Constipation in Newborn Babies

She was alone seven canicule old. ‘For three days, my babyish has not anesthetized stools,’ the mother said, anxiously. The babyish squirmed in ache and artificial to the point of axis red.

She had been on babyish blueprint back birth. While in the hospital she had anesthetized stool consistently every day, mostly afterwards anniversary feed, sometimes several times a day, until three canicule ago if al of a sudden she chock-full affective her belly and had been mostly arrant and uncomfortable.

While the babyish was on the assay table, and afterwards I had watched and saw how afflictive she was, agee her belly from ancillary to side, I knew I had to arbitrate to abate her of the discomfort.

When to intervene

I don’t consistently accept to baffle with the accustomed action of bowel aborticide in newborns.

When to arbitrate or advice with bowel movement in the bairn depends on a clinician’s acquaintance and the mother’s all-overs level. Where a mother or a babysitter is actual anxious, I tend to arbitrate added readily.

Two options

For actual adolescent newborns, say babies in their aboriginal four weeks of life, there are two capital options accessible to aid with bowel movement. Abdominal dispatch with a thermometer is one option. Inserting a glycerin suppository in the rectum is the additional option. Both procedures are simple to learn.

A glycerin suppository is a anesthetic conception that can be amid into the rectum. If acclimated it can briefly abate stool passage. Glycerin is amid into the baby’s rectum the aforementioned way a Tylenol suppository may be amid to lower fever.

It is important to accomplish abiding the glycerin suppository goes central the rectum. The suppository can be baldheaded down to a abate admeasurement so that it can added calmly be inserted. Usually already or alert a day for a brace of canicule is all that is required. If one suppository does the magic, there is no charge to repeat.

Since I did not accumulate glycerin suppositories in my appointment I absitively to do a abdominal stimulation. What I in fact was searching for was an actual relief. Had I acclimated a glycerin suppository on the baby, she may not accept confused her bowel until she got home, and that would accept been beneath adorable for the mother and the baby.

Rectal stimulation

After answer to the afraid mother my plan, and accepting her approval, I put on my gloves, took out a abdominal thermometer from the ancillary cabinet, and anointed the apparatus with Lubriderm. Vaseline can serve in abode of Lubriderm to anoint the tip and distal allotment of the thermometer. Any being able of demography a acceptable abdominal temperature can apprentice to do a abdominal dispatch on babies.

As the babyish lay on the assay table, base over diaper, I said to the mother, ‘Hold the baby’s legs apart.’

Gently, I alien the tip of the anointed thermometer about one inch into the baby’s rectum, agnate to what a practitioner would do if demography a abdominal temperature. I captivated the thermometer in the baby’s rectum for a moment until she began to advance adjoin it and with it the stool in the rectum.

The babyish connected to accomplish concerted efforts to push, and moments after an barrage of stool came rolling down. Thank advantage there was a childhood in place! Added stools came down if I wiggled the thermometer a little while it was still in the rectum.

The aboriginal allotment of the stool that came down was dry, and harder abundant to accept chock-full the toilet. Fortunately, calm with the basal bedraggled diaper, it was alone into the debris bin. Later, the stool became soft, but kept rolling down for a minute or two. Thereafter the babyish sighed, again smiled and again fell comatose on the assay table. All the physique agee and crunching went away.

‘My babyish is accept now,’ the mother smiled.

Based on my analytic convenance experience, I did not anticipate there was annihilation amiss with the babyish in altercation except that for some acumen she was clumsy to canyon stool. Temporary action was all that was needed.

When I saw them a anniversary later, mother and babyish were blessed and babyish had connected to canyon stool regularly.

What abroad could ache mean?

Many maladies that can agonize a babyish — none of which was applicative in this accurate case — ample a pediatrician’s apperception if confronted with constipated infants. Could it be Hirschsprung, a complete ataxia in which locations of the colon and rectum abridgement the fretfulness all-important to bear stool movement down and out of the rectum? Is it anal stenosis, in which the anal canal, the distal allotment of the rectum, is too attenuated to acquiesce a chargeless access of stool?

What added pediatricians think

Pediatricians alter broadly in the way they amusement contrarily advantageous babies who are clumsy to canyon stool. I batten to a few pediatricians about this accurate case. Some said they would accept done nothing, others said that babies are never constipated, while a few said they would accept waited for seven canicule afore intervening.

