There are two type of constipation — functional and organic. So, first, ask your pediatrician to rule out obstruction, impaction, infection, or any other condition behind organic constipation.
Most other causes are functional, and are relatively easily remedied. The problem is, that doctors are likely to give you some terrible advice regarding functional constipation. This advice usually boils down to the three following dogmas:
From the Textbook of Pediatrics: “There is no medical harm in stool staying in the body for a long time [link]:”
— Wrong! A healthy infant is supposed to [ideally — KM] move the bowels at least four times daily. Missing a single day enlarges and hardens up stools, and makes constipation much worse.
Author's comment: My statement above — that, ideally, breastfed infants are supposed to have at least 4 bowel movements (BMs) daily— drives some people nuts because, according to the dominant pediatric advice, frequency of bowel movements is considered “normal” in the range from 15 times a day to once a week or even longer, and for as long as the resulting stools remain soft and passable.
This position, of course, is incorrect (to say the least). Infrequent BMs are considered “normal” not because they are, but because babies don't display any outward symptoms of any clinical disorder. In this context any borderline condition, such as anemia or rickets, are also “normal” because they don't cause pain, incessant crying, high fever, or kill right away.
Here is, actually, what's happening “under the radar:” the large intestine, as its name implies, is a large organ, potentially capable of accumulating and retaining several weeks worth of stale feces. These accumulated feces are gradually expelled whenever the bowel gets overfilled with digestive and metabolic residue from the other end (i.e. from the small intestine). This condition is called 'latent constipation,' and is quite widespread in adults. Straining and large stools are the primary symptoms of latent constipation.
The highest risk from latent constipation in babies is the possibility of fecal reflux back into the small intestine — the precursor to severe intestinal inflammation, which is usually resolved by profuse diarrhea. After the diarrhea is over, the same vicious cycle starts anew.
So, ask yourself: Is this normal when my baby's bowel is loaded with several weeks worth of stale feces? Not deadly, that's for sure, but is it normal?
And the final puzzle is — why do the stools of breastfed babies remain small, soft, and moist for so long (i.e. not as dry, hard, and large as in adults in similar circumstances)?
That is because the moisture content of infant's feces is similar to the moisture content of the infant's body — around 75%. In other words, the baby's bowel isn't adept at removing moisture from feces beyond this 75% threshold.
In adults, stools become dry and harden up when their moisture content drops as little as 10%, down to 65%. Also, adults' stools are denser because solid food have higher residue content than milk or formula, and, of course, because of undigested fiber.
Second dogma states as in this quote from the American Academy of Pediatrics: “Your pediatrician may suggest adding more water or juice to your child's diet [link]:”
— Wrong again! Giving a child more water or juice is useless for constipation. In fact, excess water causes acute dehydration by stimulating profuse urination. The sorbitol in juices, such as prune or pear juice, causes acute diarrhea and disrupts stools even more. That is not the best way to relieve constipation…
Third dogma, courtesy of Mayo Clinic, recommends: “For infants older than 4 months who are already eating solid foods, give them baby food that's high in fiber [link]:”
— Wrong! Fiber dramatically expands stool size, blocks the absorption of fluids, and causes gas. This, in turn, causes bloating, flatulence, cramps, obstructions, allergies, and intestinal inflammation. In fact, this disastrous advice is the reason behind the epidemics of autism and juvenile diabetes in the United States.
For the sake of your baby‘s health and future, as well as your own health and sanity, don‘t follow these damaging recommendations. If you still doubt my words, just observe your baby, and keep a diary to confirm for yourself every single problem I have outlined above.
Finally, visit my web site to learn why following these recommendations may ruin your child‘s health.
According to the article “Prevalence, symptoms and outcome of constipation in infants and toddlers” published in The Journal of Pediatrics [link], the prevalence rate for constipation in infants (under 12 months) is near 3%, and in toddlers (up to 24 months) — around 10%. From those cases, 97% represent functional constipation, the subject of this page.
According to the same source, the dietary changes (more fluids and fiber) and corn syrup — resolved only 25% of all cases, while the use of laxatives — Milk of Magnesia or Polyethylene Glycol 3350 — resolved constipation in 92% of all cases. The authors remarked that “Both milk of magnesia and polyethylene glycol were efficient and safe in infants and toddlers.”
