Mom: Doc, Johnny has been pushing hard to go! each time he tries to poop, he strains to go because he’s constipated and I think the formula I switched to after I stopped breastfeeding when he turned 4 months, three weeks ago is responsible. I want you to give me a note for WIC to change his milk to soy formula. My neighbor says that helped her baby when he was younger.
This mother is expressing an often stated concern in clinical practice. She breastfed exclusively for the first 4 months and switched to cow-milk based formula when she found it harder to express adequate amounts of breast milk after resuming work. Breastfeeding is recommended exclusively for the first 6 months and through the first year of life. Other circumstances as in this mother affect adherence to this key recommendation. The urge to change formulas as a direct response to address perceived constipation problems as in the above scenario are very common. We’ll examine the facts together in this post.
The type of sugar in proprietary soy formulas is different from the lactose sugar commonly found in mammalian milk. The sugar type in soy formulas usually are slightly compounded forms of glucose or sucrose. These are more efficiently absorbed from the gut of young infants and are more likely as a matter of fact to result in firmer stools being passed when compared to lactose sugar based milk. They may actually make the defecation more exerting for the infant and trend towards true constipation by increasing the stool consistency.
Parents need to be counseled appropriately on newborn stool patterns. Straining in infancy is due to the developing maturation process which requires the infant to coordinate stool evacuation on many levels. This process starts by bearing down during closed expiration, followed by relaxation of the muscles lining the pelvic floor to straighten the bowel loop formed by the anal canal, all in someone lying down flat on their back! - this is usually no cake walk for the infant. Advances in age and maturation with development of trunk strength with time often make this process easier.
Pediatricians refer to stool consistency when talking about constipation in the newborn period. The passage of hard pellet-like stools, or adult-like formed stools are other clues to the possibility of true constipation in an infant. It is normal for infants like Johnny above to strain and grunt during the passage of soft-formed stools which are often pasty or “mustard-like” during infancy. The frequency of stool passage varies when breastfed and formula fed infants are compared. This variation is more marked in the first 4- 6 months of life before dietary supplements are introduced. Stool passage frequency can range from one small stool passed shortly after every feed in response to the in-built reflex that propels the gut after eating to once in a 5-7 day period in some exclusively breast fed infants.
The rush to home remedies for perceived constipation is just as as popular as formula changes and is often not warranted. Poorly absorbed carbohydrates like sorbitol in some fruit juices in the gut may aid true constipation, malt extract, Prune & prune juice etc are popular options lacking in direct evidence recommending routine use . Their use as with any intervention needs to be discussed first with your doctor if contemplating administration.
This information is for educational purposes only and not a substitute for professional medical care or advice. Always follow your healthcare provider’s instructions.