Constipation: What is Typical for Babies Transitioning to Solid Foods? with @kidsgastrodoc Rebecca Winderman, MD

Babyledweaning (0s):

Are you about to start Solid Foods, but you don't know where to start? Or maybe you started with some Purees and now you want to make a switch? The best place to get started learning about starting Solid Foods Safely is my one hour online video workshop called Baby-Led Weaning For Beginners, I just rerecorded this free training and it's packed with videos and visuals on how to safely prep babyledweaning Foods, what it looks like for the first few days, how to reduce choking risk, and what to do if your baby has an allergic reaction to food. Everybody on this free training gets a copy of my original 100 FIRST FOODS list, so you'll never run out of ideas about what to feed your baby. Next, you can get signed up for this video workshop at https://babyledweaning.co If you have one hour to dedicate to learning about baby-led weaning. Come take this free online video training and grab your copy of that original 100 FIRST FOODS list. While you're there, again, head to https://babyledweaning.co to get signed up and I hope to see you there.

Katie Ferraro (58s):

I wanna share about a new podcast I've been listening to called Meditation for Moms. So I am a notoriously high strung person. I'm a fast talker. I've never really been able to meditate on my own. So having a guide walk me through these Meditations and the fact that it's geared towards the realities of being a mom has been so helpful. So the Meditation for Moms podcast is perfect. If, you are looking for Meditations for all seasons and circumstances and all the peaks and the valleys of motherhood. The show is a little different cuz it's a podcast that is Guided by a multitude of Moms, each of whom bring their own experience and their gifts and their voice to their Meditations. So today I listen to an episode called Transcend Overwhelm and Restore Inner Harmony, which I really needed because the summer season is really difficult for me.

Katie Ferraro (1m 40s):

I have all my kids at home. We decided not to do camps this year. I'm feeling very overwhelmed by all of it. So I love being able to pop in, listen to an episode, reset and get on with my day. Check out the Meditation podcasts at https://womensmeditationnetwork.com or search Meditation for Women wherever you listen to your podcasts.

Rebecca Winderman (1m 59s):

If your baby's having one poop every four days and it's soft, then it's not constipation babies who are even weaning. Some Babies may have seven poops a day after every feed and you know, and other Babies can go once a week and then it's still normal, it's still soft. A lot of times Babies are started on rice cereal. That's the first thing we put it in the bottle to thicken, which I don't recommend. A lot of times this is their first and only food that they're eating for quite sometimes. So rice cereal can be quite constipating. So the first thing I do is I tell parents, let's maybe switch to oatmeal, baby oatmeal, whatever, oatmeal. That's a high fiber food. That's first and foremost.

Katie Ferraro (2m 37s):

Hey there, I'm Katie Ferraro, Registered dietitian, college nutrition professor and mom of seven specializing in babyledweaning here on the Baby Led Weaning Made Easy podcast. I help you strip out all of the noise and nonsense about feeding, leaving you with the confidence and knowledge you need to give your baby a safe start to Solid Foods using baby-led weaning. So you started Solid Foods your baby finally started eating and swallowing and digesting some of those foods and now your baby is constipated. What gives? My guest today is Dr. Rebecca Winderman.

Katie Ferraro (3m 17s):

She's a pediatric gastroenterologist based in New York City and she literally knows everything about your baby's gut. Now what I love about Dr. Winderman's work is that she uses a holistic and integrative approach in her practice. So she's not one of those doctors that's gonna be recommending like random supplements or jumping right to prescription meds, but rather she analyzes what in many cases in gastroenterology are going to be food and diet and lifestyle related underlying causes to your kids' gut problems. So In, this interview, Dr Winderman is going to set us straight about constipation in infancy after you start Solid Foods, what's normal, what's not, what foods are gonna cause, what outcomes in your baby's stool.

Katie Ferraro (4m 1s):

She's also gonna share that you're gonna see a lot of stuff in your baby's poop, but there's actually only one color of poop that should make you freak out. Dr. Winderman is on social media at Kids Gastro Doc and she's here today to talk about constipation and what's typical for Babies when they're transitioning to solid foods.

Rebecca Winderman (4m 22s):

My pleasure. Thanks for having me.

Katie Ferraro (4m 24s):

I know you're in between meetings, you're so busy. I really appreciate it. We have a lot of great questions, like I have a bunch of questions that parents have been asking me and then I have questions that I personally always wanted to ask a pediatric gut doctor, I know that's not your technical term. Before we get started, could you tell us a bit about your background and how you came to be known as kid's gastro doc?

Rebecca Winderman (4m 45s):

My name is Dr. Winderman. I did four years of pediatric residency and then I fell in love with GI or gastroenterology when this sort of like boom of research that was coming out around gut microbiome and I was like, oh my gosh, it controls everything. And then, you know, the last 10 years we've just had like an explosion of gut microbiome research that's come out and I was like, this is the field I wanna be in. Like I can see this being like a holistic, you know, getting, getting down to like food and diet and lifestyle and all that stuff. And I was like, I was super, I was in, I was in and then I started to do my fellowship and I realized there wasn't a whole lot on nutrition even though it was a gastroenterology fellowship.

