Integrative Lactation Care

One of the most controversial topics in infant care is: do babies (especially breastfed babies) need to poop daily?

When it comes to their baby’s health, parents often have questions about what is normal vs. what isn’t. what constitutes normal GI function and how to manage any gastrointestinal (GI) issues that might arise.

Not a week goes by where I do not hear from at least one client that they have been told one of the following by a pediatrician, family member, peer, or even a GI specialist:

• Breastfed babies do not need to poop daily
• It is normal for babies to go up to 7, 10, even 14 days without a bowel movement
• Babies consuming human milk do not stool daily because they “absorb all of the nutrients” or are “efficient with digestion”

All of these are false.

If you have heard, abided by, or even repeated any of the statements above, you are not alone. These are common misconceptions that are perpetuated by a lack of understanding of infant gut health.

All babies (and all humans) should be stooling daily. It is a vital sign for our digestive system and overall health. We’re going to dive into why, and what you can do if your baby is not stooling daily.

Understanding Infant Digestion

There is a great deal of debate over what is considered normal for an infant’s stooling patterns. Two recent research studies provide insight into this topic, shedding light on BM frequency of healthy infants and factors that may be contributing to digestive issues.

What does the research say?

In a study published in the European Journal of Pediatrics, the highest frequency of bowel movements was observed at three weeks of age. Over time, the frequency gradually decreased – but the average (across 20+ countries) was at least once per day. Breastfed babies typically had more frequent bowel movements compared to formula-fed babies.

This study underscores the importance of understanding that infant stooling patterns may vary, but that daily stooling is not an unreasonable expectation.

Another study, published in the Journal of Pediatrics, looked at functional gastrointestinal disorders (FGIDs) in infants and toddlers. FGIDs include conditions like infant colic, gastroesophageal reflux, and functional constipation, which often go hand in hand. These disorders are common in infants and can significantly affect quality of life for both the infant and their caregivers. Conditions like colic (characterized by excessive crying and discomfort) are particularly challenging. Early identification and care are both crucial.

Strategies for Supporting Infant Stooling

As an integrative IBCLC, it’s important to me that parents know that there are a wide range of strategies to help support healthy digestion in infants. Helping ensure your baby is able to poop regularly is one way you can support their short- and long-term health, and reduce fussiness/crying.

1. Ensure Sufficient Intake
   • Ensuring that your baby is consuming sufficient intake is essential. If stooling has slowed to less than one BM per day, it may be helpful to consider a weighted feeding and/or tracking bottle volume to ensure that the infant is consuming enough to trigger regular bowel movements.
2. Feed Human Milk
   • Human milk is the optimal food for the infant digestive tract and can promote regular bowel movements. It also contains prebiotics and probiotics that support healthy gut bacteria.
   • If feeding human milk is not possible, consider formula options designed to support digestive health. An IBCLC knowledgeable about formula can help you navigate this.
3. Professional Bodywork
   • Consider visiting a professional pediatric bodywork (an experienced pediatric chiropractor, craniosacral therapist, or physical therapist)
   • All babies are born with some tension, but persistent areas of tension can inhibit effective digestion. A professional bodyworker can help align the body and alleviate tension in order to facilitate healthy bowel movements.
4. Tummy Time:
   • Placing a baby on their stomach while they are awake and supervised can help stimulate bowel movements by applying gentle pressure on the abdomen and encouraging physical activity.
   • If a baby cannot tolerate tummy time for more than a couple of minutes, consider seeing a bodywork provider who can help with mobility.
5. Massage:
   • Gentle abdominal massage can help relieve constipation and promote bowel movements. Techniques include circular motions around the belly button and gentle “bicycle legs” movements.
6. Oral Function:
   • Optimizing digestion starts with making sure that an infant’s sucking and swallowing mechanics are effective. If a child is swallowing air, taking in too much milk at once, or has difficulty coordinating the suck-swallow-breathe, it can impact the GI system’s ability to digest optimally.
   • Furthermore, optimal resting tongue posture is on the roof of the mouth, which signals to the entire parasympathetic nervous system that it can enter rest and digest mode. A child whose tongue cannot rest here may have impaired digestion.
   • To optimize oral function, see an IBCLC who has advanced training in this area.
7. Probiotics:
   • Probiotic supplements may support gut health and regular stooling. It is recommended to consult with a healthcare provider before introducing probiotics. Choose one that has undergone rigorous testing and is specifically formulated for infants.
8. Dietary Adjustments (for babies 6 months and older):
   • For babies 6 months and older, it may be helpful to temporary back off solids to see if stooling patterns return to normal. If so, a slower reintroduction of foods may be appropriate to see if a particular food is causing constipation.
   • Early solids introduction (before 6 months) is NOT recommended as a solution to constipation and is likely to exacerbate gut issues in the long run.
9. Responsive Feeding:
   • Pay attention to hunger and fullness cues to avoid overfeeding, which can lead to gastrointestinal discomfort and irregular bowel movements.
   • Choose a bottle with a true slow flow (most bottles aren’t) such as the Pigeon SS, Gulicola, or Evenflo Balance to support optimal digestion.
10. Maternal Diet Adjustments
    • In some cases, changing the nursing parent’s diet can be helpful to increase beneficial components that reach baby and/or remove food triggers causing constipation in baby. More information about this can be found in Maternal Diet section below.
    • It is recommended to do this in partnership with a knowledgeable provider whenever possible.

