Norms of bowel movements in infants breastfed and artificially fed, as well as with the introduction of complementary foods

According to the Encyclopedic Dictionary of Medical Terms, constipation is delayed, difficult or systematic inadequate emptying of the intestines.

In order to understand that we are dealing with constipation, it is necessary to first determine what frequency of bowel movements is the norm for infants.

For bottle-fed babies, daily bowel movements are considered normal. The absence of a chair for 36-48 hours should worry the mother. The fact is that even the most adapted formula cannot be compared in composition with mother’s milk. It is more difficult for the body to assimilate, more like adult food, and, accordingly, the microflora in the intestines of a bottle-fed baby differs significantly from the microflora in the intestines of a breastfed baby (it is more similar to the microflora of an adult).

In turn, breast milk, made from blood and lymph matter, is ideal for the needs of the baby and is almost completely digested in some babies. As a baby’s needs change with age, the composition of breast milk also changes significantly over time, which is reflected in stool frequency.

The first days after birth, the baby receives colostrum. It has a laxative effect, therefore it promotes the release of meconium (original feces, which accumulated even before the birth of the crumbs). Depending on the fullness of the intestines, stool frequency can be from one to six times on the first day after birth. At the same time, it is thick, dark green (or almost black), poorly washed off from children’s skin.

On the second or third day, stool may be less frequent or absent altogether, if the newborn has completely freed the intestines from meconium on the first day. This is because colostrum is nutritious, but there is not much of it (from a few drops to 100 ml per day), and it can be fully absorbed without overloading the intestines.

If a woman has a lot of colostrum or milk has already come (usually this happens on the third or fourth day after the baby is born), the stool changes color to gray-green or yellow-green.

If on the fourth or fifth day the baby is still pooping with meconium, it is urgent to assess whether the baby is getting enough milk. During this period, colostrum changes to transitional milk, and then at the age of 7-14 days – to mature milk. Your baby’s stool frequency can increase significantly. The norm for up to 4-8 weeks is considered to be the number of bowel movements at least once a day (some babies can get rid of the “ballast” after each feeding). However, even at this age, the absence of daily bowel movements, as a rule, is not constipation, but is associated with a lack of milk. Accordingly, the baby simply has nothing to get rid of and no measures to eliminate constipation are required – you just need to establish breastfeeding and ensure an adequate supply of milk.

At the age of four to eight weeks, mother’s milk changes its composition again, and the baby experiences a so-called growth spurt, which is associated with an increase in the number of enzymes. The behavior of the baby during this period is different: from “hanging” on the mother’s breast to completely ignoring it. This period usually lasts from two to seven days. After such a restructuring, the baby, who emptied the intestines several times a day, may “close” for several days, which is often perceived by the mother as constipation. However, if the little one is not worried about anything, and his tummy is soft, then it is worth letting the intestines cope with the task of self-cleaning on their own.

From this point until the introduction of complementary foods, the number of dirty diapers can vary greatly from child to child. The World Health Organization takes the position that the norm for exclusive breastfeeding is the frequency of stools from several times a day to once every ten days.  Foreign pediatricians and gastroenterologists also talk about the norm of seven or more days. In particular, among American pediatricians, the rule is widespread: “a breastfed baby has the right to any smell, color, frequency and consistency of stool, if this does not affect his growth and development.”

As for post-Soviet pediatricians, many of them are still convinced that any baby (regardless of the type of feeding) should dirty diapers every day. The situation with domestic gastroenterologists is more favorable. Since the intestines are their “bread”, they are much more aware of its work than pediatricians, and the norms of stool in breastfed babies once every 7-10 days do not frighten them at all. However, for some babies, the frequency of stool even once every 10 days is not the limit. In one foreign study, a two-month-old baby emptied his bowels every 27 days, while he felt great, the feces were soft and large in volume, which means there is no constipation. Of course, the study took place under the scrutiny of medical personnel, since 27 days is. nevertheless, not a norm, but an individual characteristic.

Thus, between four to eight weeks and prior to the introduction of complementary foods, the frequency of bowel movements is not an indicator of constipation. Mom has nothing to worry about when the following factors are combined:

1. The baby is fully breastfed. He does not receive additional iron supplements, pro- and prebiotics, enzymes, syrups, etc. (any drug can have side effects in the form of constipation);

2. The kid is not worried about anything, the stomach is soft. It is worth noting here that mothers often mistake ordinary gaziki for constipation, which can disturb up to 3-4 months. It is easy to distinguish: if the child screams and pushes, you need to help release the gas in the usual way (massage, warm diaper, etc.). If the gazes came out, and the baby calmed down (even in the absence of the fact of defecation), then there is nothing to worry about;

3. Emptying of the intestine does not cause much discomfort in the child, while the stool is soft (a sign of constipation is hard, formed stool, reminiscent of sheep feces).

It is worth noting that in some babies, the number of bowel movements can sharply decrease at the age of 3-4 months, since during this period the intestines are going through the next stage of their development. And this is also, as a rule, the norm that does not require external intervention.

Thus, constipation with exclusive breastfeeding is quite a rare phenomenon and it is usually associated not with the rice eaten by the mother, but with a specific disease, therefore, it requires an appeal to a specialist – a gastroenterologist.

With the introduction of complementary foods , daily bowel movements become the norm, regardless of the type of feeding. During this period, anxiety should be caused by the absence of a chair in an infant for more than 36-48 hours. However, if we are dealing with pedagogical or natural complementary foods, when portions of solid food are limited to 1-2 teaspoons, the stool may still remain outside this norm – you need to look at the child’s behavior and stool after defecation.

