Constipation

Is my breastfed baby constipated?

The amount and frequency of a breastfed baby’s wet diapers and bowel movements can be valuable indicators of his well-being. However, there is a wide range of normal in infant stooling patterns.

The correct definition of constipation is when a baby experiences hard, dry, infrequent bowel movements that are difficult and painful to pass. Breastfed babies rarely have these types of bowel movements while exclusively nursing.

The First Few Days of Life

In the first two or three days of life, it would be typical for a baby to wet only one or two diapers per day. As the mother’s milk increases, his urine output will increase markedly. A newborn in the first few days after birth will pass dark, tarry stools called meconium, the substance he has stored since before birth. As the baby drinks colostrum, it clears the meconium out of the intestinal tract, so that within a few days stools become softer and much lighter in color. The stools are normally yellow, yellow-green or tan. It’s not abnormal for an occasional stool to be green. The odor should be mild, smell “cheesy” and not particularly unpleasant. The consistency may be described as being similar to scrambled eggs, custard, pea soup, or even prepared mustard. There are often small, seedy-looking solid particles in the stool.

The First Six Weeks

Most babies, after the first few days, have two to five soft bowel movements every 24 hours, until they are about six weeks old. The stools should be as large as a US quarter to “count” in this number. Some babies will have more frequent bowel movements, and it is possible for a healthy baby to have fewer bowel movements. If a baby younger than six weeks has fewer than two bowel movements a day, that can still be a variation of normal provided that the baby has an adequate number of wet diapers, is known to be gaining weight at an adequate rate, and the stools produced are substantial in volume. After the first few days, a breastfed baby should have at least six to eight wet cloth diapers, or five to six disposables, in 24 hours. To gauge the wetness, pour 2-4 tablespoons (30-60 ml) of water on a dry diaper. This is how the normally wet diaper of a young baby feels. It is easier to judge wetness in cloth diapers. If you are using disposables, know that there is a wide variation in brands and types. One brand may not “feel wet” while another may feel soaked with the same amount of urine. It may be helpful to place a facial tissue inside the diaper to help judge wetness.

If bowel movement frequency declines quite rapidly at any age, be sure that your baby is continuing to nurse often (8-12 times a day), on cue and is not relying too much on thumb or pacifier for sucking needs. If your baby sleeps through the night the number of daytime feeds will need to be increased to assure adequate milk intake. Regular weight checks can be reassuring to parents, to assess how their baby is growing.

After Six Weeks

It is not unusual for the bowel movements of a breastfed baby to decrease in frequency when the colostrum, which has laxative properties, is completely gone from the mother’s milk after about six weeks of age. A baby this age may continue to have frequent bowel movements, sometimes even after every nursing. It is also normal for a breastfed baby older than six weeks to have only one bowel movement every few days. Some healthy babies will have only one bowel movement a week. When bowel movements are less frequent, they should be soft, easy to pass, and more profuse in volume. As long as the baby is gaining well (1-2 pounds a month), wetting sufficiently, and is happy and content there is no cause to be alarmed by infrequent bowel movements. It is not necessary to give the baby a laxative, fruit juice, syrups or any other “helpers.” In fact, attempting to force bowel movements can have harmful consequences to your baby.

After the baby is about six weeks old, he may wet only five to six diapers per day, but if so these diapers will be much wetter and heavier. As the baby’s bladder grows, he can produce and hold more urine at a time. To judge wetness of a diaper for an older baby, pour 8 tablespoons (120 ml) onto a dry diaper. That would be considered a normally wet diaper and will give you an idea of what to expect. If at any time you have concerns about whether or not your baby is gaining and growing well, consult your health care provider.

After Solid Foods

Once solid foods are introduced to your breastfed baby around six months of age, there will be many changes in his elimination patterns. The stools will have a stronger odor and different color and consistency. It is normal to find bits of vegetables in the diaper, as even cooked vegetables are harder to digest than many other foods. After the introduction of solids, it is indeed possible for your baby to experience constipation or diarrhea, which are possible clues that he is not tolerating a new food. Some foods with iron added, such as rice cereal or infant formula, could cause constipation in some infants. Be sure to breastfeed before offering solids, to make sure the more nutritious food comes first. For more guidance, read the LLL information about best strategies for starting solid foods. The Womanly Art of Breastfeeding book is a great resource.