Infant Constipation Caused by Breastfeeding

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

Constipation in Breastfed Babies

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 5 or 6 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 considered 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 constipated if their 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.

Bowel Movement Frequency

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 not constipated.

Even if a baby has infrequent stools—only once a week or even less frequent—if they still have a normal consistency, there is nothing you should do.

Why do breastfed babies have such infrequent bowel movements? Most people believe it is because breastmilk gets digested so efficiently that there is not much left to make bowel movements. Of course, once you start feeding your baby solid foods, that will likely change. At that point, they will probably have more regular bowel movements and they will probably be firmer.

Infrequent Stools in Breastfed Babies

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

  • A baby who has delayed passage of meconium during their first few days of life and who has had problems passing bowel movements since they were born can be a cause for concern as infrequent stools could be a sign of Hirschsprung's disease—though this 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.
  • Infrequent stools in a breastfed baby in the first few weeks or months of life can be a sign that they aren't getting enough breast milk. In this situation, the baby would likely either still be losing weight or will not be gaining weight well and infrequent stools would also be accompanied by too few wet diapers.
  • When infrequent stools in an older infant are accompanied by issues with gaining weight, it could be a sign that the baby isn't getting enough to eat, has a failure to thrive, or has some other medical problem.

In all of the above cases, it's always best to keep an eye on your child's symptoms and communicate with your child's pediatrician.

Treatment for Infant Constipation

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 that occur as frequently as every other day could be considered constipation if a child strains or otherwise lets signals that passing their 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 that can lead to constipation in infants, such as cystic fibrosis, but these are usually accompanied by other associated symptoms your pediatrician will be monitoring such as poor weight gain.

Don't hesitate to call your pediatrician if you think your child is constipated or is having other issues with their bowel movements.

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 their stools, a mild laxative may be needed to "get things going."

Recent studies suggest that preparations containing polyethylene glycol (such as Miralax) may be superior to some other forms of treatment. Always be sure, however, to consult your child's pediatrician before giving your child a new medication, including over-the-counter products.

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Article Sources
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  1. Courdent M, Beghin L, Akré J, Turck D. Infrequent stools in exclusively breastfed infants. Breastfeed Med. 2014;9(9):442-5. doi:10.1089/bfm.2014.0050

  2. U.S. Department of Health and Human Services. Hirschsprung Disease. Published September 2015.

  3. U.S. Department of Health & Human Services. Your Guide to Breastfeeding. Updated October 08, 2018.

  4. Gordon M, Macdonald JK, Parker CE, Akobeng AK, Thomas AG. Osmotic and stimulant laxatives for the management of childhood constipation. Cochrane Database Syst Rev. 2016;(8):CD009118. doi:10.1002/14651858.CD009118.pub3

Additional Reading
  • Kliegman RM, Stanton B, St Geme J, Schor NF. Nelson Textbook of Pediatrics. 20th Edition. Philadelphia, PA: Elsevier, 2016. Print.