Rebecca Winderman (5m 27s):

And then at that point I started to sort of do my own research. I graduated fellowship and I then became the director of gastroenterology at a, at a teaching hospital and sort of took the holistic, you know, food is medicine approach. So I, you know, I'm pretty much known in that area of practice. So you know, very integrative, very holistic. I take a lot of patients off medications so I've definitely found my niche within gut doctor, but that's how I've become known as as kid's gastro doc.

Katie Ferraro (5m 58s):

Wonderful. And do you have children of your own?

Rebecca Winderman (6m 0s):

I do. I have a 10 year old daughter going on 30. She's fabulous. Oh my gosh, congratulations was, she was actually a premature baby. She was 29 weeks and she was fed with parenteral nutrition, so through the IV and we weaned her off successfully. But yeah, I mean she had her own gut challenges as a, as a baby also. So she,

Katie Ferraro (6m 20s):

How long was she on TPN (Toatl Parenteral Nutrition) for?

Rebecca Winderman (6m 23s):

She was on TPN for I think six weeks. It was, oh that's scary. And then scary. That was so scary. And then, you know, we had like a necrotizing enteritis scare and that finally went, came and went and she actually came out pretty unscathed. She's, she's great now. She's, you know, a mile a minute. But yeah, I mean I've, I've helped like a lot of patients that have short gut, I have patients that come to me and see me virtually across the country and the globe that we've really helped to transition them off of TPN even with a short gut. So yeah, that's my mo

Katie Ferraro (6m 58s):

Can she eat all foods now? She has like good gut health gut function.

Rebecca Winderman (7m 2s):

Yeah, she has an age appropriate diet. She loves plants. It's funny, we were at a Thanksgiving dinner and she was like, oh my gosh, brussel sprouts. And somebody was like, what? Like how did you get your kid to, and she was like, it's a plant, it's good for your microbiome. And they were like, what? So

Katie Ferraro (7m 20s):

That is awesome.

Rebecca Winderman (7m 21s):

Yeah, she has it, she has it at home for sure.

Katie Ferraro (7m 23s):

Okay, so I know she's 10 years old and it probably feels like a lifetime ago when she was starting solid foods, but can you take yourself back to when she was approaching six months of age and you guys were starting solid foods, like what were some of the emotions that were going through your mind as obviously, you know, you were probably at that point, I don't know if already practicing or at least interested in medicine or already a doctor, but then like this is your first baby and you're starting solid foods, how did you feel? What did you do? Because that's where most of our audience is right now.

Rebecca Winderman (7m 48s):

Yeah, so and interestingly like I do work with a lot of, most of the families that I work with are coming to me with like the same thing. How do we, how do we get our kids onto Solids? What are so many different recommendations four months, six months? You know, are my baby spitting it out, my baby's having a skin reaction. What are we, what does that mean? You know? So I really help a lot of parents that way. But if I bring myself back to starting Solids, I just remember being like, oh great, like I can give it to her on a spoon. She's gonna take it, it's gonna be great. We're gonna introduce one food every few days. That's how we learned it in pediatrics. And then I started to see, I was like, well what, she doesn't really wanna take it like what? You know, and I was like, maybe a different food. And I remember just being all over the place and not knowing there was no support around it, there was no, you know, baby-led weaning, you know, around for me to sort of bounce off of.

Rebecca Winderman (8m 35s):

So it's definitely a nerve-wracking experience, especially for a first time mom. And I feel those emotions when I see them in my clinic as well. It feels like years when you're dealing with, you know, an an infant, it's like, oh my God this week the, you know, my baby took this and and then the next day doesn't want it at all. Like I just, you know, I remember that feeling of like frustration.

Katie Ferraro (8m 53s):

Yeah, it's like the emotional rollercoaster from meal to to meal. And we try to remind parents like one meal does not make or break your child's nutrition status, right? Like we're looking at long-term habits and if more often than not they eventually learn how to eat food. Like you are tracking in the right direction. Yeah.

Rebecca Winderman (9m 8s):

It's so hard though. I remember as a parent I was like, yeah, but you don't understand.

Katie Ferraro (9m 13s):

Exactly. Yeah.

Rebecca Winderman (9m 14s):

I'd be like, she loved it like that other day and now she's not hitting anything all day shortly. There's something wrong and yeah, and maybe sometimes there is, but patience and, and calm in the home also is very helpful.

Katie Ferraro (9m 27s):

Okay, so nerve wracking was something I heard you say, kind of lack of support. How did you get over the hump to like gain confidence in starting Solid Foods with your baby?

