26. Jan, 2021
My Baby is trying to poop and distressed, HELP!
Dirty nappies: by 6 weeks, you have had your fair share but your baby turns 6 weeks old and all of a sudden, she stops popping so much. She may start straining and crying when trying to poop. Of course, you start to worry. Please be reassured, in healthy, terms babies, this is a normal occurrence. Here is why and what you can do.
It is completely normal in both breastfed and formula - fed babies (however, in the formula fed baby, constipation should be over-ruled). We often tell parents that a breastfed baby can go one week to 10 days without a poo and be completely fine. In his book, paediatrician Jack Newman mentions a baby going for 28 days without a poo and perfectly happy! ( I would however recommend to see a doctor after 7 days without stools!).
Note that paediatricians do not see babies if they have not pooped for 7 days or less. It is considered normal, unless the baby is unwell, has a medical condition or is extremely uncomfortable.
The fact that she is crying and straining is also normal. The medical term for this is infant dyschezia, you can read more about it here:
But my baby is distressed: what can I do?
Of course, it is human nature, especially parenting nature, to intervene when witnessing a distressed baby. Most tricks used have mainly a placebo effect, but if it doesn’t harm the baby and keeps parents happy, then there is no harm in recommending.
- Tummy massage: Youtube is filled with baby massage videos. However, it is important to check the practitioner’s credentials. Make sure you are always massaging the tummy clockwise (massaging anti-clockwise can be very detrimental to the bowels), stay below the rib cage, use a gentle touch, make the touch lighter when going over the bladder, avoid essential oils in babies less than 3 months old.
- A warm bath, warm hand or warm bean bag: placed on the abdomen can help with bowel movement.
- Gentle anal massage: ideally, we should avoid intervention as the baby has to learn to coordinate the muscles but, in some cases, a gentle rub on the anus with a little coconut oil can give the baby a little help.
- Supervised tummy time: tummy time often releases discomfort in babies.
Of course, when in doubt, refer to your G.P.
When there is a change in stools colour, frequency and/ or consistency:
In the initial post-natal period, stools frequency and colour are important factors in assessing how feeding is going,
A reversing from mustard coloured stools to green is often an indication of poor milk transfer and, if jaundice is present, the baby should be reviewed, and bilirubin levels checked due to the risk of bilirubin reabsorption by the bowels.
Green stools, mucous and other variants:
When confronted with green stools in an exclusively breastfed baby, the following should be checked:
1- Maternal over-supply: even though it is rare, lactose overload can explain green, frothy stools.
Foremilk is high is galactose which, if there are no over-supply issues, doesn’t cause any problem. However, in the mother presenting with oversupply, the baby will often fill up essentially on foremilk. While the baby is not naturally lactose intolerance, her digestive system does not produce enough lactase to break down all the galactose ingested. The excess lactose causes gassiness, discomfort, watery, foamy stools. This high galactose content repeatedly ingested can irritate the lining of the bowels hence the green stools. This can also be associated with slight bleeding.
Treatment: breastfeeding assessment should be carried out by a knowledgeable healthcare professional (breastfeeding specialist/ IBCLC) and a feeding plan put in place.
2- Rotavirus vaccine: It is not unusual for babies who have recently received the oral rotavirus vaccination to develop green stools. The live vaccine administered can cause temporary damage to the lining of the baby’s gut and unbalance the microbiome. Some babies experience an extended period of green stools following this vaccination.
Treatment: continue breastfeeding. Over time the gut will heal, but it can take 2 to 4 weeks of exclusive breastfeeding for the microbiome to re-establish itself. Be aware when changing nappies to wash hands as the live virus can be passed on to the carer.
3- Antibiotics: While we are aware that breastfeeding mothers receiving oral antibiotics often notice their breastfed baby is unsettled, there is also increasing evidence around IV antibiotics in labour and postnatally (mother and baby) which would have an impact on the baby’s microbiome. As above, it can take between 2 to 4 weeks after treatment being discontinued for the baby’s microbiome to re-establish itself.
Treatment: with all antibiotic treatments, mothers who are breastfeeding should use pre- biotics for 2 weeks followed by pro-biotics to protect their own gut health, there is no need to administer them to the baby as breastmilk will provide all that is needed. Breastfeeding should not be discontinued during treatment. Most antibiotics are safe to take while breastfeeding, but the list can be checked on the Breastfeeding Network website.
4- Maternal diet: while maternal diet is way too often (wrongly) blamed for baby’s tummy’s discomfort, some women are adamant that if they eat this or that, their baby is uncomfortable. I would never undermine a mother who is convinced of this! However, it is important to reassure mothers that they can eat whatever they want, including spices, and it will not affect their baby. Mothers who consume large amounts of green vegetable, especially in the form of juice or smoothies may find their babies’ stools to be greener, which is of no concern. If unsure, she can stop for a few days and see how the baby’s stools turn out.