If you have tried all of these strategies and are still stuck, or need help navigating next steps, please feel free to reach out or book a consult. ILC is experienced with infant constipation cases & can help you. In some cases, targeted supplements and/or gut health testing may be appropriate.

Changing Maternal Diet to Increase HMOs in Human Milk

Human Milk Oligosaccharides (HMOs) are complex sugars found in human breast milk that play a crucial role in infant gut health by promoting beneficial bacteria and protecting against pathogens. Research suggests that maternal diet can influence the levels of HMOs in breast milk. Here are some strategies for increasing HMOs through dietary changes:

1. Increased Intake of Prebiotics:
   • Foods rich in prebiotics, such as garlic, onions, leeks, asparagus, and bananas, can boost HMO production as they promote beneficial gut bacteria in the mother, which can translate to higher HMO levels in breastmilk.
2. Probiotic-Rich Foods:
   • Consuming probiotic foods like yogurt, kefir, sauerkraut, and kimchi can support maternal gut health and potentially enhance the composition of HMOs in a parent’s milk.
3. Omega-3 Fatty Acids:
   • Omega-3 fatty acids, found in fatty fish, flaxseeds, and chia seeds, are essential for overall health and may have a positive impact on milk composition, including HMO levels.
4. Increased Intake of Fiber:
   • Eating leafy greens, ample fruits and vegetables, and whole grains (if well tolerated) can influence HMO levels.

By incorporating these dietary strategies, breastfeeding mothers can potentially enhance the HMO content of their milk, supporting their infant’s digestive health and overall well-being.

Strategies to Avoid

Below are a number of common strategies that I see recommended to my patients by primary care providers for constipation, but which have been shown to cause harm to the long-term health of the infant’s GI tract. Many providers do not provide full informed consent about the risks of these interventions to patients. These are band-aids that do not address the root cause of constipation, and increase dysbiosis.

1. Suppositories
2. Prune Juice/Fruit Juice
3. Rectal Stimulation
4. Early Solids Introduction
5. Karo Syrup/Corn Syrup
6. Weaning
7. Miralax
8. Water (for babies under 6 months)

Practical Takeaways for Parents

1. Daily Stooling: Babies should poop daily. Period.
2. Symptoms of Concern: If your infant shows signs of discomfort, excessive crying, or infrequent stooling, there is an underlying reason.
3. Holistic Support: Incorporate practices like tummy time, gentle massage, and professional bodywork to support healthy bowel function.
4. Root Cause: It’s important to work with a provider who will help you get to the root cause and support your child’s microbiome.

Trust your gut here – no pun intended. If your intuition is telling you that there is more that can be done to support your child’s digestion, follow that instinct. Don’t hesitate to get a second (or a third) opinion and to advocate for your child. It’s vital to get to the root cause of your child’s challenges.

If you have tried the strategies above and need extra support to take troubleshooting to a deeper level, ILC offers virtual consults to parents here in the US and abroad.