From this information we can draw the following important conclusions:
● First, the increase in the prevalence of constipation in toddlers vis-à-vis infants points out that the transition from a fiber-free liquid diet (i.e. breast milk or formula) to solid food contributes to constipation. It sounds counterintuitive because most people believe in a material connection between foods and stools, while there is almost none, or the opposite of what's expected. I explain this paradox on this page: Constipation Unplugged.
● Second, dietary changes aren't effective in 75% of all cases, and not only are they a waste of precious time, but they may also have the potential of causing chronic diarrhea, malnutrition, and neurological damage as I explain on this page: What Is The Connection Between Infant Constipation, Diarrhea, and Autism?
● And third, due to the emergency nature of pediatric constipation, a safe laxative is more appropriate than dietary change, such as adding fiber and solid food to the infant's normal (i.e. liquid) diet.
Unlike the authors of the above-cited article, I don't consider polyethylene glycol — a potent hyperosmolar laxative — safe for infants and toddlers because it blocks the absorption of all nutrients throughout the entire intestinal tract. This blockage may quickly result in malnutrition and neurological damage, especially in babies with borderline malnutrition. I strongly suggest to avoid it.
Milk of Magnesia (magnesium hydroxide) belongs to the class of saline laxatives, and is suitable for occasional use. Giving it to the infant more than once in a short interval of time may cause acute magnesium toxicity and severe vomiting and diarrhea. So you must be very careful with it to prevent overdosing and ensuing dehydration, loss of electrolytes, muscle cramping, weakening, or arrhythmia.
For extra margin of safety, I recommend using Hydro-C — the formula I developed — instead. One container will see your child well into his 2nd birthday, and it has none of the milk of magnesia or polyethylene glycol side effects.
Even if you accidentally overdose Hydro-C, it may result in one-time liquid stools, but with none of the extended diarrheal effect. Also, it is not toxic as magnesium hydroxide, and it nourishes your baby with essential calcium, magnesium, potassium and vitamin C in synergistic proportions.
Obviously, it's best to assure that your child is always having regular stools without any external assistance, Hydro-C or not. To accomplish that, please study and follow the Gut Sense section.
There aren't that many functional causes that may affect a baby's bowel movement, particularly among otherwise healthy and well-nourished babies, because the act of defecation in infants is entirely unconscious.
Before identifying the most likely causes, let me first make it absolutely clear: unlike what you've been incorrectly told by doctors, severe dehydration is more likely to produce diarrhea than constipation. That's, incidentally, why the extra fluids did not relieve constipation in the study I mentioned above. I explain the reasons behind this seemingly paradoxical situation here and here.
And if that prune or pear juices have helped your baby once or twice, it wasn't because of fluids in them, but because of the hyperosmolar sugars and fibers in these juices, having an effect similar to polyethylene glycol.
With dehydration concerns now aside, the two most prominent functional causes of infant constipation are:
● Lack of bowel bacteria. When bacteria are missing — a condition called disbacteriosis — stools become dry, hard, and painful to evacuate because abundant bacteria retain moisture and give normal stool its amorphous consistency. Sharp pain while eliminating hard stools may result in incomplete emptying. This, in turn, causes rapid enlargement and impaction of stools, and the obstruction of the bowel.
The primary cause of the disbacteriosis in infants is... disbacteriosis in their nursing mothers. The bacteria that initially colonize the baby's bowel come from colostrum, and, later, are sustained by breast milk. The use of antibiotics to treat infections is the next cause, and antibiotics affects mothers and babies alike. I discuss at length all possible solutions of this problem here.
● Low quality of breast milk. The quality of your milk may be too low to assure the proper functioning of the infant's digestive system. This is particularly true for mothers past their prime childbearing age, or when nursing a second, third, and so on, child. When, on the other hand, using a formula that is free of any discernable side effects, then disbacteriosis is the most likely cause of functional constipation.
I do suspect that in most cases both of the above factors — disbacteriosis and inadequate quality of milk — cause functional constipation in infants, particularly when there is a history of using antibiotics.
