MS, RDN, CDN
Allison is a registered dietitian who holds a Master’s in Nutrition and Physical Fitness. She also loves helping families get creative with their wellness choices.
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When it comes to bowel movements in exclusively breastfed children, there is a wide range of normal. You might think and speak about the color, frequency, and consistency of stool more than you ever thought possible. It’s important to notice what your baby’s ‘normal’ is, so that you can tell when your little one shifts into constipation or diarrhea.
In the first few days of life, your baby may only have 1-2 soiled diapers. The first stool to pass is called meconium, a thick and dark tar-like substance your baby had stored up during pregnancy.1 Within about 3-5 days when your mature milk begins to come in and your baby begins to eat more, stools will become more frequent, typically 4 or more per day, and will look like a seedy yellow or have a slight green tint.2 Normally, breastfed baby’s stools are soft and sometimes fairly runny.3
Most babies tend to poop less as they get older, while some continue to stool after every time they eat. During growth spurts, your little one may go several days without pooping.4 However often your baby poops, they’ll be considered normal and healthy as long as baby’s stools are soft and a normal color.5
It can be easy to mistake the common soft and loose stools breastfed babies pass for diarrhea. Changes in your baby’s stool, like more stools per day than usual, multiple stools per feeding, or very watery stools, can indicate diarrhea.6
Diarrhea can occur due to a virus, parasite, antibiotics, or a reaction to changes in mom’s diet.6 Some believe that diarrhea may occur due to teething or nasal congestion, but research does not support this.7, 8
If your infant does have diarrhea, usually it will not last very long and will resolve on its own.3 However, it’s important to track color, frequency, and consistency because one of the consequences of diarrhea may be dehydration. Infants are more susceptible to dehydration, so be on the look-out for symptoms of dehydration should diarrhea last longer than a few days.
According to the National Institutes of Health, signs of dehydration in babies include:
It is important to continue nursing frequently if your baby is experiencing diarrhea to help keep them hydrated.
If your infant is under 3 months and has diarrhea; or your child (at any age) has diarrhea along with blood, mucus, pus, or continuous vomiting, contact baby’s pediatrician.
Read more: Acute Diarrhea in Older Babies and Toddlers
Constipation is extremely rare in healthy exclusively breastfed infants. When passing stool, it is completely normal for your baby’s face to turn red, grunt, or make other noises.5 Your baby’s abdominal muscles are still weak so they must work harder to have a bowel movement.10 As they become older and their muscles get stronger, they’ll be able to pass stool much easier! These noises are common and do not necessarily mean your baby is constipated.
The introduction of solid foods is one of the most common times for children to become constipated because the digestive system needs time to adapt.5 Also note that a change in stool, such as it becoming firmer and less frequent, is normal when introducing solids.11 Adding in some formula may also cause constipation.5 And occasionally, an iron supplement with higher amounts of iron may cause constipation in an infant.10
Your baby may have constipation if his bowel movements are small, hard, and dry. The consistency of the stool is a better indicator of constipation than the frequency.
Other signs of constipation include:
If your baby’s constipation is accompanied by vomiting, blood in stool, a swollen abdomen or weight loss, contact the pediatrician.
For more information on constipation in older children or in formula fed-babies, read: Constipation in babies and toddlers.
Continue breastfeeding, as nursing can help keep your little one hydrated. If your baby is older and has started solids, you can also offer additional fluids such as water.
*If your baby is between 6 and 12 months, the only additional fluid that is recommended is water, and only a few extra ounces per day is needed.12
Being adequately hydrated can also help improve constipation as well.
If you’re still noticing signs of dehydration or constipation even with continued nursing, contact your child’s pediatrician.
Read more: Is Your Baby or Toddler Adequately Hydrated?
Occasionally babies will react to something in their mother’s breastmilk, and this may sometimes cause diarrhea or constipation.6 Certain foods in mom’s diet can also affect the stool color, but this is normal!
If you’re concerned that your baby may be reacting to something in your diet, reach out to the Happy Baby Experts. Chat Now!
Read more: Is my baby reacting to something in my milk?
If diarrhea occurs and your baby is under 3 months old, or there is also blood, mucus, pus or continuous vomiting; or if the diarrhea will not go away, contact your child’s pediatrician right away.
If your child is experiencing persistent constipation for 2 weeks or constipation is accompanied by fever, vomiting, blood in stool, swollen abdomen or weight loss, contact your little one’s pediatrician.
If constipation does not improve, a small amount of 100% prune, apple, or pear juice may be added to breastmilk in a bottle as long as your baby is older than 1 month.9 The sugars in fruit juices can draw water into the intestines to help baby pass the stool.
The general recommendation is giving 1 oz per day for every month of life up to 4 months. For example, a 3-month-old would be allowed to have 3 oz per day. This technique should only be used cautiously; always contact baby’s pediatrician before trying it.
Note that juice is not recommended for infants younger than 1 year old at any other time.
The “I love you” massage for babies and toddlers can be helpful in reducing constipation, abdominal pain, bloating, and gas.
Read: Baby massage: Benefits and techniques for all the details.
If your little one has started solids, offer higher fiber foods to your baby twice per day, such as: fruits, vegetables, beans and whole grains.5, 9 Make sure these foods are in the consistency your little one can handle, and be sure to offer extra fluids anytime you increase fiber in your baby’s diet.
Read more: Why Fiber Matter for Babies, Tots, and Mama
Treatment for constipation in babies is different than for adults. Be sure to avoid using mineral oil, stimulant laxatives, and enemas to treat constipation in infants unless a doctor instructs you to do so.
We know parenting often means sleepless nights, stressful days, and countless questions and confusion, and we want to support you in your feeding journey and beyond.
Our Happy Baby Experts are a team of lactation consultants and registered dietitians certified in infant and maternal nutrition – and they’re all moms, too, which means they’ve been there and seen that. They’re here to help on our free, live chat platform Monday – Friday 8am-8pm (EST), and Saturday – Sunday 8am-4pm (EST). Chat Now!
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For more on this topic, check out the following articles:
Constipation in older babies or toddlers
Hydration to prevent constipation for the family
Why fiber matters for babies, tots and mama