Babies and Constipation

Any time there's a question related to a baby's health a parent should always talk to the pediatrician about it. Having said that, I've seen so many questions online (on any number of parenting sites) related to constipation in babies it (and based on some of what some people ask), it leads me to think a lot of parents don't really know what's normal for babies. This (besides the fact that there could be a medical reason for constipation) is the reason parents should ask the pediatrician if they think their baby is having this kind of problem.

Like everyone else, a baby's bowel habits aren't always absolutely consistent. There may be a day (or even several days) when a baby doesn't "go". The baby's age is a factor, and so is his diet.

What Parents of Newborns and Babies Under Eight Weeks Need to Know

After your baby gets through his earliest days, when stools still contain material left over from his pre-delivery days, a week-old infant may have 8 to 10 bowel movements a day. By four weeks old, the number of soiled diapers for a breast-fed baby may be reduced to about four a day. A formula-fed baby may average fewer than that, because breast-milk produces less waste.

Babies Eight Weeks Old and Older

At eight weeks old the number of movements generally averages one a day (particularly for formula-fed babies), but some may not go daily. Breast-fed infants can average even fewer bowel movements per day. So, in the first two months a reduction in the number of movements a day can simply be related to the baby's age. Things can change again once solid foods are introduced.

The color of the stool can range from yellow to brown, but even green can be normal.

According to pediatrician, Dr. Alan Greene (Ask Dr Greene.com), after eight weeks formula-fed babies generally average one bowel movement a day. Breast-fed babies may go longer than that. His recommendation, with regard to having your baby seen checked (at least once) by a pediatrician is as follows:

Formula-Fed Babies: If your formula-fed baby seems otherwise fine and goes more than three days without having a bowel movement have him checked by his doctor.

Breast-Fed Babies: If your breast-fed baby seems otherwise fine but goes seven days without having a bowel movement have him checked by his doctor. Dr. Greene points out that it can be perfectly normal for a breast-fed baby to go seven or eight days, as long as the stool is soft when a bowel movement occurs.

Babies Who Have Not Had Solids Introduced: If your baby hasn't yet had solids introduced, and his stool is hard (Dr. Greene offers "firmer than peanut-butter" as a frame of reference) or is foul-smelling have him seen by the pediatrician immediately. Although simply needing more to drink (particularly in hot weather) could be the cause of these problems, they can also be a sign of disease.

All Babies: If your baby appears to be in pain, vomits, or has blood in his stool have his doctor see him immediately.

Questions About Your Baby's Health in General: Particularly when your baby is a newborn, but right throughout his childhood, questions about his health (in the seemingly "minor" ones) should always be directed at his pediatrician.

Any time you have any questions at all, call your pediatrician's office. During business hours and when the matter is not an emergency (or a potential emergency) you can always start by asking the nurse at your pediatrician's office.

Depending on the emergency or potential emergency, either get your baby to an emergency room or call the doctor/answering service for advice. Always err on the side of caution if you're in doubt.

Other General Information About Constipation or "Apparent Constipation"

Babies receiving "extra-iron" formula can appear to be constipated both because the stool may be harder to pass, and because it may appear to have a dark green color. Some babies receiving formula with extra iron can sometimes have a little more intestinal discomfort than other babies or than they would with a "regular" formula.

Something else parents need to know is that a baby whose face turns red and who appears to be straining to have a bowel movement isn't necessarily constipated. Until babies develop enough to be able to isolate which muscles they use for any task they often just seem to use "everything they have" to pass stool.

Straining is generally normal in babies, but crying while seeming to strain may be a sign of constipation.

After Solids Have Been Introduced

Once solids have been introduced a baby's diet can cause differences in bowel movements. Foods like rice cereal can be binding if they aren't accompanied by enough fruit (particularly for a baby who leans toward less frequent bowel movements and/or one who receive iron formula). Much of the time, a simple (and temporary) change in a baby's diet can make a difference. Giving formula without iron in it (for a day or two). Call your pediatrician's office for the "OK" to try this. If your baby has already been eating it, or is ready to have it introduced, strained fruit can help. Applesauce is gentler for young babies. Peaches are another "first fruit" that can help. For older babies/toddlers who have already been having fruit juice, a little extra apple juice can help. Constipation or suspected constipation should not be reasons to introduce foods or beverages your baby isn't already taking. If your child is constipated your pediatrician may prescribe/suggest a stool softener.