Thus, if you are breastfeeding, you must address the quality of your milk first as well as eliminate the possibility of your own disbacteriosis. This quality, in turn, depends on adequate intake of primary proteins, essential fats, vitamins, and minerals before, during, and after the pregnancy, and throughout the breastfeeding. Obviously, your digestive health plays a role too — it doesn't matter how well you eat when the nutrients aren't assimilating well because of inflammatory conditions, such as celiac disease, Crohn's disease, and ulcerative colitis.
So, how do you determine the quality of your milk? Not easy... Besides a simple assessment of fat, protein, carbohydrates, and water content, the complete vitamin and mineral assay requires specialized and expensive equipment. I don't know of any lab that does it.
Unfortunately, gorging on fortified cereals, breads, dairy, juices, or overconsuming fruits and vegetables to obtain all of above essential nutrients will, at best, make you fat and prediabetic from excess carbohydrates, but may do little to improve the quality of your milk. The consumer-grade supplements, such as One A Day, are disastrous for healthy adults, and absolutely unacceptable to nursing mothers for the reasons explained here: Mass-Market Supplements: Rat Poison Or What?
The table below illustrates the principal components (nutrients) of human milk. These nutrients must enter into the milk's production pipeline no matter what. When your diet isn't sufficient, they are withdrawn — the term for minerals is resorption — from bones, and non-minerals — from tissues. When some or most of these nutrients are missing, the production of milk is terminated.
In addition to milk production, nursing mothers require a good and uninterrupted supply of these micronutrients for their own cell division, metabolic functions, blood and lymph chemistry, reabsorption back into the bones, and for other physiological functions. Here is a list of these principal “ingredients” of mature human milk:
Source: USDA National
Nutrient Database for Standard Reference,
Human Milk, NDB No: 01107
As you can see, human milk is not just water, carbohydrates, proteins, and fats, but also an extensive cocktail of organic and inorganic substances mainly derived from your diet. The 'Diet-dependent' heading in the last column means: 'this nutrient can't be synthesized by the body, or the body's stores are limited.'
Although your body stores a considerable amounts of fats and proteins, it also needs a continuous supply of essential fatty acids and essential amino acids that come primarily from non-plant sources (fish, meats, foul, seafood, eggs).
To avoid gambling your baby's health entirely on what you eat, to avoid weight gain from overeating, to keep the milk flowing, to maintain your own body in balance, and to restock the stores used up while pregnant, take professional grade (“therapeutic”) supplements for the duration of your breastfeeding plus three to six months thereafter in order to restore your body's stores of minerals and microelements that had been spent up for building up the fetus into a newborn, and, later, to produce breast milk.
This approach will assure health and safety of your baby while preserving your teeth, bones, joints, hair, nails, and skin from a precipitous and irreversible decline, so you can avoid premature aging, and it will do miracles for your self-esteem, career, sex life, and marriage.
It is also the best approach to curb an incessant appetite while pregnant and breastfeeding, which is the primary cause of post-natal obesity. This runaway appetite is, essentially, an instinctive trait that goes into override in response to nutritional deficiencies, similar to more commonplace sugars or salt cravings. High-potency supplements are the best way to satisfy this instinctive need for micronutrients without overeating.
Few generations ago women from wealthy families were giving multiple births without any apparent damage to themselves or their children. To preserve health, appearance, and prevent premature aging, they were (a) delegating breastfeeding to wet nurses — healthy young women with abundant milk; (b) spending several months at mineral water spas to restore bones soon after the delivery; (c) and consuming a prolific diet of wholesome organic food while taking their time to recover.
I, too, was breastfed by a wet nurse because my mother didn't have any milk on her own. It was probably the outcome of the prolonged starvation during World War II that ended just nine years before my birth in 1954, and had drained her body‘s stores of the micronutrients, needed to make breast milk.
Lo and behold, even without breastfeeding me for a single day, she was already wearing full dentures before age 50, and was affected by osteomalacia — a softening of the bones and the ensuing bending of the legs and spine — by age 60. To boot, she was never able to slim down the substantial weight gained after that single pregnancy, and was overweight (and miserable about it) most of her adult life.
My mother's poor physical shape and low self-esteem ruined her marriage — my parents divorced when I was 6 years old — and she never remarried. Since my wet nursing period was relatively brief, it stunted my growth and development as well. Even though my dad was 6' tall, I barely reached 5'7", and my lower chin didn‘t develop in full, so one of the lower premolars had to be extracted in my youth.
