Breastfeeding and Constipation in an Infant

a caucasian mother shows off her newborn baby to a nurse while recovering in a hospital bed
A nurse handing a newborn over to its mother. (Image: Photodisc/Photodisc/Getty Images)

Nearly every parent frets about their baby’s bowel movements, or lack thereof. A decrease in the number of bowel movements often indicates constipation in children and adults, so parents naturally despair if their baby does not have a dirty diaper each day. The good news is that babies who are exclusively breastfed are rarely constipated, even when they suddenly stop having bowel movements for long periods. Constipation can indicate a serious health problem in infants, though, so it is important to recognize the signs and know how to treat it.

Diagnosing Constipation

Constipation refers to the appearance of the stool, rather than the number of movements, according to Dr. William Sears of AskDrSears.com. Dry, hard stools or small, firm pebble-like stools, indicate constipation. Constipated infants often cry in pain before and during bowel movements, get red in the face, and pull their legs up to their stomachs, which may be hard and swollen. Streaks of blood in the stool may also indicate constipation, since the hard stool can cause small tears in the rectal wall as it is pushed out.

The Common Culprit

Dehydration is the most common cause of constipation in exclusively breastfed babies. Decreased amounts of urine, saliva and tears, and a sunken appearance of the eyes and soft spot, further indicate dehydration. Normally, by the time the baby is about 6 weeks old, the mother’s breast milk is 90 percent water. So, increasing the number of times the baby nurses may restore hydration. While small, occasional sips of water are safe for breastfed babies, larger amounts of water are unnecessary and can cause an electrolyte imbalance.

Food Allergies

Foods consumed by breastfeeding moms can lead to allergic reactions and, occasionally, to constipation in their babies. Gas produced by reactions to these foods in the baby’s stomach also can contribute to discomfort and fussiness, even in the absence of true constipation. Dairy products made with cow’s milk are the most common culprits, but other foods can cause discomfort, too. If food allergies are suspected, the La Leche League suggests mothers try eliminating or rotating suspected foods in their diets to prevent allergic reactions in the baby.

Rare Causes

If dietary changes do not alleviate the constipation, or the infant is not gaining weight, consult a pediatrician. In rare cases, infant constipation may be caused by a small rectal opening that prevents passage of the stool. Congenital diseases such as Hirschsprung's disease may also cause constipation in rare cases.

When Not To Worry

According to the La Leche League, the number of bowel movements a breastfed baby has can decrease dramatically around 6 weeks of age, and babies may go one to two weeks without having any. This is mainly because breast milk is "formulated" for optimal digestion, so there is less waste to eliminate. In addition, colostrum disappears from breast milk around this time. Without the laxative effects of colostrum, the baby must learn to control his muscles to eliminate stools, which leads to the disconcerting grunting and red faces. As long as the infrequent stools are soft, and the baby is urinating normally, it is unlikely he is constipated.

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