Ask Dr. Marla: Constipation & Bowel Function

My six-month-old seems to always be constipated. My mother says he’s not getting enough breast milk and wants me to give him apple juice. I give him just breast milk and water from a cup. I’m following my doctor’s advice about feeding him a rice cereal. I’ve heard babies shouldn’t get fruit juices so early on.  Help!

A. Constipation and bowel function is a common concern of many parents. In fact, studies show that as many as 16 percent of parents worry that their two-year-olds had constipation and as many as 35 percent of all visits to a paediatric gastroenterologist are for constipation.

First, what is your baby doing that makes you believe he is constipated? Constipation in breastfed babies is extremely unusual unless it is caused by a congenital condition. Constipation is usually defined as infrequent and painful passage of stool. Many parents are concerned their children do not go as often as they might expect and label them as being constipated when they are not. The frequency of bowel movements in babies can vary. Most children who are constipated often have no underlying medical conditions at all.

While there are congenital causes of constipation, including Hirschsprung disease (a situation where the child is born with a congenital megacolon), spinal and neuromuscular issues, hypothyroidism, cystic fibrosis and narrowing of the anus called anal stenosis, it is unlikely that your child has any of these concerns. A physical examination by your physician is important to exclude any pathology. If your child were not getting adequate nutrition, your physician likely would have commented that your child had fallen off his growth curve. Every time you visit your doctor, measurements are performed for length, weight and head circumference and plotted on a growth chart. That allows you and your physician to track growth and development and confirm it is as expected.

As your physician has advised you, in the first six months of your baby’s life, he is getting all his nutrition from your breast milk. We advise parents to supplement with vitamin D, but your breast milk is the easiest on your baby’s digestion. In fact there is less of a chance of either too loose stools or too hard stools. Breast milk also is the best support for your baby’s immune system.

At six months, we typically advise parents to introduce solids. The most common introduction is to a single-grain iron fortifi ed cereal. That is why your doctor has suggested you start with rice cereal. Although fruit can be offered after six months, it is usually added over six to nine months of age. For some babies who are growing well and satisfied with breast milk, solids can be introduced as late as nine months. This is a conversation you can have with your physician.

I generally tell my patients that babies really don’t need to drink juice at all. Adding too much juice can actually cause diarrhea and decrease the appetite for food with recommended nutrients.

It is important to feel reassured that you are offering the best source of nutrition to your baby. Comments from friends and relatives, while meant to be helpful, can often undermine a parent’s confidence. For that reason, I would encourage you to review your concerns with your physician and seek reassurance from the expert that your child’s growth and development, stool patterns and introduction of solids are appropriate. PC

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