Rebecca Winderman (9m 36s):

I really just paid attention to baby. Like I paid attention to her and her cues. If she was interested in it, I allowed her to explore it, you know, in a, in a obviously an age appropriate way. If she was in a way that, you know, at a younger age, I, you know, obviously mushed it up I grapes, I have trauma over being, you know, a pediatric resident. We had a horrible incident with a baby that choked on grapes, but you know, everything cut up very small, but sort of like a very like laissez faire approach like If, you know, if she was interested I did it. And you know, as a gastroenterologist I see a lot of feeding disorders even in infants and toddlers because you know, you get these like worried mothers and I don't blame them. I, I would start to do that myself where it's like they're playing or whatever and you're just like running after them with the, with the spoon and, and these are the kids that end up in toddler years really starting to have some issues and food aversion.

Rebecca Winderman (10m 28s):

So yeah, little by little and and letting her lead the way,

Katie Ferraro (10m 31s):

We just had Shannon Goldwater from Feeding Matters on in two separate episodes talking about pediatric feeding disorder. And so it's like so wonderful to hear physicians using that term and being aware of pediatric feeding disorders and knowing about referrals and stuff because you make a a good point like you're personally interested in nutrition but more than 90% of physicians in this country have never taken a dedicated nutrition class. And so to find a medical doctor who really understands nutrition science but also like the real life applications of like, please don't stress these Moms out about getting enough iron and I know we're gonna talk about iron today. And so for our audience, like those parents that are listening right now, they've either just started Solid Foods or they're getting ready to start solid foods or maybe they've done a few foods and they're like, oh my gosh, my baby actually started digesting some of these foods and now they're constipated, typical constipation, what can parents expect?

Katie Ferraro (11m 21s):

Like this baby is moving from that weaning period where they were going from a hundred percent of their nutrition from infant milk and now they're gradually getting more nutrition from food and less from infant milk. Why does constipation occur and is it okay?

Rebecca Winderman (11m 34s):

Yeah, so it's interesting I, let's just first define constipation because many parents and myself included when I was in that position, think that you know when when you hear straining that that that may be Constipation. So let's just define constipation as hard stool. If your baby's having you know, one poop every four days and it's soft, then it's not constipation. I know it sounds crazy, but babies who are even weaning, some babies may have seven poops a day after every feed and you know, and other babies can go once a week and then it's still normal, it's still soft. And so it's really about the consistency. So that's just straight out. And then yes, you're right this period of time this Weaning starting Solids is a very, very typical common time for babies to start having some constipation hard stools.

Rebecca Winderman (12m 20s):

Why does that happen? So you know, a lot of times babies are started on rice cereal. That's the first thing we put it in the bottle, the thick in which I don't recommend. A lot of times this is their first and only food that they're eating for quite some time. So rice cereal can be quite constipating. So the first thing I do is I tell parents, let's maybe switch to oatmeal, baby oatmeal, whatever oatmeal that's a high fiber food. That's first and foremost. The next thing that we, you know, when we talk about why, you know, ba Babies in this phase often have Constipation, you also have to realize like they're coordinating digestions the first time Babies are actually having to digest whole foods. And so sometimes, you know, motility isn't all there for every, everybody, we all have different motility.

Rebecca Winderman (13m 4s):

And so Babies sort of developing that gut motility and learning how to, you know, digest the foods, break them down. Sometimes they have bloating, sometimes they're gassy and it's sort of just like challenging the gut to figure out exactly how quickly it should move, how much it should be digesting. And so sometimes what'll end up happening is it'll just be slowed down. And so it's just a factor of like, you know, maybe not what they're eating and maybe just the development that stage that they're in. So that's one reason. And the other reasons, you know, obviously being, so we spoke about food, rice, cereal being real, people are really happy on that. And I would say, you know, the next thing is is motility and then you know, another thing to consider and while I say motility, I'd like to just actually get this out in the clear that moms should know exactly to the tea that their baby has pooped within the first 24 hours of life.

Rebecca Winderman (13m 57s):

If a baby has not pooped within the first 24 hours of life, 95% of babies pooped within the first 24 hours of life, that 5% have an increased significantly increased risk of something called Hirschsprung's disease, which is a congenital disease of motility, meaning that their end of their colon does not contract and will not allow stool to come out. So the thing that I always ask parents and sometimes like I don't even remember like did my kid poop in the first few? Like yeah,

Katie Ferraro (14m 25s):

I feel like you got a lot of other stuff going on. Like I got this baby out and then If you like immediately within the first day have to start worrying about stuff. This is crazy

Rebecca Winderman (14m 32s):

And it's not the end, it's, it's forever. Yeah. So just making sure you know for a fact and, and If you don't know for a fact you can always get your medical records and should from any hospital whe where your child was born. So motility food and, and yeah I would just say, you know, paying attention to different foods in general about what baby's eating, everyone's a little different. So I always ask parents to keep a journal and a log like what constipates one may not constipate the other. So you know, it's just sort of challenging that that time in in their, you know, GI tract of development.

Katie Ferraro (15m 3s):

I don't wanna put words in your mouth, but I wanna hear it from a gastro pediatrician doctor, constipation is not an indicator that your baby can't digest that food. Is that true?

