307 – Constipation and UTI

Season Intro and Episode Overview 0:00

Hi, welcome to season three of the baby manual podcast, the holistic mama's handbook. This season will go through alternative and supportive care to help you take care of your little one when they're sick, but too young to take most medicines. I'm your host, a pediatrician and mom, and the author of The Baby Manual and The Holistic Mama's Handbook, Dr. Carol Keim. Hello, welcome to this week's episode of the Baby Manual podcast. Today we're going to be talking about constipation and urinary tract infections, or UTIs.

To start off with constepation, only about 3% of infants get truly constapated. So it's pretty rare in babies who are less than a year old, but then it is a lot more common in older children after the first year of life. Now, if your baby is around a month old, somewhere between four and six weeks, they go through a phase that's called Discoordinate Stooling. And that is a time that a lot of parents think their baby has constipated. So when that happening, the baby's actually learning how to use their muscles to poop, and so they squeeze their belly muscles really tight, but they also squeeze the anal sphincter closed at the same time, then it just builds up a lotta pressure and they grunt,

Understanding Constipation in Babies 1:08

cry, turn red. They look constepated, But it's not anything that they've eaten, it is not really constipation. When the poop finally does come out, its nice and soft. But also their frequency in poops will go way down around a month of age while they're learning to poop like this. So you might notice them pooping initially for the first couple of weeks of life about every time that the eat and then all of a sudden they just stop poop for potentially days on end, could even be a week or more. So it can be a really remarkable change, and they look super uncomfortable, And they are pretty uncomfortable during this phase.

Now, unfortunately, you mostly just have to wait for it to pass, but if you go back and listen to the episode about colic and reflux, You can use a lot of those tricks to help them with the gas at least and help him feel a little bit better. But there's not really anything that you should do to Help them poop at this time, because they just Have to learn how to coordinate their muscles. Now, if your baby is not around a month old or they've already gone through this phase, then they might actually be constipated.

Constipation in babies in the first year of life looks like pellets in a diaper, so kind of like deer poop or tiny little balls of poop that come out. It's really fairly hard. And if you're baby's having this, you should talk to your doctor if they're less than six months old, or if haven't started any solids yet. Once babies start solid foods around four to six months of age, and really the WHO recommends six-months-of-age, the Academy of Pediatrics says you can try as early as four months- of- age with some foods.

And actually, if you go back to the episode of the Baby Manual podcast about feeding, we talk about that a bit more too. But once your baby is starting foods like that, you want to also add in some water. I find that parents who don't give their children water with the foods, the kids do tend to get more constipated around that time. Also, dairy can be constipating. So when children are around a year old, a lot of parents will switch them from either breast milk or formula to cow's milk, or they'll just start adding cow milk in and giving it to them in cups.

And I see a lotta constepation at this age. When some kids get diarrhea from it, cow' milk is pretty irritating to the gut, so it can cause Either constipation or diarrhea, or what I call consturia, it's not a real thing, but alternating consti-pation and diarrhea can happen around a year of age because of the cow's milk. So what we suggest actually, a lot of pediatricians don't recommend milk at all anymore. Your kid doesn't need milk. Milk is a source of calcium, fat and protein and that's in just about any other food that they have.

So just give them water. Water is the very healthiest thing that babies and children and actually even adults can drink. The water is really good for you. If you just start giving water around a year of age and finish up whatever formula you have on hand, if you've got some and then you can switch to water, And if you want to do kind of a gentle weaning with formula, you can start watering it down after a year of age. Up until a, year you wanna make sure you're mixing formula appropriately or just giving breast milk straight.

But then after year, you can start making either of those a little more watery by starting with like three quarters of the formula or breast milk, one quarter water for like a week and then go to half and half, and go three-quarters water and the go full water after that. And that's also a way to get your baby off of bottles around a year of age too. Once you start putting water into their bottles, they don't crave it as much and they're less likely to be eating at night and there also less like that you get cavities.

And it's much healthier for them and for lots of reasons, less risk of ear infections, lesser risk obesity, all kinds of reason to switch to water instead of milk around that age. From a Western standpoint, if your baby is six months or under and they seem to be getting constipated, they're probably a little dehydrated and just need to have more breast milk or formula. We don't add water in before they're eating foods because they can get these electrolyte shifts where they don' t have enough salt and sugar in their blood and it can be really dangerous over time.

