Understanding Why Breastfeeding Can Cause Constipation

How to Manage Constipation in Babies Who are Breastfed

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How often do babies who are breastfed normally have bowel movements, and what is the definition of constipation in these infants? How can you manage this common concern?

Constipation in Babies Who Are Breastfeeding

Babies who are breastfed can often go several days without a bowel movement. Even though their stool is soft, it may seem like they have many days of no stool followed by a "blow-out." For an older infant or child, going five or six days without a bowel movement would usually be a problem.

In an exclusively breastfed baby who is gaining weight normally, however, this behavior is usually normal. As long as the "blow-out" appears painless, most parents have nothing to worry about.

Definition of Constipation in Infants

In younger infants, constipation is often defined more by what the bowel movements look like than how often they occur.

Younger infants are usually referred to as constipated if their bowel movements are like hard, little pellets, or if they are very large, firm and difficult to pass. Some people also consider an infant to have constipation if his bowel movements have a consistency that is thicker than peanut butter and if the child appears to need to strain to pass them.

Simply straining to pass a loose or soft bowel movement, however, is probably not a sign of constipation.

How Often Do Breastfed Babies Have Bowel Movements?

It's important to note that babies who are exclusively breastfed very rarely get constipated.

After having very frequent bowel movements during the first month or two of life, exclusively breastfed babies then begin to have bowel movements much less frequently. In fact, some breastfed babies only have bowel movements every week or two. In these children, as long as the bowel movements are watery or soft when they finally have them, the child is likely normal and not constipated.

Should You Use Prune Juice So Your Baby Has More Frequent Stools?

Even if a baby has infrequent stools—only once a week or even longer—if he still has a normal consistency there is nothing you should do. Why do breastfed babies have such infrequent bowel movements? Most people believe it is because breast milk gets digested so well that there is not much left over to make bowel movements. Of course, once you start feeding him solid foods, like cereal, that will likely change. At that point, he will probably have more regular bowel movements and they will probably be firmer.

When Are Infrequent Stools a Problem in Breast-Fed Babies?

There are some situations in which it is definitely not normal for a breastfed baby to have such infrequent bowel movements, including:

  • A breastfed baby in the first few weeks or month or life, in which case it can be a sign that he isn't getting enough breast milk to eat. In this situation, the baby would likely either still be losing weight or will not be gaining weight well and may not be having enough full wet diapers.
  • An older infant who isn't gaining weight well, in which case it likely would also be a sign that he wasn't getting enough to eat, has a failure to thrive or has some other medical problem.
  • A baby who has delayed passage of meconium during his first few days of life and who has had problems passing bowel movements since he was born. When this occurs, the infrequent stools could be a sign of Hirshsprungs disease. Hirshsprungs disease is uncommon, affecting only 1 in 5,000 babies. Evidence of constipation in this disease usually appears towards the end of the first month of life.

Treating Constipation in Breastfed Infants

Though constipation is uncommon in babies who are breastfed exclusively, it is common once solid foods are introduced into their diet. At that time, even bowel movements which occur as frequently as every other day could be considered constipation if a child strains or otherwise lets you know that passing her bowels is uncomfortable.

In addition, children who have painful bowel movements may begin to hold their stool (to avoid the pain) causing further discomfort.

The vast majority of the time, this type of constipation is "normal." There are a few medical conditions which can lead to constipation in infants, such as hypothyroidism, cystic fibrosis, and others, but these are usually accompanied by other associated symptoms such as poor weight gain.

Normal constipation in infants is a common reason for visits to the pediatrician. Most of the time, dietary changes can resolve constipation. At first, especially if your child has begun to hold her stools, a mild laxative may be needed to "get things going." Recent studies suggest that preparations containing polyethylene glycol (Miralax) may be superior to some other forms of treatment. Learn more about the management of constipation in infants and the different treatment options available.

Call your pediatrician if you think your child is constipated or is having other issues with his bowel movements.

Sources

  • Gordon, M., MacDonald, J., Parker, C., Akobeng, A., and A. Thomas. Osmotic and Stimulant Laxatives for the Management of Childhood Constipation. Cochrane Database of Systematic Reviews. 2016. (8): CD009118.
  • Kliegman, Robert M., Bonita Stanton, St Geme III Joseph W., Nina Felice. Schor, Richard E. Behrman, and Waldo E. Nelson. Nelson Textbook of Pediatrics. 20th Edition. Philadelphia, PA: Elsevier, 2015. Print.

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