Dear Lisa,
My daughter is 12 weeks old and has went from one stool a day to many. She was on antibiodics...Zithromax and Flagyl in the last month. Her poops sometimes have mucus in them and she is going up to 10 times a day. I was told to change her formula from Good Start to Nutramigen. She has become extremely irritable since switching her? She used to sleep though the night and is waking up again. Fussy all day long and never used to be.
“Help! Any Suggestions?”
Dear “Help! Any Suggestions?”,
It is very concerning when an infant has such a marked increase in the amount of stools per day, especially when the stool contains mucus. Since your baby’s bowel movement and feeding pattern were previously normal, it would be important to have an evaluation by your Doctor to determine the cause. A common cause for a change in stool pattern as you described can be due to a virus or infection. It is also reasonable to consider your daughter’s antibiotic use as a potential factor. Although Antibiotics are necessary to treat infections, unfortunately they do not come without side effects.
Everyone has intestinal flora or normal germs in their gastrointestinal (GI) tract. These germs serve to fight other microorganisms that enter the GI tract and prevent the new germs from causing an infection. When a patient receives antibiotics, the antibiotics alter the flora in the GI tract by killing the normal flora which is meant to be protective. (1) This makes the patient more susceptible to the invasion or overgrowth of other germs which can lead to infection. Therefore, when a child develops a change in stool pattern after antibiotic use, this alteration in the child’s intestinal flora should be considered.
In treating an infant’s diarrhea, Doctors and Nurse Practitioners may recommend temporarily switching the infant’s formula. Formulas such as Nutramigen are chosen because they are easier to tolerate. The milk proteins are chopped into smaller pieces which makes the formula easier to digest. In some cases a rice based diarrhea formula or soy based formula may be recommended because they tend to bind the stool and slow down the diarrhea. Mothers who are breastfeeding are recommended to continue to do so because the components in breast milk protect the baby.
Lactoferrin, a potent bacteriostatic is abundant in breast milk. This in combination with other antibodies and anti-infective enzymes, found in breast milk helps to destroy the pathogens that cause diarrhea. (2) Lactobacillus bifidus is also naturally present in breast milk. It promotes the growth of beneficial bacteria in the gut and discourages growth of other germs.(2)
Some Health Care Practitioners recommend that children with a diarrhea illness take Probiotics such as Lactobacillus. This recommendation is based on the information from a multitude of studies that show the benefit of supplementing a child’s diet with Probiotics for the treatment of diarrhea.(3) A meta-analysis of nine randomized , controlled studies demonstrated that Lactobacillus is safe and effective in the treatment of children with acute infectious diarrhea, much of which was due to rotavirus.(4)
Because of this evidence that Probiotics are beneficial, scientists are in the process of creating a drink for children who suffer from diarrhea. In order to duplicate the effects of the protective enzymes found in breast milk, scientists have added Lactoferrin and Lysozyme to an oral electrolyte solution. Their research thus far has shown that this new formulation significantly reduced the duration of diarrhea and also reduced the rate of recurrence of diarrhea in children.(5)
Although this information about Probiotics is very promising, it is important to use caution when giving a child Probiotics. The current products on the market today are not approved by the U.S. Food and Drug Administration, which means they are not regulated. Since the manufacturing and labeling is not regulated, a product purchased may not have the ingredients as labeled. In a British study of 13 Probiotic brands, only two contained the ingredients as labeled and the other 11 brands did not contain the listed Lactobacillus acidophilus ingredient, contained extra species, lacked a listed species or included ingredients less than 0ne-tenth of those advertised.(6) Therefore it is important to follow your Doctor’s recommendations regarding Probiotic use.
The Gastrointestinal specialists that I worked with commonly prescribed Probiotics for children with diarrhea. In some cases they recommended them for younger infants if the situation warranted. Even though Priobiotics are considered a good treatment for diarrhea in children, it is important to remember that their long term safety is not known. In addition, Probiotics should not be given to children with diseases that alter their immune system. There have been case reports of immunocompromised children who took Probiotics and became ill with a blood infection.(3)
In regards to your daughter’s condition it is important to have repeat follow up visits with your Doctor in order to monitor her condition. If her symptoms continue, your doctor may need to assess her for dehydration, an electrolyte imbalance or weight loss. In addition, changes in her diet or laboratory testing may be required. In some cases Doctors may order stool cultures, urine testing or bloodwork in order to determine if she has dehydration or an infection. During the follow-up visit it is a good time to discuss the possible effect that the antibiotics may have had on her condition and your Doctor’s opinion of Probiotics.
If your daughter has a fever, vomiting, listlessness, feeding difficulties, is inconsolable, has excessively foul smelling bowel movements, a dry mouth, a sunken soft spot, lacks tears, decreased urine output, blood in her stool, signs of abdominal pain or increased frequency in her bowel movements it would be important to see your doctor without delay.
I hope your daughter has a quick resolution to her symptoms and is back to herself soon.
References:
(1)Rosenthal M. C. difficile is more virulent, more resistant and affecting younger, healthier patients. Infectious Disease in Children. 2006. Aug:35.
(2)Riordan J. A Practical Guide to Breastfeeding. St. Louis Missouri: The C.V. Mosby Company. 1983:36.
(3)Zangwill K. Protecting against rotavirus disease and its complications. Infectious Diseases in Children. The Management and Prevention of Rotavirus. 2006. March:S9-13.
(4)VanNiel CW, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics. 2002.109(4):678-684.
(5)Zavalet N. Abstract #3855.2 Presented at: The Pediatric Academic Societies' Annual Meeting; 2006:San Fransicisco.
(6)Hamilton-Miller JMT, Shah S, Smith CT. “Probiotic” remedies are not what they seem. BMJ. 1996;312:44-60.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice for Infants
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