Breastfed babies and constipation

People used to think that breastfed babies never got constipated – we know now that this is not the case. Constipation is certainly uncommon in breastfed babies, but it does happen.

Breastfed babies may poo several times a day, especially in the first few weeks of life. After a month or so the frequency may reduce; they may go a few days without having their bowels open. Sometimes this is OK – breast milk is such a perfect food for babies that there might not be much waste.

In order to decide whether or not it is OK to poo infrequently, we have to look at the whole child – and not just their poo! Some things that would suggest constipation in a baby would be:

• Reluctance to feed when they have not done a poo for a couple of days, then being hungry again once they have had their bowels open.
• Appearing to have an uncomfortable tummy, relieved by doing a poo.
• Passing a large quantity of poo all at once. Even if it is soft/runny, storing up a large quantity of poo means that the lower bowel has been stretched, and this is not good for any baby.
• Disturbed sleep, crying, drawing knees up, stretching legs out, straining, distended tummy - relieved by doing a big poo.

The first thing to do is to check the breast feeding – it may be that the baby is not getting enough milk. The midwife and/or health visitor should be asked for advice, and there are several breastfeeding organisations – see websites below.

If constipation does need to be treated, breastfed babies can be treated just the same as any other child following the NICE Guidelines, which suggest using macrogol laxatives like Movicol or CosmoCol. However, since these come in the form of a powder which have to be mixed with water they may not be ideal for breastfed babies, because:

• The baby’s tummy may be full up after drinking the macrogol water, so they might not feed properly.
• It may be very difficult to get the baby to drink from a bottle/cup if they are exclusively breastfed.
• They may not like the taste of the macrogol water – Mum may be able to express some breast milk to flavour it to encourage the baby to take it.

---

Alternative treatments would be:

• A different oral laxative, such as Lactulose or Senna.
• A small Glycerine Suppository.

In order to decide which is the best treatment for their baby, parents will need to see their GP and/or health visitor.

---

Further information on breastfeeding is available from:

• National Childbirth Trust (NCT) - see particularly 'Constipation in Babies'
• La Leche League (LLL)
• Association of Breastfeeding Mothers (ABM)
• The Breastfeeding Network (BFN)
• National Infant Feeding Network (NIFN)
• National Breastfeeding Helpline - 0300 100 0212