Breastfeeding and Constipation

Question of the Week

A breastfeeding baby
Babies who are exclusively breast sometimes go days or weeks without having bowel movements.. Photo by Tom Fullum/Getty Images

Q. I have some concerns about my 3-month-old grandson. He only has bowel movements every 5 or 6 days. They are not "hard" or difficult for him, but they just don't seem normal to me. It's almost like he has a "blow-out" on some days and doesn't do it again for a long time. His doctor has told his mom to give him prune juice, but he's on breast milk, and of course hasn't started anything else yet. Is this o.k.? Thank you for your help. Buka, TN

A. 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, this behavior is usually normal.

Babies and Constipation

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

So a younger infant would be constipated if his bowel movements were like hard, little pellets, or if they were very large, firm and difficult to pass. Some people also consider an infant to have constipation if his bowel movements had a consistency that was thicker than peanut butter and the child strained to pass them.

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

Breastfeeding and Constipation

Keep in mind that babies who are exclusively breastfed very rarely get constipated.

After having very frequent bowel movements during the first month or two exclusively breastfed babies then begin to go much less often.

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, then they are likely normal and not constipated.

So it sounds like your grandson doesn't need any treatment since it doesn't sound like he is constipated.

In cases like this, I personally don't recommend giving an infant prune juice or doing anything else. Giving extra water, apple juice, or prune juice would be appropriate treatments for an infant that really was constipated, though.

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 likely have more regular bowel movements and they will probably be firmer.

Constipation Problems

There are some situations where 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 either.
  • an older infant who wasn't gaining weight well, in which case it likely would also be a sign that he wasn't getting enough to eat, had failure to thrive, or some other medical problem
  • a baby who had delayed passage of meconium during his first few days of life and who has had problems passing bowel movements since he was born, which could be sign of Hirschsprung's Disease

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


American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics 2012; 129:3 e827-e841

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