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Forum Name: Pediatric Topics

Question: 1 Month Old Constipated


 msash4785 - Tue Jul 13, 2010 1:50 pm

My baby just turned a month old on sunday. He was going #2 regularly after he was home the first week. I am formula feeding him. He has had trouble pooping the past few weeks. I was told by the nurses at my pediatricians office to give him diluted apple juice once in the morning and once at night. Could it possibly be the Iron in his formula or should I make an appointment to take him to his doctor? The apple juice is helping but I don't want to have to continue to do that.. I want him to be able to go on his own with out me jumpstarting it with the apple juice.

Thanks,
Concerned 1st Time mom
 Debbie Miller, RN - Tue Jul 20, 2010 1:56 pm

User avatar Hello,
Of course breast milk is the preferred food for infants and this is much less a problem when breastfeeding because it contains the perfect balance of fat and protein. Formula often causes some GI distress. However, it is important to be certain we are talking about constipation since a formula-fed baby could be "normal" with a different schedule than what you may think. Formula is not digested well so it remains in the stomach for longer periods of time and infrequent stools can still be normal for your baby under these circumstances.

If an infant is truly constipated the stool consistency will be formed (firm, dry and pebbly), more like individual peas or pellets. A soft paste consistency in the stool, no matter how infrequent, or even following straining and gas, is not constipation; just "infrequent stool" and it is due to the high residue left in the colon of the artificially-fed baby.

Crying while passing a stool, or bleeding from the rectum can also indicate true constipation. These events should be reported to the baby's doctor.

Do not switch to soy formula (it may be even worse) and do not add cereal to such a young baby. These are sometimes tried but are not successful. Also, your baby needs the iron contained in the formula but it is really not the cause of constipation in the small amounts contained therein. It is a common falacy that the iron causes constipation.

Sometimes doctors will recommend the addition of sugar (lactulose) such as with Karo corn syrup added to the formula or giving juice (fructose) as in apple, pear or prune juice. But, introducing your baby to fruit too soon may make him more likely to develop allergies so unless he is truly constipated it's best to avoid altering the formula. The problem with any additional feedings (water, juice) is that the baby is at risk for not getting adequate nutrition - the breast milk of formula is needed in sufficient quantity and filling the baby with other liquids may reduce his intake so be careful with how much you give. I would suggest diluting the juice and limiting this supplement to 2-4 ounces/day total.

Some babies will do better with a change in formula, but eliminating milk by using a substitute or using a less-healthy low-iron formula is not a good idea unless there are other concerns. Any change in formula will take a couple of weeks for adjustment so be patient and talk to your doctor about this.

It is possible to induce lactation even after starting out with formula, should you be inclined. Again, talk to your doctor about this option.

Some exercises to help relieve infant constipation include gentle tummy massage (clockwise direction at baby's naval, massaging in circular motion moving hands out and away from the center of the baby's tummy). Try giving a warm bath for relaxation (you can follow with a tummy massage, using baby lotion - they love it!). Some gentle bicycling of the baby's legs can sometimes help get things moving. Move the legs gently as if he were riding a bicycle while lying on his back. This sometimes helps them with gas as well.

In some cases your doctor may suggest an infant suppository to help him if he is straining.

Best wishes.

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