I get asked about infants stooling patterns quite a lot, typically from worried mothers who have an infant who has slowed down on stooling, maybe 1-2 days, sometimes 7-10 days. The baby might also be gassy, not sleeping or fussy. Moms often will ask various sources if this is normal or expected. I was certainly taught to believe this with a variety of reasons as to why. As an IBCLC I don’t consider this to be normal, anymore, and I will list some of the reasons as to why later. In my opinion, the information I had been provided over a decade ago is still how health professionals and peer support are being taught in their education and orientation to units and job positions that support infants and mothers is also teaching this way.
The number one reason I hear is that breastmilk is just highly digestible & there is nothing left to dispose of. My common sense response to those who say ‘it’s just absorbed’, is why then when babies finally do have a bowel movement is it always reported as “a huge blow out” or why do babies have “poop days”. The days are described as days where, once the stooling starts, it does not stop for several diaper hours. If it was readily absorbed, it wouldn’t be an explosion or take hours to clear out the bowels. In recent years more information has come out to tell us that, in fact, there are known constituents in breastmilk that are not digestible. One specific component is human milk sugars that are attached to the lactose molecule in breastmilk. They can make up to 20% of the content of milk. So, to think that ⅕ of the intake of what an infant consumes is not digestible, makes one wonder where it goes. It appears though, that this doesn’t have a role in nutrition, but instead in gut health. The bacteria of the infant gut is what thrives on these human milk sugars, not so much that an infant's growth thrives here. This could be one of the reasons why we may often see a baby gaining weight well, but not be stooling. But we might see a colicy or gassy baby, because the gut flora isn’t quite ideal. I find often getting more milk into the baby helps these symptoms. More milk = more human milk sugars = more healthy bacteria. Not to mention other little things that end up in stool. The process of digestion alone would have some sort of byproduct left, even just the epithelial cells of the digestive tract sloughing off along the way.
I stated the number one reason that I hear as a reason why babies might not be stooling is that people believe breastmilk is digestible and I have provided some reasons as to why this is not true. But, I am actually more concerned about another aspect of the non-stooling situation, beyond just human milk sugars and bacteria content. I have shown my belief of *if milk is going in, stools need to be coming out”. When I come across a non-stooling infant, I want to have a look at the growth patterns of these infants. I mentioned thriving infants above because it is very important to discuss infant weight gain in all of this. Watching just pee alone is dangerous as babies can get to a pretty scary place before they start to really slow down on the peeing and may be in a state of failure-to-thrive at that point. We can possibly avoid that by watching stooling. I will say it one of the first signs of lower than required intake in many many babies I have worked with.
This can all actually have a long term effect on breastfeeding. As babies take in less milk & have slow or no weight gain , milk supply can be lowered, resulting in even less milk being taken in by the baby and the cycle continues. It can also be a sign of more going on and the sooner we intervene and assess the situation, the sooner we can strategize solutions to prevent things from a downward spiral.
What should we expect in a babies diaper then? This is what I recommend. As babies get closer to 4 months, they may slow down to 2-3 diapers a day, but in the early days and weeks fore sure with each good feed or couple feeds, there should be a bowel movement.
I also want to mention that these ideas and supporting information is quite new, so just like we have to be patient with babies and how they grow and change and develop, we have to be patient with the research and learning of the changes and developments coming out in breastfeeding. As much as we have been breastfeeding “forever”, it was a time before so much evidence and research existed and was desired.
If you are concerned about your babies stooling patterns, I am always happy to help explore that with you. I welcome you to reach out for a consult, in person or virtually.
(originally posted Feb 21...I am sure more will be added as time and linked thoughts come up)