Pediatrics: Lillian Beard, M.D.

Bowel Movement Questions

• My 5 month-old moves her bowels approximately every three days, is this normal?
• Is it normal for my 3 month-old to have bowel movements after every feeding?
• My 3 month-old baby has had severe constipation for 2 days. She is in absolute agony when she tries to have a bowel movement. What can I give her to make things come back to normal?

By Lillian Beard, M.D.

Questions from new parents about feedings, bowel movements and sleeping have been those most commonly asked over my more than 25 years of pediatric practice. I always remind them just how important it is for us to recognize and celebrate that each baby is unique, an individual creation; as such they may not always conform to our standard expectations of what's "normal" for what they "take in" or the timeliness of what they "eliminate."

In general, babies who are breast-feeding tend to have more frequent and softer stools. The younger the infants the greater the likelihood for more frequent bowel movements. Breast-fed babies will average 4-7 bowel movements during the course of 24 hours, and some may eliminate a little after each feeding. Formula-fed babies may have different patterns, some very dependent on the type of infant formula.

The American Academy of Pediatrics recommends breast-feeding as the optimum choice for your baby's nutrition. However, if you are not breast-feeding, the Academy states that an iron-fortified infant formula is the only acceptable alternative. True constipation is not an every day occurrence in 3-month-old infants.

I have a few suggestions which might stimulate easier bowel movements.

• When your baby seems to be straining to have a BM, place the palms of your hands beneath the soles of her feet, allowing her to push against them.
• While she is on her back, gently press and massage the lower left side of her abdomen; this may stimulate the muscles to contract and move matter for evacuation.
• While baby is on her back, grasp her legs by her knees/ thighs and move them in a bicycling motion onto and away from her abdomen. This is another fun and relaxing way to stimulate muscular activity.

Sometimes the type and brand of infant formula will make a big difference in your baby's pattern of elimination. Most "regular" iron-fortified infant formulas contain a combination of two types of cow milk proteins-the hard, curd-like casein and the softer whey. This softer, "comfort" protein, digests easily, as does breast milk, and parents report softer stools, with a similar frequency of movement as breast-feeding babies. I suggest that you check with your baby's pediatrician before making any feeding changes.

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