The assorted answers are not surprising, back clinicians act based on their experience, ambit and breadth of practice.

Tips on preventing bairn constipation

Consider breastfeeding your newborn. Breast milk may acquire laxative properties, and breastfed babies are beneath constipated than formula-fed babies. No amount whether you accept breast milk or formula, augment babyish actual frequently, on demand—when babyish is arrant due to hunger, and absolutely every 2-3 hours. Follow instructions anxiously while bond delicate babyish formula.

The earlier a babyish gets, the added means clinicians accept of amid during periods of constipation. In my next commodity I will altercate ache in earlier babies and in accouchement as a whole.

The aloft commodity is not advised to amusement or analyze any medical condition. Take your babyish to a pediatrician if you are anxious that he or she is constipated.

Hurricane Harvey and Floods Inspire Humanity, Compassion, and a New Look at Climate Change

The heroic and unselfish response to catastrophic Hurricane Harvey, which hit Texas on August 25, 2017, continues to inspire people to live in a way that shows compassion for their fellow humans. No matter what one’s religion or upbringing have been, one tends to develop empathy for people who need shelter, food, and other special attention. Humans learn to live compassionately by example, especially when they observe unselfish sacrifices made by others who assist people in need. These are the valuable lessons learned from the devastating scenes amidst the storm, those calls for help that we observe both on the ground and on television. Each heroic contribution made by volunteers opens hearts and minds while developing a degree of moral support for the environmental protection groups. In short, concerned people want to make efforts to make this a better world in which to live by finding out how to safeguard their neighbors.

It was inspirational to see the Navy rescuing citizens of Houston as well as others throughout southeastern Texas. Their heroic, humanitarian efforts were so admirable as they responded adeptly to the needs of people in danger. One helicopter saved seven stranded people and then courageously took off again to look for others trapped by the flood waters. The military acted so bravely during the flood although one naturally hopes they will not have to respond to such devastation again in the future.

Neighbors, journalists, foreigners, and people of all ethnicities and religions lent a hand when spontaneously put to the test. A group of journalists risked their lives to save a senior citizen in his car when he mistakenly drove into a deep stream of water. Rather than ignoring a domestic animal in danger, a group of men saved a dog that had been about to drown in the threatening waters. Nursing homes were evacuated while other vulnerable, hospitalized people were carried out by volunteers. Such courage abounded to accomplish great rescue missions!

People in Texas worked together regardless of race, origin, or nationality during the catastrophic event. It was soothing to know that homeless people were being supplied with shelter, with clothes, and with a place to sleep. Seeing others who do good deeds to help people in need encourages viewers to consider how everyone can assist one another. Although most people are too far away to assist in many humanitarian operations, one might consider living in a way that prevents future occurrences of other catastrophic weather events.

Many do not agree that climate change exists; however, the possibility is worth serious examination so as not to put future generations in harm’s way. Providing a fine and free science education for all young people and taking better care of our planet might prevent future tragedies related to climate. By considering these possibilities, we can make a positive difference, even from afar. Moreover, the time has come to re-examine our priorities. Do we really need a lot of material goods? Are we defined by our possessions? Would it be possible to utilize alternative forms of energy so as not to damage or pollute the environment? We can be heroic if we change our ways so as to protect the environment for future generations. We can be heroic if we accept others as they are and assist them in times of need, much like the first responders did in Texas.

Managing Risk at Your Site

There are many risks in healthcare. Many of these risks are so serious that when they occur patients die. As noted in its landmark study To Err is Human in 2000, the Institute of Medicine stated that there were as many as 98,000 deaths attributable to medical error in hospitals in 1997. Since the publication of this study much has been done to prevent these errors and untimely deaths. I believe that it is important now not only to look at preventing these types of errors but also to examine risk in broader terms for the benefit of patients and providers.

Let’s begin by thinking about the question, “What keeps you up at night?’ That is, what errors worry you as a clinician or administrator significantly? Could it be:

  • A patient falling her room after surgery
  • An allergic reaction to a medication in a child
  • The spreading of flu virus at a clinic
  • Patients who are unhappy with the care that they are given
  • The infection of a clinician by HIV or hepatitis

These are just a few of the many adverse events that can cause serious consequences. It is not enough to try to avoid the many risks by trying to do better the processes that are being done. Rather, healthcare providers need to adopt risk management strategies that will help them actively prevent risks and overcome the consequences when adverse events occur.