But some babies’ poop remains green, if no other symptoms are present, relax! Breastfed baby’s poop comes in many colours, from yellow to darker mustard to greenish-yellow.
Sometimes, all is well and the baby's stools remain green. This is normal, the colour of a breastfed baby stools are in the range of brownish, greenish and yellow.
- Mucous in stools:
It is worth considering Cow Milk Protein Allergies (CMPA) if other symptoms are associated.
More info can be found on here:
However, CMPA is rare (0.5-1% of EBF babies and 5-7% of formula-fed babies).
Treatment: a breastfeeding specialist or IBCLC should evaluate feeding, and if CMPA is suspected, a referral to a reputable allergy paediatrician recommended.
Evidence is moving further and further from elimination diet or breastmilk substitute such as highly hydrolysed formulas. They have been linked to an increased in food allergies later on in childhood.
Paediatricians sometimes recommend early introduction of solid. However, paediatric dietician Caroline King who is responsible for writing up guidelines on the introduction of solid in infants for the NHS (Imperial College London) argues against the case. Early introduction of solid (before 6 months) does not significantly improve allergies, reflux and other associated symptoms but is linked with increased admission to A&E for G.I. tract infection.
2- Upper airways/ chest infection: another reason for mucousy stools could be that the baby has a cold/ chesty cough. The mucous produced is swallowed and passes through the digestive tract and into the stools.
Treatment: this passes as the baby gets better.
In any doubt about your baby's stools, visit your G.P.
Disclaimer: these information are for guidance only and do not replace the advice from your doctor.
Allergy Burden in the U.K.: http://www.publications.parliament.uk/pa/ld200607/ldselect/ldsctech/166/16607.htmCourdent M1, Beghin L, Akré J, Turck D Infrequent stools in exclusively breastfed infants.
- Breastfeed Med. 2014 Nov;9(9):442-5. DOI: 10.1089/bfm.2014.0050. Epub 2014 Sep 22.
- Kelly Mom, Lactose Overload, https://kellymom.com/health/baby-health/lactose-intolerance/
- A. Marcobal, J. L. Sonnenburg 2013 Human milk oligosaccharide consumption by intestinal microbiota Clin Microbiol Infect. 2012 Jul; 18(0 4): 12–15. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671919/)
- Jantscher-Krenn E1, Bode L. Human milk oligosaccharides and their potential benefits for the breastfed neonate. Minerva Pediatr. 2012 Feb;64(1):8399(https://www.ncbi.nlm.nih.gov/pubmed/22350049)
- Petra AMJ Scholtens, Dominique AM Goossens, and Annamaria Staiano Stool characteristics of infants receiving short-chain galactooligosaccharides and long-chain fructo-oligosaccharides: A review World J Gastroenterol. 2014 Oct 7; 20(37): 1344613452. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188896/)
- Lomer, Parkes, Sanderson Review article: lactose intolerance in clinical practice – myths and realities. J. Alimentary Pharmacology and Therapeutics Volume 27, Issue 2 January 2008 Pages 93–103 (http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2007.03557.x/full)
- Ramig. Pathogenesis of Intestinal and Systemic Rotavirus Infection J Virol. 2004 Oct; 78(19): 10213–10220. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC516399/)
- Isabelle Beau,1,2 Jacqueline Cotte-Laffitte,1,2 Monique Géniteau-Legendre,1,2 Mary K. Estes3 and Alain L. Servin. An NSP4-dependant mechanism by which rotavirus impairs lactase enzymatic activity in brush border of human enterocyte-like Caco-2 cells. Cellular Microbiology (2007) 9(9), 2254–226 (http://onlinelibrary.wiley.com/doi/10.1111/j.1462-5822.2007.00956.x/pdf)
Chang Hwan Choi* and Sae Kyung Chang
- Alteration of Gut Microbiota and Efficacy of Probiotics in Functional Constipation J Neurogastroenterol Motil. 2015 Jan; 21(1) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4288092/)
- Dubois NE, Gregory KE Characterising the Intestinal Microbiome in Infantile Colic: Findings Based on an Integrative Review of the Literature. Biol Res Nurs. 2016 May;18(3):307-(https://www.ncbi.nlm.nih.gov/pubmed/26721871)
- Riodhan- Wambach, Breastfeeding and Human Lactation, 2016
- 12. Rotavirus vaccination vs breastfeeding reduction: http://kellymom.com/blog-post/breastfeeding-protects-against-rotavirus/