelling on the umbilicus (belly button) seen in some newborn babies after the cord has detached. Most umbilical granulomas will resolve eventually without treatment.

Treatments that can be tried for umbilical granuloma include the following:

  • Salt - put a pinch of table salt on the granuloma, cover with a piece of gauze for 10-30 minutes, then remove with clean warm water and gauze. Do this twice daily for 3 consecutive days
  • Alcohol wipes - Wipe the granuloma with an alcohol wipe at every nappy (diaper) change for 3 days
  • Silver nitrate - this is my least favorite option as it can cause burns on the surrounding healthy skin. If your doctor does use this treatment, put some vaseline on the skin surrounding the belly button (umbilicus) to protect it.
Whatever treatment you use, it is important to keep the granuloma dry - folding over the top of the diaper (nappy) may help.

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