Dr Phil Kieran: Do I need to change my diet to help my breastfed baby's constipation?

Formula-fed babies tend to all have similar bowel habits going 1-3 times per day. The 'normal range' for breastfed babies however is much more variable.

Tue, 25 Jul, 2023 - 02:00

Dr Phil Kieran

My five-month-old baby suffers from constipation even though he’s exclusively breastfed. Do I need to change my diet or will his bowel movements settle down in time?

I think could fill a book on just describing the variation in baby poop and the questions that I get about it.

Before I had my own kids I had very little idea about the range of normal colour and frequency other than “it varies a lot”. After having my own, their bowel habit was so different from day-one that I now understand this statement in a way books could never convey.

Constipation is a relatively common issue for babies and more so for formula-fed infants. Formula-fed babies tend to all have similar bowel habits going 1-3 times per day. The 'normal range' for breastfed babies however is much more variable.

When I was working in paediatrics I heard a consultant telling a parent that anywhere from 10 dirty nappies per day to one every 10 days is normal — and finding this range absolutely incredible. Although this would be more to the extreme ends of 'normal' it really shows that the range is enormous.

I say this before addressing your case as a lot of times when people come in with constipated breastfed babies this is what is happening. They aren’t constipated, they just aren’t going very frequently.

Constipation causes hard stools and often pain during bowel movements. Although in longer-standing cases of constipation you can develop diarrhoea (called overflow diarrhoea), this is much more common in adults or older kids and this is why your GP may prescribe laxatives for diarrhoea.

If the stools are soft and the baby isn’t upset when passing then I wouldn’t worry about it. If you do find that they are constipated, you could try offering a little cooled boiled water to the baby after a feed. In general however, it's best to wait until a breastfed baby is six months old before introducing water to their diet.

Don't forget too that drinking sufficient fluids while breastfeeding is important for overall maternal health - make sure to stay well hydrated (see the HSE's factsheet on this here.)

Constipation tends to improve around 6-8 months of age as the baby starts to sit up. This strengthens the abdominal wall muscles and can help to pass stools if they are having difficulty. As you wean them onto some solids the fibre intake will increase, helping the bowels to move.

I would also like to talk about constipation more broadly as it is a very common issue and very misunderstood.

The mainstay of treatment for constipation in kids older than one year is laxative use. The laxative most commonly used is something called Macrogol. This is a very safe laxative and can be used at high dose without difficulty.

The biggest thing to know is that treating constipation takes time. You have to retrain the bowel — so a rule of thumb is you need to take a laxative for at least as long as the constipation has been present (often months or even years).

This article was edited to clarify the role of hydration in maintaining overall maternal health while breastfeeding.