Dr. Green recommends a remedy that may have been used by your mother or grandmother: One teaspoon of light Karo syrup in 4 ounces of water. (For anyone not familiar with Karo syrup, Karo syrup is a corn syrup product that was used for years in home-made baby formula, before commercial formula was available.) As with so much advice about dealing with common problems with babies, however, Mayo Clinic's website does not recommend use of Karo Syrup in treatment of constipation in babies. In fact, a 2006 report by the American Academy of Pediatrics raised issues about the fact that manufacturers of corn syrups cannot guarantee products will be free of bacterial spores (although there had been no cases of infant botulism directly linked to corn syrup). Dr. Green addresses the Karo syrup concern on his site, on the following page:

http://www.drgreene.com/qa/karo-syrup

With regard, and due to respect, to the Mayo Clinic's recommendations for helping a baby who has constipation, however; I'm not sure I'm entirely comfortable with some of the recommendations Mayo Clinic offers either (but only because they suggest fruit juice for infants over two months, and beans and prunes for babies older than four months old; and I didn't give my own babies fruit juice until they were well past two or three months old. Because I believed beans and prunes were "on the strong side" for babies, I didn't given my own children beans until they were well over a year old, and I never gave them prunes - because applesauce and apple juice did the job more pleasantly and, I thought, gently, for babies and toddlers. Whether or not I, as a non-physician, am comfortable with recommendations on a medical site doesn't matter, I know. Still, based on the diets of babies I've know (in addition to my own) and based on the fact that babies' digestive systems aren't mature until they're past a year old or beyond; I, personally, would not follow ALL of the recommendations on the Mayo Clinic site (with the ones at issue here having been mentioned above). The only reason I've taken the liberty of including this little section of"editorial opinion" is that I want to offer in this Hub the kind of information I'd offer my own son or daughter if they had a baby and asked for my input. I suppose one day I, too, will become a "wacky grandma" with her own ideas about remedies. For the record, I did not give my three children Karo Syrup, not only because the "controversy" hadn't, to the best of my knowledge, been raised when they were babies; but also because one baby's early-infancy "belly issues" were resolved when the doctor said he shouldn't be on the extra-iron formula; and because all other issues of any of my babies' being "irregular" were associated with having had solid foods introduced (and were consistently resolved with the "extra-apple sauce" remedy).

With the exception of doing something like adding a little more apple sauce for a baby who is already eating apple sauce, or slightly changing the balance of something like rice cereal and fruit (or other slight adjustments to a baby's existing diet), I would not give a baby anything awfully different without first checking with the pediatrician. Over-the-counter medicines, Grandma's strange home remedy, or anyone else's medication or remedy shouldn't be given to a baby. Heed the warnings on over-the-counter products that children under two should not be given the remedy/medicine without the advice of a physician.

Your pediatrician can advise you as to whether or not your baby is really constipated, and s/he can best determine how to treat constipation that is real (and not just a normal situation that has been misinterpreted by an inexperienced parent).

Something else to keep in mind is that cow's milk may contribute to some apparent constipation, either when your baby is switched to it from formula (which is usually cow's milk with iron, nutrients, and other added ingredients) or breast milk; or because he may have some intolerance to it. By the time your baby is old enough to be switched to cow's milk, chances are he's been eating fruits and having some fruit juice, so, again, adding a little more fruit (not bananas) to his diet may help with the transition. If your child seems to be chronically constipated after beginning to drink cow's milk discuss it with your doctor.

Whether your precious baby is feeling absolutely fine or a little under the weather, having you there to make him feel safe, secure, and calm makes every day that much better.  Even when he's feeling a little under the weather, never underestimate the power of your soothing voice and loving arms.