Rebecca Winderman (15m 14s):

Yes, and the same is true about looser stools during this period of time. Like my go-to and I know it's so annoying for parents is like if your baby is gaining weight and growing and developing appropriately, what we have on our hands here is likely not disease. It could be annoying, it could be, you know, spit up. So I hear a lot also like it's, it's a laundry problem, it's an annoying problem but it doesn't necessarily mean your gut is not functioning appropriately. So, and that's especially true if let's say we introduce a little bit of of pair of juice or a little bit of p prune juice and the baby poops normally then we know it's diet related and, and sometimes I do that challenge while waiting, you know, to figure out,

Katie Ferraro (15m 54s):

Oh I have a very well curated question for you about the juice because that freaks parents out. So thank you so much for explaining the typical constipation and like what you can expect. Can you talk about problematic constipation? Like what are the red flags that we wanna be looking out for to know if the Constipation the baby's experiencing is not that run of the mill that you would expect with a gradual transition to solid foods? Like how do we know if it's maybe something more serious?

Rebecca Winderman (16m 18s):

Yeah, so you know, that's something to definitely keep track of and, and red flags I would say for sure are, you know, stools that are, you know, very black like we call them tar stools and that that is something to be concerned about. I would also say like stools that are so big that are sort of ripping the, the rectum or you, you see bright red blood streaks around it. That's, I would say something that's abnormal. And then any sort of constipation that we can't work around with diet is, is a problem like the, you know, but I would say 98% of constipation, like I could probably this today I could walk into my waiting room and say, you, you, you, you, you, you, you all of you eight month olds, you all are coming for the constipation situation.

Rebecca Winderman (17m 5s):

Let's talk about it.

Katie Ferraro (17m 6s):

Hey, we're gonna take a quick break but I'll be right back.

Katie Ferraro (18m 0s):

And I wanna point out that the eight month thing is of interest because even though you start solid foods at six months of age around there you guys, plus when your baby's showing the other reliable signs of readiness to eat because it's such a long process for the baby to learn how to eat, you're not always gonna see the constipation right off the bat cuz they're not actually chewing and swallowing anything. But about eight weeks into starting solid foods is when it really starts to click for babies and that's where they're actually starting to get some more dietary fiber in their body and they're getting these different proteins and compounds and you will see the constipation. So I love that you identified the eight month olds as the ones where this is really going to kind of crop up.

Rebecca Winderman (18m 37s):

Yeah, a hundred percent. Yeah. And they're also, you know, coming obviously off of formula at this point. So you're really seeing, now we're talking about diet exclusively almost in in the, in the setting of constipation, right? We're no longer relying on fiber in the formula for that anymore. You're really exclusively relying on whatever baby takes by mouth. But yeah it doesn't need to be juice. But I, what I like to do is I like to just give like let's say two to four ounces for a week and then if they can stool normally, okay we're not dealing with disease now we just have to tweak diet around a little bit. That's just a sort of like rule out for me.

Katie Ferraro (19m 8s):

Okay and I feel like I can ask you this cause I know you do a ton on social media too, like anytime you mention juice parents are like, oh my gosh that's child abuse y AAP says absolutely no juice for Babies prior to and like yes across the board we want your baby eating fruit and not drinking it. But we do know that certain types of fruit juice because they contain a naturally occurring sugar alcohol that these types of fruit juice promote motility. So If you get stuck a little bit of apple or a little bit of pear or a little little of prune juice, is that the end of the world if parents need it for Constipation management.

Rebecca Winderman (19m 39s):

So I would say for parents that are hesitant around having, you know, fruit juice, you know giving that juice, you know, off the shelf, there's always a way to do it. You can blend it, you can juice it yourself, you can cut it up into little, little tiny pieces you can, you know, mush it around. The one thing I will say with the Purees is a lot of times people take the skins off before they puree it. And so I would just recommend throwing the skins into the, you know, food processor, not ever giving anything with skin directly to, to a child. It's a choking hazard because

Katie Ferraro (20m 9s):

You're getting that you again and it's apple pear and prune that just have slightly higher levels so they, they will promote more, more motility. We're not talking about feeding your baby oranges or orange juice here and you know, grind up the skin.

Rebecca Winderman (20m 19s):

Yeah, I wouldn't recommend actually eating Prunes themselves even though some of them are very, very soft. But If you can blend them in the food processor and give them, you know, by by mouth that's final. So, but they're a little difficult to manipulate and

Katie Ferraro (20m 30s):

I Prunes are wonderful but again, no sticky dried fruits for babies because they don't have the strength of their muscles yet to clear those from the roof of their mouth or the sides. But you can make a prune puree so easily you guys and I'll, I'll share a really easy homemade apple prune puree recipe with you in the description and the show notes for this episode. Make it yourself. It makes a great substitute for jelly too. Like If you have older kids and you peanut butter and jelly, I love homemade prune puree because you don't have any added sugar in it. You can get it nice and thin, do it off of a preloaded spoon or out of an open cup. Your baby's getting the prune. But If you also just like wanna resort to prune juice every now and then. It's not the end of the world. Now can you talk about like if you're relying on this like daily cuz some parents are like, ooh I gotta do the Prunes every single day or my baby won't have a bowel movement.