So you don t want to be adding water into anything for the first six months before their doing any foods. You just feed them more often. And if they're being underfed, that does cause constipation in young babies. And, if that's not enough to do it, sometimes it can be related to a food intolerance or possible allergies. So talk to your doctor about it if you think that might be happening. Definitely, If you ever see any blood in the diaper, talk with your doctors because that can also be a sign of allergy as well.

When they're starting the solid foods, and when I say solids, I mean things like you can either do purees or you could do baby lead weaning. You want to give about one ounce of water for each ounce food that they eat. And just offer it to them. They don't necessarily have to drink all of it, but they should be at least offered about ounce per ounce water. Again, avoid milk completely until they are one year of age. It's okay to have dairy products. babies in the first year of life to have cheese, butter, yogurt, those kind of things.

But cups of cow's milk are not recommended until at least one year age and really, ideally not at all. Cow's Milk is for baby cows, not for babies humans. And it's not terribly healthy. So yeah, avoiding milk can help with constipation. For children six months and older, you can give more water if they're still constepated. definitely after a year of age, they can have as much water as they would like to drink. And I like having water in water bottles, especially ones with straws. It seems to be really easy for children to drinks out of water bottle, and you can find one, there are all kinds of different ones.

The ones that have like silicone tips or straw seem to easy to children.

Treatments and Remedies for Constipation 7:00

Or you could use cups, it's okay to let children drink out cups around, well actually at any age. Just is pretty messy until they're a little over a year, but cups of water are great. You can also use those special cups that have like sippy cups, you know, that the top is sealed but they can still drink out of it. Any of those are fine and they're all okay for oral motor development as well. It's okay, for children and babies to be drinking out cups with straws or just regular cups. You can use prune juice as a medicine once your baby is six months or older.

And the reason we consider prunes as medicine is it's a very strong laxative. If they're between six and 12 months of age, you only want to give about half an ounce, two ounce at a time, and you want give it straight. Don't mix it with water or anything because the idea of pruned juice is really that it does kind of irritate the gut. It kicks up digestion and it makes everything flush out. If you give too much prune juice, they will get diarrhea. So start with maybe a half an ounce once a day. You can go up to half ounce twice a days in that first six to 12 months and then potentially even go to as much as one ounce at a time.

And then over a year of age, you can do one to two ounces at time of prunes juice. Also, increasing fiber will help with constipation, and fiber is found in fruits and vegetables, in whole grains, those are really good. And we often will recommend what we call the pea foods, which is like peaches, plums, pears, prunes. Those are all really great for digestion and for helping everything go through. They're kind of like rhodorotors for the intestines, they just clean everything out. The things like belly massage, tummy time, especially in younger children and babies, laying on their tummy or just any pressure on the tummy can really help with digestion.

And warm compresses to the abdomen that are not too hot can also help. Now, the one medicine that we typically do from a Western standpoint for constipation is polyethylene glycol, which is Miralax. And the way that that works is kind of like those gel beads that you see that kids get that, you put them in what they start off like little pearls and they like puff up. It's like that on a microscopic level. By the, way, don't let your children eat gel beans. They can actually cause a blockage in the intestines.

But so Mirallax works by absorbing water into it and fluffing up you know it's a powder, it is clear, and it has no taste. So no color, no real texture, maybe slightly slippery texture but very little bit of texture. This is great for children who are over a year of age if they are truly constipated because it doesn't stimulate the intestines it just works physically to pull water into the intestines. And so it doesn't cause them to be addicted to it. They don't become dependent on it to poop. Now that said, some children do need it on a very regular basis.

Make sure if they are having Miralax that they're drinking lots of water because it will keep pulling water in to the intestine and their body can become dehydrated. if their body becomes too dehydrated then there's not enough water to pull and then it just stops working too and can make things potentially worse. So they need extra water while they're doing Mirolax. The dosing is one capful per eight ounces of water or more water. You can also use juice, whatever other type of drink your child would like to drink, but really water is the healthiest thing for them to drinks.

