If you thumb through most books about breastfeeding, you are not likely to find a section on constipation. This is because true constipation in a fully breastfed baby is very rare. In fact, most experts agree that if a breastfed baby is constipated, there is something medically wrong.
Breast milk is a natural laxative; however a breastfed infant may become constipated due to the introduction of foods or formula. Formula in particular is constipating. If you have recently started giving your baby formula, this may be the reason for the constipation. The single best remedy is simply more breast milk.
Reasons for constipation in a breastfed baby:
1. Illness that requires medical care (call your doctor!)
2. Formula consumption
3. Starting solids
Signs/definition:
1. The American Academy of Family Physicians defines constipation as a delay or difficulty in defecation (pooping) for more than two weeks. In a newborn (less than 6 weeks old), the AAFP recommends that parents contact their physician if their infant has had fewer than five bowel movements per week over a two-week period
2. Hard, pebble-like stools
3. Excessive straining and crying in pain. Some straining, grunting, and fussing is normal. Babies are learning how their bodies work. Grunting, straining, and fussing that results in a soft bowel movement is not constipation and does not need to be treated.
Remedy/Treatment for babies younger than 6 months:
1. If you have been exclusively breastfeeding, call your doctor right away. This could be a sign of a more serious problem and your baby needs to be evaluated by your health care professional. Constipation along with weakness, a weak cry, and reduced eating could indicate botulism. While very rare, this is a life threatening disorder and requires prompt medical care.
2. If you were providing formula as a supplement, but mostly breastfeeding, stop giving the formula and exclusively breastfeed. Cow's milk protein is very irritating to a baby's tummy and intestines. Providing only breast milk will help sooth that irritation.
3. If you have been formula feeding, start breastfeeding (if your baby is less than 2 weeks old) or get the help of an International Board Certified Lactation Consultant (IBCLC) to re-lactate. Even if you have never breastfed before, you will most likely be able to produce milk. If breastfeeding is simply not an option for you, use donor breast milk. You can either contact a milk bank (this could be expensive) or you can ask a trusted friend or family member for some of her milk.
Some health care providers discourage using un-processed breast milk since you could be exposing your baby to drugs or illness through the donor milk. However, if you trust this person and their baby is healthy, you most likely have nothing to worry about. This could be a great use for the frozen breast milk of friends who aren't sure what to do with their surplus supply. While you can try an alternate formula, they are not derived from human milk, therefore it is likely the problem will not be solved or could even get worse.
Babies older than 6 months:
1. More breast milk! If you are in the process of weaning, go back up on the number of feedings per day until the problem resolves. Back down on how much food or formula you are giving. See a Registered Dietitian to discuss solid foods that are less constipating for your baby.
2. Time. Usually, constipation will go away without any help from special foods or medications. Although there are over the counter treatments for constipation, talk to your health care provider before using them. Repeated bouts of constipation can be a sign of a more serious problem.
3. If you are certain it is constipation and you have approval from your health care provider, the American Academy of Family Physicians states that "Parents may give infants 1 oz of sorbitol-containing juice (such as prune, pear, or apple) to treat constipation." This should only be given to babies over the age of 6 months.
4. Some health care providers recommend giving corn syrup for constipation. This is not necessary as the other treatment options mentioned will usually work better. However, if you do decide to give your baby corn syrup, put 1 teaspoon in 2 oz. of water. Do not put the syrup directly into formula or pumped breast milk. Corn syrup works by drawing water into the intestines and stimulating the intestine to move stool on through. It is easy to overdo the corn syrup and cause diarrhea and electrolyte imbalance. Both of these problems can be harmful to your baby.
References:
http://www.aap.org/publiced/BR_Medicine_OTC.htm
http://www.aafp.org/afp/20060301/849.html
Julie Morgan is a Registered Dietitian and International Board Certified Lactation Consultant. She specializes in breastfeeding support for the military community. You can learn more about Julie and about breastfeeding at her web site [http://www.brilliantbreastfeeding.com/]
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