Risk management like Business Process Management (BPM), a subject of earlier newsletters, is made up of a number of well-defined steps, which include identifying potential risks, assessing and analyzing risks, developing or altering processes to prevent risks, implementing strategies to minimize risks, evaluating risk management strategies and improve processes to further reduce risks.

Identifying Risks. There are many risks in healthcare, as stated above. For most providers there are too many to actively manage. Thus, it is important to identify which are the most important risks to avoid in order to use resources wisely to prevent or minimize risks. If you have identified your most important processes as part of a BPM program, you may want to first consider examining these processes to identify what can disrupt the processes or what can go wrong to produce adverse outcomes. For instance, you may find activating patients in their own care a very critical process and do so by having patients with chronic conditions help create a care plan along with their clinicians. Thus, you will want to examine the joint creation of a care plan by patient and clinician to see what can go wrong.

You may want to identify events defined by regulations as critical risks. For instance, minimizing hospital acquired infections at surgical sites may be critical to prevent since this can cause financial loss for the hospital and potentially serious consequences for the patient.

When identifying critical risks it is important that clinical leadership and administrative leadership be involved and that criteria be established to identify which adverse events pose critical risks.

Assessing and Analyzing Risks. Assessing risks involves calculating the likelihood of an adverse event occurring and the impact or consequence of an event should it occur. Analyzing risks involves examining the conditions that allow an adverse event to occur or to see what can be done to prevent an it from occurring. For instance, as I stated in my May 2016 newsletter, a patient with diabetes has a likelihood of 68% of dying from heart disease. This has been documented by the American Heart Association. The cost for treating diabetics with heart disease is significantly greater than those without. The American Heart Association states it costs $3900 more annually. For providers with risk-adjusted contracts with payers this is a significant consequence, thus a significant risk.

Not all risks can be quantitatively assessed. For instance, what is the financial impact on an ambulatory site if it receives many poor reviews on social media? Some events are so rare that it is very difficult to assess quantitatively the risks. For instance, what is the impact of a patient or relative of a patient bringing a gun into a Level 1 trauma center?

Analyzing risks involves looking at processes or outcomes that allow an event to occur. For instance, providers may have no processes in place to identify which of their diabetics are in danger of developing heart disease. Thus, they take no action to intervene before the patient develops heart disease. Analyzing poor social media reviews may involve using a local business that helps businesses monitor social media posting to identify any negative postings and to identify the causes of the negative postings.

Developing New Processes or Altering Processes to Prevent or Lessen Risks. Prevention is best at managing risks. Thus, after identifying risks and assessing impacts, it is important to design new processes or alter existing ones to prevent an adverse event from occurring. Of course, this course of action should apply to those events which have the most impact. A team of those involved in a process that carries significant risks along with leadership should help in designing new processes or modifying existing processes. Costs should be considered in the new or altered process. If prevention is too costly and the impact of an event not severe or frequent, corrective action may not be pursued. A good example of a new process to prevent falls after surgery, especially in orthopedic units in a hospital, is the use of pressure sensitive devices to alert staff when a patient is out of bed unattended.

Implementing New or Altered Process. Once a team has developed a new process or altered one it should be implemented uniformly in affected areas. This may require training of staff. Implementation should be done exactly as designed.

Evaluation and Continuous Improvement. Once a new process for preventing or decreasing risk is in place, it should be monitored using indicators (kpi) identified by the design team. Evaluation should focus on the degree to which risk has been decreased and the decrease in negative consequences. The evaluation team should also focus on ways that processes can be further improved to achieve greater success in lowering risks.

My personal physician and the medical group of which he is a part believe that Medicare recipients should have annual physicals. I follow his advice. This year after two years of slightly elevated calcium in my blood panel we investigated the cause. We found that I had a dysfunctional parathyroid gland. I had a parathyroidectomy recently to solve the problem. Because of his attention I was able to avoid broken bones and kidney stones. His attention to details and the policy for annual physicals avoided the risk of these occurring. My opinion of my care from him and this group remains very positive.

I believe that outside of meeting regulatory obligations that most healthcare organizations do not focus enough on risk assessment. The effort of focusing on and analyzing risk need not be overly time or resource consuming. If you have a Business Process Management system in place risk assessment can be added to the cycle naturally and pay handsome rewards in doing so.