If you are doing juice I always recommend diluting regular juice, not prune juice here, but regular fruit juice. Dilute it down to about half and half because juice has a lot of sugar in it. Even when you squeeze it yourself, you know, make fresh juices, that takes all the fiber out of the plants and then just concentrates out the water, the sugar, and yes, vitamins as well. But there's so much sugar there and you couldn't possibly eat that many fruits as you can put into a glass of juice and drink.

it really is not great to have all that sugar. So water it down to at least half water to juice ratio. The total amount of juice that children are allowed to having a day over a year of age is four ounces total, which is just not very much. If you're doing something like Miralax, hiding it in juice will make it perhaps a little bit more appealing to your child and make them more likely to drink some of it. You can also use tea if you would like to mix that in with. When we start with babies in the first year of life, we started with a half a scoop to a full scoop at a time, and it can be once or twice a day.

And what's really cool about this stuff, it doesn't get absorbed into the body at all, so it is a very safe medicine. It just stays in intestines. but you can essentially titrate it up or down as much as you need to. So if you make, like say, say you a scoop of it in eight ounces of fluid, you could keep that in the fridge and give them a little bit at a time, but typically children will need about half a scoop to a scope once or twice a day when they are actually constipated. So from an acupuncture standpoint, acupuncture can help with constipation.

There are points for that. And then also some Chinese herbs can helps. So if you speak to a Chinese acu-puncturist, that can be really great. They can guide you in terms of what would be most helpful for them. Chiropractic care can also help with constipation. And I've heard pediatric chiropractors joke that pretty much every child will poop after an adjustment, and I have seen it with my own children as well. So yes, chiropractic is really great for constepation, they adjust the low back. Remember pediatric chiropractic, is very gentle, there shouldn't be popping, twisting, with children, they can use a little clicker called an activator, which is a very specific, it looks like a pogo stick.

They just put it on one of the edges of one the bones on the back and click it a few times and it doesn't hurt. If you wanted to find a pediatric chiropractor near you in the US, we have a website, icpa4kids.com, and I'll put that link in show notes as well so you can find that. I do definitely recommend chriopractic for constipation. It seems to really be helpful. From nutrition and supplement standpoint, so again, high fiber foods. You can do fiber supplements. There are fiber gummies that you can get.

But honestly, fruit and vegetables are the healthiest thing that your child can eat. I personally take a supplement that is called Juice Plus, and I also have a link for that in the show notes on my Linktree page. and it's an affiliate link. I've been taking Juice Plus since I was pregnant with my first child, so that's now seven years ago that I started taking it. And what I found when I start taking, all it is is fruit and vegetables that have been turned into juice and then powdered. So it takes out all the sugar and salt when they freeze dry it, and you're left with the fiber that is in there.

It's not juiced like you would with a juicer, it has that fiber in it What I found was that even though I was pregnant, I did not have pregnancy constipation. Like, my pregnancy construction went away completely when I started taking it. And it's just because there's so much fiber in it and also because of all the vitamins in and the really concentrated nutrients of the fruit and veggies. I felt like I had more energy. It really felt good taking. So I've been taking continuously since then. They also make little gummies for children where they use that same powder and they just add in tapioca starch so they are vegan.

and they add in cane sugar. There's no other additives, like there's not artificial colors or flavors. They do put in extra vitamin C into it because that is water soluble and that comes out when they freeze dry it. And there are some probiotics in it as well. So it's really, really great for, I found, at least for my gut, that I feel really good when I'm taking it And my child really likes the gummies. They taste really good. And I sometimes eat those as snacks as well. So if you wanted to go to my affiliate link in the bio as, well, Juice Plus is something that is a direct sales company, so you do have to get it from somebody who's affiliated with the company.

This is the one time I tell you not to on Amazon to look for it, because if find it there, it's either not the real product or it expired or actually illegal for people to be selling it. If you have a friend that does Juice plus, definitely get from them, support them in their local business. If you don't have a friend that gets it and it sounds interesting, you can check out that link in my bio there. But yeah, I'm a huge fan of that in terms of, instead of like, say, fiber gummies that you would get at the grocery store, those tend to have lot of additives in them and a lot like fake things in there that I think are not as good for the gut health.