Katie Ferraro (21m 12s):

That's a little bit of a a bandaid I would say instead of maybe addressing the underlying problem while your baby's never pooping, right?

Rebecca Winderman (21m 18s):

Yeah, the same thing. So first of all, I just also wanna say, you know, many people are tempted to, to put suppositories and all that stuff. I, I do not recommend that so I just wanna get that out of the way. But If, you feel your baby's dependent on any one thing to stool, I would say see a gastroenterologist because no matter what any function If you need something to function, it's an issue you're having dependence on it, we need to sort of figure out, yeah it's a bandaid. We need to figure out what is going on underneath that, that bandaid that's really not allowing baby to poop. Now in general, food is not, it's difficult to become dependent on food when we say it's a stimulant, it's not a true chemical stimulant that a drug dose stimulant that we would talk about to st stimulate bowel contractions and produce a stool.

Rebecca Winderman (22m 2s):

But I would just say this, I would say start with you know, once every few days and see how it goes, right? Like everything needs to be adjusted for every baby in a little bit of a different way. And I think paying attention to baby is so important and they will tell you and their stools will tell you, keep in mind though what you're feeding that day, you may not see in stool until 48 hours after depending upon how frequently your baby stools. So try your best. I know it's hard to not make any real changes obviously unless there's a huge, you know, reaction or emergency or something. But try to hold off on, you know, throwing everything at at the sink. You know like for me I always call it like Russian roulette.

Rebecca Winderman (22m 43s):

Parents come in and they're like, and I tried this formula and that formula and this and da da da and I was like, how long did you try a week? I'm like, oh okay. I mean that, you know, Babies need some time to sort of get a adjusted to it. We're just introducing brand new things to this, you know, little body.

Katie Ferraro (22m 58s):

I have seven kids, I have a singleton, a set of quadruplets and a set of twins and by the time I got to my twins it's like you've seen a lot of things. I'm not a medical doctor but I have also like taken children to urgent care because they're so constipated and their abdomen is so distended and I can tell that this child is not being themselves and they literally just give you a suppository and then I was like hold up like I can buy this over the counter myself from a drugstore and not saying that you need to use it all the time, but like I have found on occasion for a six month Weaning period, a baby might benefit from a suppository once or twice. Again not relying on it every single day but like do you recommend that parents have suppositories on hands or at least know what they are? Cause like they just send you a massive bill after urgent care and all they did was give your kid an over-the-counter suppository.

Katie Ferraro (23m 42s):

Which like just blew my mind.

Rebecca Winderman (23m 44s):

I also deal with it on my, as a patient I'm like oh my god, is this how it is? Like I don't see any of that when I see patients I just see the, you know, my front front facing you know, system. But yes, okay suppositories, why I don't like them is because Babies actually can become pretty dependent on them once in a while. Okay, but the question really is If, you got to the point that you needed a suppository, what happened before then and then you know, how long did we wait for that? And then also I never wanna get to that point but so if I'm working with a parent, I, I always say If, you feel you need that reach out. I mean I'm a different kind of doctor. I give 'em my phone number to patients my like the one my mom calls on like yeah just text me, we'll figure it out.

Rebecca Winderman (24m 28s):

But you know, I would say sooner than giving suppository because they really can become dependent on those, you know, if somebody has a motility issue, a diagnosed issue, they need some, some patients need it and, and then, but I wanna diagnose that first. I don't wanna, I don't wanna, you know, If you find yourself using suppositories every week. We have something to talk about. Can you give it once in a while? It's not recommended by our society. You know what I do sometimes say is like If, you can put some Vaseline and not even go up but just like stimulate around like the little tush area Like that in and of itself can be very stimulating and can help Babies push it out. But the suppository I don't like cuz they force contraction oftentimes contract so much that they're pushing out a large amount of stool that wouldn't usually come out at that time all at once.

Rebecca Winderman (25m 14s):

And you can have some like tearing of the mucosa of the rectum. So I have to say no to the suppositories. Okay, but

Katie Ferraro (25m 22s):

Great, great segue into into the MiraLax question because we have parents who are like routinely like mixing MiraLax in all their babies' food and I'm like are you getting very reliant on MiraLax? At which point, you know, it's just like I used to work in older adult nutrition and they freaking love Metamucil. It's like hey Metamucil is an insoluble fiber, all it does is help like with your gut motility, let's address the underlying problem of why you need so much Metamucil. Cuz your diet, your exercise, your fluid is off if you're relying on that every day, is MiraLax like the equivalent of that for Babies?

