The standing pediatric advice to accept irregular bowel movements as normal is a principal cause of constipation in infants and toddlers. After irregularity turns into constipation, the ensuing treatment with fiber, fluids, and juices often causes diarrhea, and is, in part, behind the epidemic of autism in the United States.
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
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
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
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%
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
Finally, visit my web site to learn why following these
recommendations may ruin your child‘s health.
What should you do if your
infant experiences irregularity or constipation?
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
● 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
● 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)
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
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
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.
But why is my baby constipated in the first place?
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
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.
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
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
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
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
healthy adults, and absolutely unacceptable to nursing mothers for the reasons explained
here: Mass-Market Supplements: Rat Poison Or What?
How to improve the quality of your breast milk?
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
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
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
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
I realize what some of you may be thinking next:
— Oh, he is giving this self-serving advice to peddle
— 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
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
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?
Stern Warning To Nursing Mothers
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
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
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,