Really, adding any fiber in will help with constipation. Psyllium husk is something that is another supplement for constipation. The thing with psyllum, so it's a powder that you put into a drink, sort of like Miralax. The downside with that stuff is that it has a lot of texture to it and a little bit of flavor. So it kind of tastes like hay, like dried grass, and the texture of it is kindof gritty but also gooey. It's sort of like jello with sand in it. I had to be on that when I was a kid because Miralex didn't exist yet and it was not pleasant to drink.

you definitely feel it and notice it in your drink and some children do like that so you can also try psyllium. Dried apricots are really good in addition to those pea foods that I had mentioned before. Apricot or any other dried fruits really can help as you know it's just more fiber and children are able to eat more of them. Just be cautious that if you are doing dried fruit that it is really just the fruit in there and there is some sort of a natural preservative like a vitamin C type of preservatives in their or, you know, tocopherols that you'll sometimes see.

Those are healthier and a lot of times dried fruit will have sugar in it. So just check the sugar content on it because you don't want to really be getting too much extra sugar with that. Fruit is naturally sweet and if you can dry your own fruits too, children are able to consume more dried fruits than regular fruits. But again, still fruit and veggies always, number one, if they can get five to 10 servings a day of fruit or veggies and serving is the size of a fistful, then you don't need to supplement typically.

Prebiotics and probiotics are also supplements that can help with constipation. Probiotic are the healthy bacteria or healthy yeast that help to digest foods and prebiotics or the things that feed those. And pre biotics are again typically things like fiber and inulin and things you find in fruit and veggies. And just a reminder too, I also have an affiliate link for supplements in my show notes and that'll give you 10% off of the vitamins and supplements if you wanted to choose any of those. They're all really good companies and again, you don't have to get them from me.

You can totally support your local pharmacy or grocery store. That's great. If you want to order them online, this is a way for you to a discount on those ones. All the brands that are on there, I don't have any specific affiliations with any of those brands with the vitamins and supplements, but they're all really good. They all have research behind them. Actually, Juice Plus also has research back it, which is why I first started taking it. I read all the articles myself to make sure that they were actually done well.

And it's really important to me that when I am recommending something that I'm doing it for a good reason and that it is actually really proven and trusted. So all of these companies that on their and the Juice plus as well are all good companies. great ethics, they have great products as well that actually are what they say that they are. All right, from a homeopathic standpoint, You can speak to a certified classical homeopath about this. Remember that homeopathy is not fully supported by Western science, but one of their principles is that the remedy that a person needs is based on their constitution.

And so for something like constipation, they look at the whole person and things about their personality, their behaviors, and they somehow use that sort of constellation of things to find the right remedy for that child. So there's not like a single You know this one works for everyone type of situation and not a one-size-fits-all approach and so if you speak to a certified classical homeopath or even a naturopath about These alternative and homeopathy treatments. They might be able to guide you a little bit better From an aromatherapy standpoint, there are some oils that can help actually either in a diffuser or rubbed onto the abdomen.

And I saw some really great research for this as well. It was really cool. So things like ginger, fennel, peppermint, rosemary, lemon, and lavender oil. Again, these are all in the show notes if you want to read this. You can put those into a diffuser or they could be mixed with a carrier oil and rubbed onto the abdomen. Remember when you are diluting oils with the carrier, you want to make them very dilute for children because oils are super concentrated and they can burn your child's skin if you put them straight on.

or if they're too concentrated when they are mixed in. Also, none of these should be taken by mouth. Remember that essential oils are too concentrate for children and they very irritating to the gut and so they should not be given by the mouth to children. They could potentially be poisonous. We used to do castor oil for constipation back in the day, like, well, probably more like my grandparents' day. But it's not really recommended anymore either because it is so irritating to the gut and it tastes pretty bad.

What you can do with castro oil is, and actually for any of these other essential oils, you make a warm compress with a, warm wet washcloth and put some of the oil onto that, put a spoonful of oil on to that compress and that onto the abdomen. That can also potentially help with constepation. And then one other thing that really is helpful for constipation is yoga. If you go onto YouTube and just search yoga for construction, you'll find some really great videos and those are actually really, really helpful.

And there's ones that children can do as well. So yeah, check that out. All right, UTI, and the reason I put these together is because one of the most common causes of UTA in children or urinary tract infection is constipation. We can't fully explain it from a Western standpoint, but we just know that children who are constepated tend to also get urinal tract infections. So symptoms of a UTI are frequency, urgency, and dysuria. So what that means, frequency is they're going more often, but only a tiny bit is coming out each time.

