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Constipation: The Essential Guide for Parents of Breastfed Babies

Likely as not, you’ve heard plenty of people giving you advice on your baby’s constipation. I’d urge you to look to an expert — and, in this case, an experienced parent — to give you the real facts about constipation.

Recently, I interviewed pediatric gastroenterologist, Dr. Bryan Vartabedian. (Dr. Vartabedian is the author of Looking Out for Number Two.) Get his book if you need practical, accurate advice about your baby’s #2 — or a good chuckle from the author’s great sense of humor. From it, I learned several little-known facts, and you will too! But what especially caught my attention was what he says about constipation.

How many times your baby “goes” depends on his age

Dr. V., as he is affectionately called, emphasizes what I’ve been preaching to parents and professionals for years. The number of poopy diapers you can expect in the first month is very different than in later months. Dr. V. emphasizes that in the first month, your baby needs to produce at least 4 stools a day.

After about 1 month, breastfed babies can have big delays

I totally agree with this, not only from reading research and Dr. V.’s book, but also, because I’ve seen it! Breastfed babies who are more than a month old can go several or many days without having a stool. (Poo, poop, poopie, turds, #2, or whatever word you choose.)

A word of caution here, though. In one case I vividly remember an exclusively breastfed 4-month old who repeatedly went 10 or more days before passing a stool. Her pediatrician treated her for “constipation” when, in fact, she had a frighteningly small weight gain, because she just wasn’t taking in enough food.

True constipation in breastfed babies is “almost unheard of”

Parents sometimes tell me that their breastfed babies are constipated. But if I ask enough questions, I’ve found that parents misinterpret what constipation is, or they are giving formula or other food.

Constipation is a pushing problem, not a frequency problem

Dr. V. defines constipation in one simple sentence: It’s “a difficulty or inability to pass poo.”

Babies are not miniature adults. But like adults, frequency of elimination varies from one individual to another. And, Dr. V. says that the pushing problem is usually associated with a dry, hard stool. However, a baby might have trouble pushing a soft stool, too. In any event, it’s not related to the calendar.  And, after the baby starts on solids, there are a number of possible reasons why he might be constipated.

Sources of constipation

There are a number of reasons why I would warn against soy. (Be sure to listen to my interview with Dr. Heather Patisaul.) But Dr. V. explains, “the way that the soy protein intermingles with the fat in formula creates constipation.” Dr. V’s give details for his other “favs” for potentially-constipating foods, i.e., rice cereal, bananas, milk (and cheese) and carbohydrates.

Iron in formula is not the cause of constipation

It’s true that formula has more iron than the mother’s milk. But Dr. V. says that “overwhelming evidence failed to show any connection between iron in formula and constipation.”

Prune juice is not a cure-all

We all know prune juice has a softening effect because it contains sorbitol. Dr. V. says that it’s possible that any fruit juice will do the trick but warns juices cannot be a substitute for mother’s milk, or even formula.

I doubt there’s any science to this, but I’ve had breastfeeding mothers tell me that their kid’s constipation was resolved when they — the mothers — drank the prune juice. Cause and effect? Maybe. Coincidence? Maybe. Worth a try? Definitely!

Quick fix “natural” remedies might not be either

That’s right. Dr. V. warns that herbs, teas and drops aren’t necessarily a good idea, just because they are “natural.” He doesn’t completely forbid such things, but he’s not keen on them.

Stimulation addiction

Stimulating the baby’s anus with a thermometer or a cotton swab can be a trap. It works the first time, and parents continue to do it. But some babies come to depend on this stimulation, which they should not. Luckily, Dr. V. gives some good tips for “detoxing” your baby from this stimulation.

When to worry

Much as we’d rather not think it so, some babies have serious problems. Dr. V. gives some practical tips for understanding when to seek professional help.

I wish I had this indispensable book long ago. Dr. V.’s experience and wisdom are clearly evident, yet his lighthearted and somewhat irreverent tone makes this book a true delight to read.

What are you questions about constipation? Let me know if the comments section below!

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