Rebecca Winderman (25m 51s):

So that's a great question. So first of all, MiraLAX should not be given to any baby under the age of one. That is, I mean hands down for me a recommendation. I mean If, you need MiraLAX for your baby to stool, you need to see a pediatric gastroenterologist, there's something going on there. So I would not recommend that. But when it comes to dependency, I mean I get this question a lot like I have to agree with you about the adults. Like it is not a given that as you enter a certain age, like all of a sudden Constipation becomes a normal thing. Like Constipation is never a normal thing and you know, we gotta adjust somewhere, include something, movement, anything for that. So and and the same holds true for Babies, right? Like we can adjust, we can work together, we can work on, you know, so many different things before we do any sort of suppositories or MiraLAX.

Rebecca Winderman (26m 35s):

So let that out of the way. But when it comes to dependencies, you know the reason that so many gastroenterologists love MiraLax is because again it is an insoluble fiber but it's also just something that will soften the stool. So it just brings in water, it will not make your baby poop so it doesn't have any motility aspect to it and that's why everyone loves it. You, there's no way to become dependent on it. And in fact when we talk about a l even getting a little bit older or even getting to like potty training years, I don't know if this is at all your population but it will be all of your Babies will become potty trained. So that's a different thing we're talking about because those kids you, you can even withhold through MiraLax, you give a a kid a whole bottle of MiraLax and they can withhold so it's good and it's bad.

Rebecca Winderman (27m 18s):

We can use it long term because of that and then it doesn't always help us as a result of that.

Katie Ferraro (27m 23s):

Hey, we're gonna take a quick break but I'll be right back.

Katie Ferraro (28m 38s):

And I love that you mentioned that a lot of pediatric gastroenterologists, they do love MiraLAX and like instead of addressing the underlying diet stuff like I love that you do have kind of the food is medicine and the holistic approach because you get the importance of the Foods that we're eating and and if again if we're reliant entirely on white rice cereal, which you talked about it, you know essentially being a refined white carbohydrate with absolutely no dietary fiber in it from an arsenic standpoint, we know that every major health body recommends against regular use of rice containing foods for babies because of the potential for arsenic toxicity, a heavy metal. So there's lots of reasons to do variety and so I teach this a 100 FIRST FOODS program where we help Babies eat a hundred different foods before the time they turn one and parents will say, you know, from time to time you guys heads up you're gonna see some remnants of these foods in the baby stool as their guts learning how to digest some of the newer foods.

Katie Ferraro (29m 25s):

You mentioned it briefly like don't go throwing everything in the kitchen sink and switching everything up. But is there any concern when you see for example, corn in the stool or like bright red stools after the baby eats beets, like parents freak out especially the beets cuz they think it's blood but like the corn in the stool or the other Foods in the stool, is that problematic?

Rebecca Winderman (29m 44s):

No, it's actually a great thing. It means your gut's working perfectly well. In fact, you know the that's you kind of almost are should be, you know, reassured when you see something like that it shouldn't scare you. It should definitely be like all right my baby's gut knows what to, what to throw out, what to keep and that's good you know a lot of times like I said, your gut is really developing, it's, it's learning how to digest and while it may not digest it well, it went through it, you know, it shot out whatever it didn't need. Baby's still growing. Now I would say this If, you start to see like mucus oily stools. Then I would say, you know, let's take a look. Let's see, there may be some digestion issues there, but in terms of Solid whole Foods, I'm okay.

Rebecca Winderman (30m 24s):

They're gaining weight, they're doing okay, perfectly fine.

Katie Ferraro (30m 27s):

You mentioned the tar stools earlier and I think a lot of people who had a baby are familiar with this cuz If, you took a prenatal vitamin, had iron in it, you inevitably had some degree of Constipation and your poop turns black for Babies who are on iron supplements. What sort of changes in the stool can parents expect to see?

Rebecca Winderman (30m 43s):

I'm so glad you asked. So yeah you can see black stools and not only that If, you go to test them for blood in the stool, they will test positive which is also a very scary thing, right? Because that's what we're concerned about when we see tari black stools is we consider what we call an upper GI bleed or a bleed from above, you know in the stomach area because as blood goes down it gets digested by the GI tract and it becomes black. And so when we see tari stools we think, oh gosh, there's an upper GI bleed, we test it for blood. And so the, when patients are on iron many times they'll have black stools and then we'll test it and we'll be like oh it's a cult blood positive, you know, baby's having a bleed, it's a problem. What I always say is, you know with those situations is If, you can hold off on the iron for one or two days and then test If you're looking to test for blood.

Rebecca Winderman (31m 32s):

It should usually be negative if that's the case. But yes, lack stools can happen when you're on iron but take a picture because we really appreciate that when you bring them in.

Katie Ferraro (31m 42s):

That's what we say about allergic reactions. We take all the pictures you guys and document things too cuz I know you think you're gonna remember but especially If, you're concerned or state of heightened awareness slash panic like you might not actually recall all the details. So taking pictures and documenting these things is important. I wanna ask you if I can ask a few questions that our Instagram followers asked when I said that I was interviewing you and we're talking about Constipation, they have a couple really good questions. Alice w wants to know do Probiotics help for Babies?

