[sbaglio]

I have to say, the way I approach this is drastically different from the way I did before I became a parent. That being said, my patients still loved me, so I guess I must have been doing something right!

I've walked in your shoes. DD is 19 weeks old now and doing great, but we went through 3 formula changes, glycerin suppositories, prune juice, gripe water, Mylicon, mechanical maneuvers, and plain hoping on a prayer.

If I look back now, I truly believe that she would have been fine had we just kept to one formula and waited things out. I always advised my patients not to change formulas, as this can really cloud the picture. What did we do when our child was bloated and shrieking at 3 am? Run to CVS and buy a different formula. I chucked my own advice. Hey, you live and learn, right?

What I've learned (now not only from books, but also from experience) is this:

- Congenital lactase deficiency is EXTREMELY rare. Kids may become transiently lactase deficient with sloughing off of the villi of the intestine after acute gastroenteritis, but this is not often the case in an otherwise healthy 2 week old. The whole "lactose free" or "lactose reduced" thing in the formula world is largely just marketing.

- When you see an improvement, it's hard to tell whether it is due to true pathology (e.g. MSPI) or just your infant maturing. We were so busy trying things and changing formulas, that we kind of forgot that DD was growing and maturing, and that maybe the improvements we saw were just due to her, and not due to all the various interventions.

- Young infants cannot coordinate well the sensation to push stool out (contracting the abdominal muscles) with the sensation to allow the stool out (relaxing the pelvic floor muscles). It takes them many weeks to do this. Have you ever seen your infants struggle for hours, making you think he/she is constipated, only to finally see very soft stool come out? That's why.

- As aclee said, if the stool is not hard, and comes out soft, it is not likely constipation. See above.

- Stooling patterns can vary wildly. DD started off stooling with every feed (on Good Start), then went to every 3 days (on Isomil), and now poops daily (on Gentlease). And the colors are wild too. Again, if the stools are not hard, constipation is way down on my list.

- Gassiness is real. Babies' suck reflex is also immature for the first few weeks, and they swallow a lot of air in feeding, leading to bloating and discomfort. Start off with a bottle that reduces air (we used Dr. Brown's, which worked great), try Mylicon, burp after every few ounces of milk.

Just my own tips. Obviously, you should see your own doctor about your concerns.