The Poop on Poop 

Normal Bowel Movements & Constipation


We have to start with a definition first.  Constipation is passing stool that is as hard as rocks.  It has nothing to do with the number of days that kids go in between stools, or the effort involved in passing the stool. What we do about it varies on age and diet.

Breastfed infants in the first week of life

Exclusively breastfed babies in the first few days of life should clear all the meconium stool by day of life 4-5.

 The stool transitions from black meconium to green, tarry meconium to brown to yellow.  And if all is going well, then the baby should be passing yellow stool on day 4-5 of life.  The first milk that the breasts make, the colostrum, is a great laxative.  The more colostrum the baby gets,  the more poop they pass. That means that any breastfed baby who does not stool (in the first week of life) is not getting enough milk.  That is an emergency and I would really like to hear from you and maybe  see you and your baby.

Breastfed infants after the first week of life

Exclusively breastfed infants stool a bunch in the first few weeks of life, sometimes with every feeding.  The stool can be quite watery, yellow or green.  If it's explosive, click here.

Most (but not all) babies will have a change in the stool pattern after the first few weeks, sometimes abruptly.  The baby's gut gets to a certain level of maturity where it starts to absorb all of the nutrients out of breastmilk and there is less stool to pass.  Nothing may change.  Another pattern for breastfed infants in their second month of life is one "honey-fill-the tub- up-the-back-in-the-hair-throw-away-that-outfit" stool a week.

Breastfeeding babies who are nursing well, gaining weight and having at least 6 wet diapers a day are rarely truly constipated.  No matter how much grunting or groaning they do or how much gas they pass.  Really gassy breastfed baby?  Click here.

Formula fed kids

Formula introduces adult bacteria into the gut right away, and that means that the poop looks very "adult" right from the word go.  

Infant formulas supplemented with ARA/DHA (all of them) contain too much fat for the newborn gut.  Breastmilk doesn't have much fat in it initially because the gut can't metabolize it. So, with all the extra fat in a formula-fed baby's gut, they will likely have diarrhea the first several days of life. afterwards, that pattern changes. The kids may have one to several soft, formed light yellow to green -brown stools per day, but every kid is different. As long as the stool is soft when it comes out, even if it's been a few days, the child is not constipated.

Kids are supposed to turn 14 different shades of red when they are trying to pass stool. If the stool is soft when it comes out, the child is not constipated. Really. They have no belly muscle tone to speak of, and really to added help of gravity as adults do, so they have to strain to get the stool out. That's how they do it and it's normal as long as the stool does not look like rocks, blood or asphalt when it comes out.

Please don't change formulas without talking to us. True formula intolerance is diarrhea, not constipation. We can deal with constipation without changing formula.

If your child is passing rocks, then I suggest use of a glycerin suppository as a way to help relieve the constipation without adding a bunch of empty calories (like in juice) to the baby's diet.  They are available over the counter, can be used once a day, and are inserted in the rectum as a means of stimulating a bowel movement.  If you are using them regularly, I need to know about it, so we can check to make sure there isn't something more serious occurring. 

For older children, this may be the only time in the first year of life where I suggest juice.  You can try 100% pear juice, one ounce for every month of age your child is, diluted in one ounce of water, every day.  If there is no improvement, increase it to two times a day.  If they have diarrhea after the juice, then it was too much juice.  You have to play with it a little until you get the right balance.  And you are looking for soft stool, without regard to the amount of effort your child puts into pooping.

I'm not a fan of Karo syrup.  It works like juice, introducing sugar into the gut.  That sugar pulls water into the gut and the stool gets runny.  Although I've never seen it with anything but honey, botulism is a risk with unpasteurized products.  Karo syrup is unpasteurized and it'd prefer that we stay away from it.


Toddlers don't intentionally do anything that hurts. Sooooo...all it takes is one or two painful poops and we have a problem. The kids will get the urge to poop, remember that it really hurt the last time that they did it, and will hold it back, till the next time they really have to poop, and then they'll withhold again until they just can't anymore and they pass a huge, toilet-clogging stool that really hurts, often with bright red blood that surrounds it. Which sets up the problem all over again.

What has to happen in order to fix it is to make several consecutive stools non-painful so we can "unteach" their brain that pooping is painful. 

The first step is cleansing the gut. Making them poop and poop and poop until they are empty (until they are  essentially pooping chocolate pudding). Suppositories may help, but only move the rocks that are near the rectum, so they have to be helped along with pediatric Fleets enemas or more powerful laxatives.  I usually use Miralax, which up until recently was a prescription medication.  It's now available over the counter. It's a powder the completely dissolves in 8 ounces of juice or water.  (Don't try it in milk, it's disgusting, and it fizzes over in carbonated stuff)  I recommend using it three times a day until the kids poop chocolate pudding and then once a day to keep the stool soft.  Some tinkering of that dose may be necessary, but you get the idea-- induce diarrhea and then give just enough to keep the stool soft.

Then, we have to let the gut get used to being empty. The gut is a muscle, and that muscle has undoubtedly been stretched and is a little stupid for a few days. So no diet changes are going to help, at least initially.

Diet changes

Infants should breastfeed exclusively for the first 6 months of life.  And infants who are nursing well shouldn't be constipated.

Kids who are formula fed (or breastfed for that matter do not need rice cereals.  They have iron in them, which in addition to the other iron present in ALL infant formulas, can be constipating.  When we start infants on food, it should be real food, like fruits and vegetables.  And fruits and vegetables have fiber which helps keep bowel movements regular.

In toddlers and older children, the biggest constipating foods are the dairy products, milk especially, so try to cut down on that.  Too much cow's milk is an important cause of iron deficiency.

The important diet changes involve increasing fiber and decreasing junk food.  Peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes and dates are all high in fiber and should be in the diet 3 times a day.  Whole grain foods like bran flakes and muffins, oatmeal, brown rice and wheat bread should be substituted for the processed white rice, white bread and muffins.


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