Urgency means that it just comes out pretty suddenly without a lot of warning. In children who are potty trained, we sometimes see them having accidents. And in children that are still in diapers, we might just notice tiny amounts of urine in the diaper and it might be smelly as well. And dysuria is pain with urination. So for younger children who are pre-verbal, will see them crying when they pee. It can be hard to assess because babies don't love sitting in wet diapers either. Did they cry just because they finished peeing, or is it because it was while they were peing?

UTI Symptoms, Causes, and Treatment 22:00

So really, the volume of urine will give you a good idea. If it's a normal size pea, it is normal for them to just cry because their wet. But if only tiny bits are coming out each time. and they're crying while it's happening. Or for older children, if they tell you it hurts to pee or they are afraid to go to the bathroom and trying to hold it in, that can be a sign of urinary tract infection. Now for young girls, especially in this under three age group that we're talking about here, They can get irritation or vaginitis and that can cause symptoms like this as well.

And with that, a lot of times like the vulva will be irritated and red and they might still be having these tiny bits of urine. They might be crying or afraid to pee when they go. So if you're not quite sure yet, you can always talk to a doctor, but maybe a first step is just doing a plain water bath, like having them sit in plainwater. See if they're able to pee in the bath because that can sometimes help too when they, even if, they have a UTI, it helps with the pain. But if their having vaginitis, plain-water is the very best thing.

You don't want to be using anything like soap, any creams, lotions, anything. If you are using a cream after the bathroom, do something unscented like petroleum jelly, and that could potentially help with that pain, Young boys also will sometimes get painful urination and actually girls too if their pee is too concentrated. So if your child is a little bit dehydrated, that will cause them to just pee out small amounts and cause it to be painful when they go. Make sure they are drinking lots of water even if they have any of these signs of UTI.

Even if they do have a UTI, you definitely want them to be drinking lots of water to help flush that infection out while they're on the medication. So any of these sort of signs should be treated both symptomatically with things like plain water baths and then also in drinking lot and lots water. Now there shouldn't be any blood in the urine. Typically with a urinary tract infection, there's not any visible blood. And if you do see blood the in urine, that usually means that there is something wrong with their kidneys and you need to go to the doctor right away.

The test for UTI is a urinalysis. And like I mentioned, in addition to constipation causing UTIs, there's a couple of other risk factors. Being in a wet diaper for too long can do it or in wet swimsuit in the summer or tight clothing or sweating. So like, I see a lot more UTs in summer because kids just get, you know, if they have like say leggings on or swimsuits and they just get wet and sweaty. That can cause irritation in that area and can lead to UTIs. And then also bubble baths can do it. We don't fully know why from a Western standpoint, but my suspicion is that soap and bubbles in the bath can also kind of get the particles from the poop to sort of wash around in water and maybe bring it close by.

I don t know. Urinary tract infections are more common in girls, and that's just because the urethra is closer to the anus, we think that that is why, but boys can get UTIs as well. Now for babies that are less than a year old, sometimes the only sign that we see of a UDI or the first sign we that see is that they have a fever. So remember, definitely in the 1st 6 months of life and even up to 1 year of your baby's immune system isn't fully developed yet, A UTI can pretty quickly spread up into the kidneys and then even into bloodstreams.

A fever in very young babies is a serious red flag and you need to go to the emergency room if they are less than six months old and they get a fever. And actually, they're starting to change those recommendations a little. So definitely in the first two months of life, you need to go to the ER. But they are saying now between two and six months you can call your doctor first. They are probably going to send you into the emergency room unless they open and can fit you right in. And they can do a year analysis to check to see if your baby has a UTI.

The Western treatment for UTIs is antibiotics because it's a bacterial infection. In addition to all these other symptomatic things that we recommend, Antibiotics are the thing that are gonna help and make the infection go away. And they usually start to help, like the child starts to feel significantly better by the second or third dose. So if it's the right antibiotic, they feel better pretty quickly, within a few hours. If they are not feeling better or if they have any reaction to the medication, of course call your doctor right away and they can get them switched over to something else.

Make sure you're increasing water intake. Cutting back on sugar, sugar feeds bacteria, so you don't want to give them too much sugar. I would avoid juice while they have a UTI. We used to recommend cranberry juice, but really with cranberries juice there's so much in it. It's sort of a, you know, like the pros and cons kind of are equal there. It doesn't really tend to help. Usually children can't consume enough cranberry juice that it would be helpful, and the sugar in it does, unfortunately, feed the infection.

