MS, RDN, CDN
Allison is a registered dietitian who holds a Master’s in Nutrition and Physical Fitness. As a Certified Wellcoach Health & Wellness Instructor in private practice, she loves helping families get creative with their wellness choices.
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 all of these elements because any deviation from your baby’s normal into constipation or diarrhea can cause discomfort and might require management and, in some cases, medical attention.
In the first few days of life, your baby may only have 1-2 soiled diapers. He’ll first pass meconium, a thick and dark tar-like substance your baby had stored up during pregnancy.Within about 3-4 days when your milk comes in and your baby begins to eat more, his stools will become more frequent, typically 4 or more per day, and will look like a seedy yellow or green color.
After six weeks, some babies may have as many as five bowel movements a day, while others may have one bowel movement every few days, or somewhere in between. Wherever your baby falls in the range, he’ll be considered normal and healthy as long as his abdomen is soft and he is not expressing any discomfort.
If your baby is experiencing diarrhea
First know that breastfed children generally have soft and loose stools normally, which parents often confuse for diarrhea.
Noticing any changes in your baby’s stool, like more stools in a day than usual, multiple stools per feeding, or very watery stools can indicate diarrhea. Diarrhea can occur due to nasal congestion, teething, a virus or antibiotics and also in reaction to changes in mom’s diet.
If your infant does have diarrhea, usually it will not last very long and will resolve on its own. However, it’s important to track color, frequency, and consistency becauseone of the consequences of diarrhea may be dehydration. Infants are more susceptible to dehydration so watch for signs such as dry eyes or mouth, infrequent urination, irritability or lethargy. Be sure to continue nursing frequently if your baby is experiencing diarrhea to help with hydration.
If your infant has diarrhea, or your child (at any age) has diarrhea along with blood, mucus, pus, or continuous vomiting, contact his pediatrician.
If your baby is experiencing constipation
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. Infants have weak abdominal muscles and can’t sit up to pass a bowel movement, so they are working against gravity and it can be challenging. None of this means your baby is constipated.
Rather, 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.
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. It is also not uncommon for babies to become constipated with the introduction of iron supplementation.
If your baby’s constipation is accompanied by vomiting, blood in stool, a swollen abdomen or weight loss, contact is pediatrician.
Keep your baby hydrated
Continue breastfeeding, as nursing can decrease further diarrhea and help your child recover. If your baby is older and has started solids, you can also offer additional fluids such as clear broth. If you’re still noticing signs of dehydration or constipation even with continued nursing, contact your child’s pediatrician.
Be mindful of your own diet while breastfeeding
Occasionally babies will react to something in their mother’s milk and this could cause diarrhea or constipation in some cases. If you’re concerned that your baby may be reacting to something in your diet, reach out to the Happy Mama Milk Mentors and check out Breastfeeding Challenges 101: Is my baby reacting to something in my milk?
Inform your healthcare provider if diarrhea or constipation persists
If diarrhea persists, occurs in your baby under 3 months of age, or occurs in the presence of blood, mucus, pus or continuous vomiting, contact your child’s pediatrician right away.
If your child is experiencing persistent constipation for 2 weeks or constipation accompanied by fever, vomiting, blood in stool, swollen abdomen or weight loss you should contact your child’s pediatrician.
Avoid adult treatments for constipation
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.
A bit of Juice
If constipation is difficult to clear, 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 4 weeks. 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 sparingly, and contacting your baby’s pediatrician before implementing is imperative.
Note that juice is not recommended for infants younger than 1 year old at any other time.
Massage your baby
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 eating solids, increase the amount of fiber in your child’s diet
Offer high fiber foods to your baby like fruits, vegetables, beans and whole grains in addition to providing more fluids. For more information on constipation in older children or in formula fed-babies, read Constipation in babies and toddlers.
Infant Constipation. Healthy Children.org. Date accessed 18 May 2017.