Dear Lisa,
My baby is 3months, 2 weeks old (born September 29th) and is having constipation issues. He was born a big baby (11lbs. 8oz.) so pretty much since birth we’ve given him both breast milk and formula, but I have now stopped breastfeeding. We are going on the 3rd week of no breast milk and his constipation has been an issue pretty much ever since.
We were giving him some cereal previously but we thought that was causing the constipation so we stopped and decided to wait until next month to try it again when he can have fruit too. But he’s still constipated on just formula. We’ve been giving him some remedies to help his constipation and they’re working (we’re switching on and off from #1- 2oz water mixed w/ 1 tsp brown sugar and #2- 1oz prune juice mixed w/ 1oz water). The constipation he had on cereal seemed to affect him and bother him. But the constipation since he’s been off cereal isn’t like that. He’s not really agitated by it; it doesn’t seem to hurt him. He’s still a happy smiley baby and sleeping well.
My main concern is why he’s constipated. Is it that his body/digestive system is still adjusting to switching to solely formula? He’s been on the same formula since birth; can he have an issue with the type of formula now all the sudden? He does spit up, but don’t all babies to some degree? I’m concerned that if he’s constipated now on just formula, what’s going to happen when he goes to solid foods in a couple weeks? Could his stools possibly be changing with the only formula diet, meaning less frequently and thicker? Should we just stick with what we’re doing now by trying to thin out his stool withthe remedies mentioned and wait and see?
“Need Help With Constipation!’
Dear “Need Help With Constipation!”,
If your baby is 3 weeks old, born on September 29th, then the only food that is recommended is Breast milk or formula. It is not recommended to introduce food, cereal or fruit until the child is between 4 to 6 months old. (1) The early introduction of food into an infant’s diet can lead to food allergies. (2) I would not worry that you did your baby any harm by giving food early, but from this point on, it would be important to wait until he is at least 4 months old before introducing any solids.
A babies stool pattern normally changes when there is a change in the diet. Babies that are breastfed are expected to have many stools per day for the first month or two. (3) In some cases breastfed babies can have a bowel movement after every feeding. The appearance of the stool is loose, seedy and yellowish in color. As the infant gets older the bowel movements usually slow down to one stool per day or one stool every few days. (3)
Babies that are bottle fed normally have thicker, less frequent stools. They tend to have two to four stools per day in the first month progressing to one to three stools or less per day. (3) The stool is “soft” in nature as compared to the watery stools found in breast fed babies. (3)
The changes in your baby’s stool pattern are most likely related to his dietary intake and transition to formula. In addition, some formulas tend to be more binding than others.
For example, children who ingest soy based formula tend to have thicker stools and may become constipated. Rice cereal also tends to be binding for many babies. Therefore it would be expected that an infant’s bowel movements become thicker when he ingests rice cereal or soy formula.
Just because a baby has thick, infrequent stools does not mean that there is anything wrong or that he is constipated. Constipation is defined as hard, rocklike bowel movements. (3) Frequently constipation is accompanied by straining and difficulty passing stools. Many parents of young infants misinterpret normal straining and grunting as signs of constipation. Infants normally strain and grunt with passage of stools because their abdominal musculature is not developed enough to pass stools easily. This straining does not necessarily mean that the infant is constipated. The frequency of stools also does not determine if a child is constipated or not. The frequency of stools can change in response to a diet change, according to the amount of fluid a child gets and a child’s activity level.
There are a few ways that you can prevent your child from becoming constipated. First make sure the formula is prepared correctly. When preparing baby formula it is very important to accurately follow the directions on the label. (4) If the correct proportions of water are not added to the powder and the mixture does not contain the correct amount of fluid, the baby may become constipated. In addition, many cans of baby formula appear the same. It is easy to confuse “Concentrated Formula” with the “Ready toFeed ” formula.
“Concentrated Formula” requires the addition of water in order to have the proper balance of fluids and nutrients. “Ready to Feed” formula does not require the addition of water. An error in this area can be dangerous to the child and is very easy to make since the writing on the can is typically quite small. This mistake can bring about an osmotic shift leading to dehydration and possibly renal crisis. (4) This is why is very important to follow directions carefully.
It is also very important to prepare the powdered formula with tap water as the formula company recommends. Tap water in the United States is monitored and regulated as opposed to bottled water or spring water which is not. (5) The exact components of bottled water are not known. Therefore the amount of minerals found in bottled water may be too much for an infant. For example, if the bottled water contained an increased amount of aluminum, this could lead to constipation. An excess in Magnesium can lead to diarrhea. (6) Besides the unknown levels of minerals, microorganisms can also be unknowingly present in bottled water.
Lastly, make sure your child is receiving the correct amount of formula per day and the correct amount of fluids. If a baby does not receive enough fluid in his diet, his body will compensate by holding in stool so that fluid can be taken from the stool and absorbed into the body where it is needed. Therefore, not giving enough formula can lead to constipation.
From your description, it seems that your baby is having normal bowel changes due to alterations in his dietary intake. Since he is not agitated or in pain, and his bowel movements aren’t hard balls, it would be a good idea to just monitor him at this time. It is also important to expect a decrease in the number of bowel movements per day as your son gets older. The sugar water and prune juice that you gave your son for his constipation seemed to alleviate the problem. These are both good choices for babies who are constipated. Although feeding your baby these items may no longer be necessary. You should discuss with your your son's Doctor.
Yes, it is true that many babies experience spitting up or Gastroesophageal Reflux (GER) symptoms in infancy. Evidence has shown that spitting up or Gastroesophageal Reflux may occur in up to half of all healthy infants from 0 to 3 months old. (7) As long as the spitting up is not associated with fever, excessive irritability, respiratory symptoms, abdominal distention, difficulty feeding, is not bilious and is not projectile there is no need for concern.
In regards to your son’s present diet, it would be a good idea to leave him on his present formula and let his body get used to it. It also would be important to not introduce any solids until he is older. Since your baby is a large baby, his calorie requirements are higher, so it is expected that he will drink more formula than other babies his age. If your baby’s stools become very firm, consist of hard balls, his abdomen becomes distended, he begins to vomit, becomes listless or has difficulty feeding, you should bring him to the Doctor's for an evaluation. It is also very important to check with your baby’s Doctor before making any dietary changes, especially during the first year of life.
If you are interested in reading more stories on the Pediatric Advice Website about Infant Feeding topic log on to:
The amount of formula a baby should take.
Food Allergies
References:
(1)Grassia T. Pediatricians: Discuss healthy nutrition during well child checks. Infectious Diseases in Children. 2006. Aug:54.
(2)Bassett C. What to do when Foods become allergens. The Clinical Advisor. 2005. Dec:43-47.
(3) Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 291, 784.
(4)Riordan J. A Practical Guide to Breastfeeding. St. Louis Missouri: The C.V. Mosby Company. 1983:7.
(5)John Hoptins Bloomberg School of Public Health. Public Health New Center. Researchers Dispel Myth of Dioxins and Plastic Water bottles. Available at: http://www.jhsph.edu/PublicHealthNews/articles/Halden_dioxins.html. Accessed Oct 2006. (6)Brunner L, Suddarth D. Textbook of Medical-Surgical Nursing. 5th ed. Philadelphia, PA: J.B. Lippincott Company.1984:793.
(7)Hassall E. Decisions in diagnosing and managing chronic Gastroesophageal reflux disease in children. J Pediatr. 2005. 146:S3-S12.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice About Keeping Babies Healthy
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