Rebecca Winderman (32m 10s):

So Probiotics do not help for most case scenarios and I don't recommend them. I recommend having probiotic rich foods. I recognize that most kids will not eat fermented foods but certainly kafir, certainly yogurt, most yogurts have it. We don't recommend it. We used to think that it may be at best was not, was not helpful, but we've actually seen case reports of babies getting toxic or septic from 'em.

Katie Ferraro (32m 31s):

Can I tell you how refreshing it is to hear a medical doctor who does a lot of social media not recommending supplements like probiotics, like thank you very much for having integrity in nutrition and medicine because unfortunately a lot of your colleagues do not and they recommend blanket things across the board instead of acknowledging foods that are naturally rich in probiotics And also the fact that the variety of foods you're offering your baby, that's the prebiotics, that's the food that's feeding the good bacteria. Don't go messing with a good thing you guys.

Rebecca Winderman (32m 59s):

Yes and you we need to teach our gut have like a balance of good and bad bacteria. Your gut knows what to do a hundred percent and I know exactly what you're talking about, you know, and I always tell parents, you know the health industry out there is a billion trillion dollar industry and the chances of you actually needing one of those supplements is so low that I would recommend against any of it unless your doctor has recommended it like vitamin D or iron. I would say that's the only ones I recommend.

Katie Ferraro (33m 25s):

And Jayzk92 wants to know, can you share more about what the different colors of baby's poop mean?

Rebecca Winderman (33m 31s):

Most of the time all different kinds of colors. Green, yellow, brown, even sometimes if it's a little red, like you said with beets, as long as you know your baby had beets and it's not a recurrent problem, all of that is normal. The one kind of stool color that is absolutely 100% never normal is clay colored, pale colored, gray colored stool that is indicative of a liver problem and that is an absolute emergency. So that's my bit on stools.

Katie Ferraro (34m 2s):

Toro13 wants to know is nugget type of bowels normal? This is typical for our seven month old unless we feed a banana

Rebecca Winderman (34m 9s):

Time to feed more bananas cuz nuggets stools, little pebbles are usually constipation. So you know have a banana or incorporate.

Katie Ferraro (34m 17s):

Is it true that If you do like let's say your baby has nugget, nugget, nugget like pellet, pellet, pellet, but then it's followed by a big soft blowout like problem erase problem gone, right? Like the soft blowout is the indicator that we've moved on

Rebecca Winderman (34m 28s):

A hundred percent you're basically a gastroenterologist,

Katie Ferraro (34m 32s):

Stop it, you're basically a dietitian. Okay, heater114, how long is too long between poops? My baby is super gassy but can go days between poops. This is for a seven and a half month old.

Rebecca Winderman (34m 43s):

Yeah, so like, like we said, soft stool is good stool so as long as baby's soft some baby stool once a day, some baby stool once a week. As long as it's soft, I'm okay with it Any more than like seven days though I'm, I'm like all right, we gotta take a long blood

Katie Ferraro (34m 57s):

That BLW parents' mind the seven days thing cuz they're like what I know, I know but really like clinical constipation isn't it like longer than seven days? That's when you would start to worry and that's when most parents are like, oh maybe it's only been three days.

Rebecca Winderman (35m 9s):

Yeah I know. Well the thing is like right there are people you can stool every day and still be constipated. If you're having a little pebble every single day, then that doesn't count as a stool, right? So that's something to keep in mind. Also, the frequency is not as big of a deal to me as it is the consistency.

Katie Ferraro (35m 22s):

All right, how about duration? Because Samantha J. Reyes is saying how long should Constipation last while we're introducing solid foods?

Rebecca Winderman (35m 30s):

Oh that's a great question. Well as long as you're introducing a lot of variety of Foods, you shouldn't really be experiencing Constipation for too long.

Katie Ferraro (35m 38s):

Toddlers can still be constipated, especially if they adopt like your typical toddler's sad brown diet, right? Like

Rebecca Winderman (35m 45s):

Yeah, yeah, I mean think, I mean Babies are obviously not little adults but I mean I I in general they're pretty resilient and If you change diet around, you'll find that, that the Constipation will acutely go away. But yeah, like chronic, I mean then we're gonna hit potty training then we hit school age. I mean these are all Constipation, you know, it's a, it's a party, it's a Constipation party. So,

Katie Ferraro (36m 4s):

Okay Alice w another question. She's seeing mixed information online. Shocking. Is yogurt and sweet potato good or bad for poops?

Rebecca Winderman (36m 13s):

Yeah, it really depends, right? Like If, you have a cultured yogurt, like a highly cultured yogurt, then that would be good for Constipation because you're introducing, you know, Probiotics in there that can help break down things. If you're introducing highly processed yogurt, it's mostly milk, cow's milk, right? And that can worsen Constipation when it comes to sweet potatoes. Sweet potatoes blended with the skin are excellent for constipation as are sweet potatoes without the skin. They're an excellent source of fiber but be careful because they get stringy and you can choke on them. So I would say only pureed.

