Constipation is uncommon in childhood, particularly in breastfed babies, but it can happen. Breastfed babies tend to have fewer episodes of constipation and diarrhea than babies fed with formula because breast milk is easier to digest than formula.
In older children, constipation is common and accounts for approximately 3% of visits to pediatric outpatient clinics and up to 25% of visits to pediatric gastroenterologists.
A baby may be constipated if he is passing hard stools such as pebbles or if his abdomen is distended. As each baby defecates on its own schedule, the frequency of bowel movements is not always an accurate indicator of constipation.
In this article, we examine the possible causes of constipation in breastfed babies. We also observe the symptoms of constipation in babies and home treatments and remedies.
The American Academy of Pediatrics recommends that babies have exclusively breast milk up to 6 months after birth. During this time, they advise not to give the baby extra food or liquids unless a doctor recommends it. After the first 6 months, parents or caregivers can introduce solid foods into the baby's diet.
A parent or caregiver may notice changes in the baby's bowel habits and the color and consistency of their stool if they decide to change to the infant formula or when they begin to introduce solid foods.
A 2018 study examined the bowel habits of 83,019 newborns in Japan. According to the authors, most cases of constipation coincided with the transition from breastfeeding to infant formula, regardless of whether the woman gave birth vaginally or by caesarean section.
A baby can develop harder stools and constipation after starting solid foods. Certain foods, such as rice cereal and milk, can cause constipation in babies younger than 1 year.
Other possible causes of constipation in breastfed babies include:
- Not having enough fluids.. Fluids help feces pass through the intestines gently.
- Disease. Infections can cause a baby's appetite to decrease or cause vomiting and diarrhea, which can lead to dehydration and constipation. Medical conditions that affect the gastrointestinal (GI) tract, such as Hirschsprung's disease, can cause constipation and other digestive symptoms.
- Retention stool. Babies can purposely avoid having a hard or painful stool, a behavior that doctors call retention. Babies who have diaper rash can also hold back to avoid pain.
- Stress. Exposure to new environments, travel or weather changes can be stressful for a baby. Stress can affect your physical health and can cause a change in stool frequency and possibly constipation.
A woman who is breastfeeding may wonder how her diet affects her breast milk and if her choice of food can influence the digestive health of the baby.
According to the Centers for Disease Control and Prevention (CDC), women do not need to avoid specific foods during breastfeeding.
However, it may seem that babies avoid feeding after a woman eats a particular food. In this case, the woman may wish to refrain from eating that food for a while and reintroduce it later.
Women may also want to limit or avoid caffeine during breastfeeding because small amounts of caffeine pass from the woman to the baby through breast milk.
Experts suggest that most women who breastfeed can safely ingest 300 to 500 milligrams of caffeine per day. Excessive amounts of coffee can reduce iron concentrations in breast milk, which can cause mild iron deficiency anemia in some babies.
Although most women do not need to restrict their diets during breastfeeding, they should aim to eat a nutritious and diverse diet.
Although changes in the frequency of a person's bowel movements may indicate constipation in older children and adults, this is not necessarily the case for babies.
Newborn babies can have multiple bowel movements every day. According to the National Institute of Child Health and Human Development, 3 to 6 weeks of age and older, breastfed babies can have only one bowel movement per week because breast milk leaves a minimum of solid waste to pass through the digestive tract.
Breastfed babies older than 6 weeks can go from several days to a week between bowel movements.
Babies often show signs of exertion, such as crying or reddening in the face, while defecating. However, effort does not necessarily mean that a baby has constipation. Babies can take a while to learn to evacuate.
Symptoms of constipation in breastfed babies may include:
- be overly picky
- crying for prolonged periods
- refuse to feed
- have a hard and distended belly
- have rectal bleeding
- pass hard or bloody stools
- crying during a bowel movement
- experiencing weight loss or little weight gain
Normal bowel habits vary from one baby to another. Parents and caregivers should monitor the bowel habits of their babies and take note of any changes. Doing this can help them decide when they should take the baby to the doctor.
It is possible to treat constipation in breastfed babies at home using various remedies. However, constipation in exclusively breastfed babies is so rare that parents and caregivers can talk to a pediatrician before trying home remedies.
Changes in the diet of a baby who is taking formula or foods other than breast milk can help relieve constipation. Women who breastfeed can also try to eliminate from their diet foods that have an association with childhood constipation, such as dairy. However, changes in a woman's diet may not affect the baby's digestion.
Babies who eat solids may have difficulty digesting foods high in fiber or dairy products if parents or caregivers introduce them too soon.
Fiber-rich foods can also help relieve constipation in babies that can tolerate most solid foods. These foods include:
- whole grains, such as oatmeal or barley
- skinless fruits
Fluids help move stool through the digestive tract. Increasing a baby's fluid intake can also help relieve constipation.
Exercise can stimulate a baby's intestines and help him defecate. However, babies who cannot walk or crawl will require a parent or caregiver to help them exercise.
Parents and caregivers can help relieve constipation by gently moving the baby's legs by bike with the baby lying on his back.
Putting the baby upside down to squirm, reach and play with toys can also stimulate bowel movement.
Parents and caregivers can gently massage a baby's stomach to help try to relieve constipation.
Massage techniques to consider include:
- using the fingertips to make circular movements in the stomach
- gently bend the baby's knees and push the feet towards the belly
- gently sweeping an open palm from the top of the baby's ribcage to his stomach
A warm bath can help relax the baby's abdominal muscles, which can cause stool to pass through the digestive tract more easily.
Parents and caregivers should talk to a doctor or pediatrician if their baby:
- seems distressed or in pain
- has a hard and distended belly
- pass stool with blood
- have rectal bleeding
- refuses to eat
- he has fever
- lose weight or cannot gain weight
- often has trouble defecating
A doctor can diagnose constipation in babies by checking their medical history and performing a physical exam. Rarely, a doctor may order additional laboratory tests, such as a stomach x-ray, to diagnose or rule out other conditions.
If home remedies and dietary changes do not relieve a baby's constipation, a doctor may prescribe a mild laxative or suppository.
Parents and caregivers should never administer these treatments to a baby without first talking to a trained health professional.
Constipation is not common in breastfed babies. It usually occurs as a result of changing to a formula or starting solid foods.
Having rare bowel movements does not always indicate that the baby is constipated. Babies with constipation are likely to expel hard stools shaped like pebbles.
Home remedies can help relieve constipation in breastfed babies. If a parent or caregiver is concerned about their baby's bowel movements and the accompanying symptoms, they should take them to see a doctor.