I also suffered from ADD/HD and dyslexia throughout my formative years. For that reason — a striking disparity between my written and spoken words — my teachers always considered me a cheat, and treated me accordingly. I can assure you none of the above added much to my development or self-esteem, and I don't wish this kind of harassment on any child.
I was spared from the same contempt by my peers because I was a ferocious and reckless punk, ready for a fistfight at the slightest provocation. The snapshot on the right is circa 1977. You get the idea...
In secret from my mother — she was categorically against all sports because of my poor eyesight, — I took several years of intense pro-boxing level training and weight lifting, and that kept my free from abuse and bullying on and off the street.
So, if you don't wish to compromise your child's future, or get fat for life yourself, or ruin your marriage, or can't afford a wet nurse, or few months to recover at a mineral water spa isn't a viable option, take instead the professional-grade supplements described here.
I realize what some of you may be thinking next:
— Oh, he is giving this self-serving advice to peddle his supplements.
— No, I am not. If you and your child are well, just keep doing what you've been doing all along. My recommendation to take supplements is addressed to breastfeeding mothers who are having problems with their own health, or milk quality, or infant constipation. If that applies to you too, besides giving you priceless information and incredible value in these supplements, I am also disclosing their formulas in full, so you can obtain similar components a la cart from any reputable health food store.
It may end up costing you more in time, money, and effort, and the quality may not be as high, but, at the very least, you'll have a choice, and I'll sleep tight knowing that my recommendations are unbiased and motivated by your good, not profit.
Also, before questioning my professional integrity or my need to make a decent living, count your own money first. A single dental implant to replace falling out teeth because of bone demineralization caused by pregnancy and nursing, will run you more than the entire cost of professional-grade supplements for two years. Ditto a single week in a spa, or a two weeks of paying a wet nurse in order to preserve your sparkling teeth, supple joints, shiny nails, slick hair, springy breasts, and smooth buttocks.
So, if there is a need for supplements, don't be a dunce, and do the right thing for your body, for your partner, and for your baby. Also, keep in mind that your child will need a healthy and happy mother alongside for another 20 plus years. And if and when anyone tells you that 'you don't need any stinkin' vitamins,' ask them why, according to the recent study of the healthcare professionals in the United States:
“The number of physicians recommending dietary supplements to their patients is highest among obstetrician/gynecologists (OB/GYNs) (91 percent), followed by primary care physicians (84 percent). In addition, the study shows that almost three quarters of physicians (72 percent) and more than three quarters of nurses (88 percent) say it is a good idea for patients to take a multivitamin. [link]”
So, the only difference between my advice and these progressive doctors and nurses is the emphasis on the quality of the recommended supplements. By defining “quality,” I mean the following: Don't take junk, unless you want your child to ingested the same junk through your milk. And for the same reasons you wouldn't gamble you baby's health with melamine-laced formula from China purchased at a dollar store, why would you gamble two lives — yours and your baby, — on the supplements of questionable provenance and subpar quality?
Ideally, the breast milk (or formula when milk isn't available) should be the sole nutrient your child gets until she can chew. Sure, Gerber and the likes can pulverize any junk into palatable pulp, and make it irresistible to a child by adding an industrial sweetener, but that doesn't mean that this garbage is good for your baby, or belongs to pediatric nutrition.
The idea of commencing any food other than milk or formula as early as the fourth month is false and misguided — infants don't produce enzymes to digest anything, but breast milk (or its replacement) until they grow teeth and can chew.
Yes, you are reading me right — anyone suggesting giving solid food to a toothless baby, particularly with fiber, is badly mistaken, and this practice wasn't influenced by what's good for babies, but by the ruthless and relentless promotion of processed infant foods, such as purees, juices, cereals, yogurts, ice creams, candies, cookies, and the like.
I realize that this statement may offend almost all pediatricians, nutritionists, and dietitians in the United States, but I can't help it. If you are a medical professional reading this, and your blood is boiling with rage at the messenger (of bad news), think about all of those kids made sick for life by this reckless advice.
In general, I am more temperate in my views regarding assorted medical harms showered on consenting adults — at least grown-ups have the time and capacity to think it over for themselves, — but not babies and their panicky young mothers, who worship their doctors and look up to them in awe for guidance.
Wishing you and your baby good health and good luck,