Katie Ferraro (36m 46s):

Hey, we're gonna take a quick break but I'll be right back.

Katie Ferraro (37m 59s):

Another question about iron Foods. So how do you best serve iron rich Foods and not be constipated? Maybe you could talk about the difference between supplemental iron and food-based iron

Rebecca Winderman (38m 9s):

In general. I'm really against adding, you know, supplements they, you know, to diet. So you know, the only time I say that is like, you know, vitamin D probably across the board and obviously if you're breastfeeding exclusively, there's certain clinical scenarios where like, yes, breastfed in exclusively you get vitamin D, let's move on. But you know, if a, if a baby's severely anemic, yeah I'll give iron, you know as a supplement comes as a liquid, you know like we were saying can cause black stools. But yeah I try to really give iron rich Foods and so when we talk about that like there are, you can puree like green spinach into stuff that ha, that's iron rich and you know we talk about also different forms of banana. I always get this question too like is banana good or bad for Constipation?

Rebecca Winderman (38m 49s):

So you know a ripened banana, you can throw that in there, it's so sweet you can throw it in with anything. So dark leafy greens like I would, I puree them with like the most like off like going off bananas like it's crazy like I mean you wouldn't believe and and it's delicious. So yeah I would say I always focus on dark leafy greens.

Katie Ferraro (39m 8s):

Oh this is wonderful. Thank you so much for answering everyone's questions and tell us, okay, where can our audience go to learn more? Cuz like I think people that like gut stuff are like, wow, I need more Dr. Winderman in my life.

Rebecca Winderman (39m 19s):

Yeah, I need more of them in my life. I love patients that are motivated. It's awesome. You guys teach me a lot too and I love when people come to me and they're motivated, they Google, everyone hates Dr. Google. I'm like, oh my god, really? Where do you find it? That's great. Let's, let's take a look. You can find me on every platform. I'm on Instagram, TikTok, YouTube, Facebook, LinkedIn and it's @kidsgastrodoc. And I have a website, https://www.kidsgastrodoc.com/ and I, on that website there's a blog section and there's tons of information, tons of articles I've written out about various kids GI stuff. So feel free I read all of my dms also, not everyone does that like I guess I need a personal assistant but I don't have one yet so I'll answer.

Katie Ferraro (40m 4s):

Okay. Dr. Winderman, any parting words of wisdom parents who are just like, oh I'm just starting solid foods, my baby is having constipation. What's like the one thing that you want them to keep in mind as they walk away from this interview?

Rebecca Winderman (40m 16s):

I would say easy. Does it take a deep breath. We only have to get through today. We focus on Tuesday and then we focus on Wednesday. The truth is Moms are more of doctors than I am. You know, you guys are the ones that spend so much time, so just, just, you know, pay attention to baby, they'll tell you what's going on and you're doing a great job. You're here, you're listening. I mean you, you guys are amazing and and this is what it's all about. So easy. Does it?

Katie Ferraro (40m 42s):

Thank you so much. It's been wonderful chatting with you.

Rebecca Winderman (40m 46s):

Likewise, thank you so much.

Katie Ferraro (40m 48s):

Okay, that was one of the longer guest episodes I've done in a while. All numbers point to and everyone who helps me with my podcast is like you need to do shorter episodes but I can't when you have someone that interesting like Dr. Rebecca Winderman and she is just in the zone about babies and pooping like I had, so I ended up asking her so many more questions that were on the original question list, but like she was super cool and rolled with it and I'm so glad that she got to answer all of your guys' questions from Instagram as well. Her social media is good. She's online at https://kidsgastrodoc.com, I really, really like her vibe. I like that she is food-based, plant-based. She's straight up about, listen, I'm not gonna tell you to go buy a bunch of random supplements and I mentioned it in the interview, but like that's pretty random these days, especially for a lot of even credentialed healthcare providers that are working in social media.

Katie Ferraro (41m 36s):

So she's definitely one to check out. If you like evidenced-based information about your kiddo's gut. And I stayed on with her for like a little while even after the interview and I was like, do you mind? I'm so annoying, but like If you mind if I ask you a question about what of my kids' gut things? And like she can not only speak very eloquently about Babies, which that is a, a good majority of the kids that she sees in her practice, but she does bigger kids stuff too. So I think she's definitely worth someone keeping an eye on because your child's gut stuff will progress as they get older and a lot of it is diet related, but she blew my mind with what's going on with one of my kids. I had no idea. And so she's a wonderful practitioner, such a warm person, so full of knowledge. I hope you guys will go check her out and support her work. I'm going to link to all of Dr.

Katie Ferraro (42m 18s):

Winderman resources on the show notes page for this episode, which you can find at BLW podcast.com/348. A special thanks to our partners at AirWave Media If, you guys like podcasts that feature food and science and using your brain. Check out some of the other podcasts from AirWave. We are online at https://BLWpodcast.com. Thank you guys so much for being so heavily invested and listening for like literally almost an hour about Constipation. You're the best. See you next time.