What to do in case of constipation in a baby

As soon as the mother gives the baby the first spoonful of complementary foods, she should make it a rule to periodically offer water, since water promotes comfortable digestion. It is important to note that water only “works” in conjunction with fiber. If there is still no fiber in the child’s diet, then there is no point in relying on water as a laxative.

If there is no stool for 24 hours, the very first thing to do is to increase the amount of water on offer. It is better to drink from the cup right away, showing by your example exactly how to drink. Children’s mineral water is best suited for these purposes, since it is not only liquid, but also potassium. With a lack of potassium, intestinal contractions (the so-called peristalsis) sharply weaken, which may be one of the causes of constipation. Most of all potassium is found in raisins, dried apricots, prunes, figs. There are no mineral salts in boiled water, so if you really take boiled water, it is better to steam one tablespoon of raisins in a glass of boiling water, and give the baby the resulting broth to drink.

However, it is not always possible to solve the delicate problem under consideration by ordinary supplementation. The number one drug generally accepted all over the world to help with constipation in children of the first four years of life is the use of lactulose syrup (duphalac, lactusan, normase, etc.). Use this drug as directed by your doctor! It is worth noting that lactulose is contraindicated in galactosemia (violation of carbohydrate metabolism in the way of converting galactose (simple sugar) into glucose), lactase deficiency (lactose intolerance), individual intolerance. In addition, the use of lactulose can cause a temporary increase in gas formation (to alleviate the condition, it is possible to use drugs that neutralize gases in the intestine – espumisan, sub-simplex, bobotik, etc.).

In general, lactulose is a prebiotic (i.e. food for its own beneficial intestinal flora), but at the same time it has the ability to soften stool, due to which a laxative effect is achieved.

In case of sudden constipation (which is quite common in babies at the beginning of the introduction of complementary foods), I give a one-time 1 tsp. lactulose 24 hours after the last stool. If it didn’t work, another spoonful 12 hours after the first. On this, everything, as a rule, happens.

However, if the baby is prone to constipation, at the beginning of the introduction of complementary foods, you can drink lactulose with a course to normalize the bowel function. For these purposes, it is better not to give the child immediately the dose recommended in the instructions (for example, for Lactusan it is 5 ml for children under one year old), but start with 1 ml and gradually increase by one ml every 2-3 days (otherwise you can get diarrhea instead of constipation). Having achieved the result, it is recommended not to stop taking it, but to maintain the effective dose for a couple of weeks, and then slowly reduce it.

In the event that lactulose has not produced the proper laxative effect within a couple of hours, some pediatricians recommend using a gas tube. Other pediatricians do not recommend using it categorically in order to avoid injury to the child’s mucosa. Accordingly, before using it is worth consulting with a doctor whom you trust. In any case, a gas tube will be a better alternative than a cotton swab, which is certainly not intended for such purposes. The procedure for using the flue gas tube is as follows:

  • boil a tube (we take the smallest tube) and vegetable oil (you can immediately buy sterile at the pharmacy or use petroleum jelly);
  • a stele on a changing table (or whatever is used instead) a disposable diaper or oilcloth;
  • we lay the baby on his back, bend the legs at the knees and press them to the stomach (to hold the legs, you can attract the dad), a child over 6 months old can be laid on the left side, also bending the legs to the stomach;
  • we treat the small tip of the tube and the child’s anus with sterile oil or petroleum jelly;
  • gently, with rotational movements, insert the tip of the tube into the rectum (the smallest is enough for 1-2 cm, from 6 months of age and older – up to 4 cm) and hold for about 10 minutes;
  • if the feces did not go, slightly twist the tube, move it a little further (but no more than 3 cm for a child under 6 months old, and no more than 5 cm for a child over 6 months old), hold it for another 5 minutes (but no more than 15 minutes in total !);
  • after bowel movement (or after 15 minutes, if emptying has not occurred), the tube must be carefully removed.

After the end of the procedure, the baby must be washed, and the tube should be washed with soap and boiled.

Another of the most affordable and safest ways to deal with constipation in babies in the first year of life is candles with glycerin. Better to use candles made especially for children (glycelax, etc.). However, if it is impossible to purchase children’s candles, you can use 1/4 of an adult candle. The application should also be discussed with a specialist.

The action of suppositories is aimed at lubricating the walls of the rectum, while they give in to irritation and the intestines spontaneously cleanse. It is believed that glycerin is not absorbed in the intestine, therefore, the drug acts only externally, without affecting the internal organs, which, of course, is its advantage.

However, glycerin suppositories can be used only when the baby reaches the age of three months. Earlier application is possible only under medical supervision.

In the event that the above methods did not help, as a rule, an enema (for example, microlax) is prescribed. Enemas were left “for last” due to the fact that they help to wash out the beneficial flora and increase dysbiosis, which already worries many babies up to a year.

Based on the foregoing, the following conclusions can be drawn:

1. For children on artificial (or mixed) feeding, as well as for all babies after the start of the introduction of complementary foods, daily bowel movements are characteristic. A lack of stool for 36 to 48 hours is a cause for concern.

2. Breastfed babies older than 4-8 weeks and before complementary feeding have the right to any stool frequency, if nothing bothers them, the stomach is soft, bowel movements do not cause discomfort, the stool is soft.

3. Children on artificial (or mixed) feeding, as well as all babies from the moment of the introduction of complementary foods, should be offered water (preferably children’s mineral water, not boiled), since water contributes to comfortable digestion.

4. In the first-aid kit, it is advisable to have a preparation based on lactulose, glycerin suppositories in case of sudden constipation.

5. If constipation is systematic, it is necessary to consult a specialist (preferably a gastroenterologist), especially if there are other symptoms (frequent regurgitation, poor weight gain, pain during emptying, etc.).

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