So we don't recommend cranberries juice anymore. There's a medicine that's called finazopyridine. It's also called pyridiom. These are all names for the same medicine. This is in the show notes too. But this is for older children. Phenazopyridine is actually a dye. It's a bright orange, like a dark orange color, and it makes their pee come out super orange. it will stain anything it gets on, so it'll stain clothes. I'll make the whole inside of the toilet look orange after they go. Kind of looks like blood sometimes because, you know, typically pee is yellow and red plus yellow makes orange but this it's very very orange colour.

Usually I recommend this in older Children because it is available as a pill and they have to be able to swallow pills. but for adults too. And the way that phenazopyridine works is it just kind of coats the urinary tract all the ways from the kidneys down and it numbs it a little bit and so it works like a local painkiller and that can be really helpful for the pain of a UTI. For younger children, you can do things like acetaminophen, which is called paracetamol outside the US, or ibuprofen, and ibiprofens only for age six months and up.

And those can help a little bit with the pain. They're not going to do a whole lot and they're certainly not gonna help as much as the antibiotics are. once the infection goes away. So yeah, it's okay to do acetaminophen or ibuprofen for the first day or two. But again, if your child has urinary symptoms and a fever, you definitely need to get into the doctor quickly because it is a sign that that infection is starting to creep up their urinery tract and could potentially get in to their bloodstream, cause sepsis and be really dangerous.

and then yeah plain water baths to keep them clean or if they're in diapers still you can just use water wipes. I would avoid using anything sunted in that area because the the urethral opening gets really sensitive and irritated and can really hurt to use things like scented wipes From an acupuncture standpoint, yes, acupuncture can help with UTIs and herbs can also help as well. But keep in mind, because it's a bacterial infection, if they're not feeling significantly better in a day or two, then they probably need to see a Western doctor for antibiotics.

If they are having just this urinary frequency and there aren't actually signs of infection in there, definitely acu-puncture is helpful for that. From a chiropractic standpoint, they don't typically work specifically for UTIs. We don' recommend pediatric chiropractic as a UTA treatment. From a nutrition supplement standpoint, again, limiting sugar, limit dairy because it tends to be a little inflammatory, avoid processed foods, because they're inflammatory and then low acidity foods. Things like citrus fruits, orange juice, and things like tomatoes, pizza, pasta with tomato sauce, those are all pretty acidic.

Strawberries are pretty acidic. Those can actually be little more irritating when they are going pee because usually with the UTI, the pH is a bit acidic as well. anything that makes it more acidic can just make it sting a little bit more. You can do cranberry supplements, although the cranberries supplements that don't have sugar in them tend to be pills. And so the child has to take pills in order to do that. Although if you can find a cranberry supplement that is like in a capsule, you could open that into something like yogurt, applesauce, whatever, and give that to your child.

They might be able to that by the spoonful. But remember, cranburys are super bitter and most children don�t enjoy taking them. Probiotics can also help a little bit with the UTI, and then, of course, if they're on antibiotics, it's a good idea to be taking probiotics. You want to take probiotic at least two hours apart from antibiotics so that they are not just getting killed as soon as they hit the stomach, so they have a chance to actually get further down into the gut as that antibiotic is absorbed, then they can kind of continue working.

And you want keep doing probiotcs for several days after the antibiotic has stopped. From a homeopathic and also aromatherapy standpoint, these are typically not recommended for UTIs, mostly because they're just not as effective and UTAs can potentially be dangerous in young children. For adults, you can consider some homeopathy. You can speak to an aromat therapist, but I haven't really found anything that's great from either of those standpoints for treating UTIs and definitely not in children I hope this was really helpful.

Sorry, this is a long episode today. If you check out the Holistic Mama's Handbook, I also have a section on pinworms. And pin worms are the most common cause of itchy butt in children. That's a good one for you guys to check in there. Next week, we are going to be covering two of the atopic diseases, allergies, and eczema. So make sure you're subscribed, stay tuned, And I look forward to talking to you then. Have a great day! Thank you for listening to the Baby Manual Podcast. Please hit that subscribe button below so you don't miss the new episodes as they come out.

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