How Often Should a Baby Poop? And Other Important Questions…
Last week, I wrote about BabyM’s nap strike. This week, we’re recovering from another kind of strike. BabyM went 7 days without pooping. I like to think I’m pretty laid-back about these sorts of things, but I admit to being a little worried – enough to do some research on it. So today on the blog, I’m going to write about baby poop.
I’m sort of sorry to bring this up, because I think it’s one of the worst parenting clichés – this idea that we become obsessed with our offspring’s bowel habits. But the thing about parenting clichés is that they’re often true. Part of caring for babies is keeping an eye on what goes in and what comes out. And by day 5 of BabyM’s poop strike, I starting searching both Google and PubMed for more information about normal poop frequency, how to tell if a baby is constipated, and what to do if he is. By day 7, when BabyM casually had his long-awaited bowel movement, I felt much more informed and relaxed about the whole situation.
How often should a baby poop?
This a surprisingly difficult question to answer. You can take two babies of the same age, both exclusively breastfed, and one may poop several times per day and the other may go once per week. That’s pretty fascinating to me, and it means that lots of different poop patterns can be normal.
For the first few weeks of life, you can expect several poopy diapers per day, and some babies will poop after every feeding. As babies grow and their guts mature, the transit time slows. By the second month of life, it is not unusual for babies to skip a day or two between poops, but again, there’s a huge range of normal here.1–3
There are some fun examples of comments about infrequent pooping in breastfed infants in the research literature. In a 1951 Lancet paper, Dr. Israel Gordon introduced his study of poop patterns in infants by noting the outdated belief that breastfed infants should always poop at least once per day and following with this comment:
“Those of the modern school such as Plaunder and Schlossman (1935), Williamson (1947), Ellis (1947), Watkins (1948), and Spock (1947) have discovered that it is not necessary for a healthy breast-fed infant to have bowel movements every day; but none of them has produced evidence that a number of normal infants have been studied or that the scatter with respect to age, and type of feeding, has been investigated. Large sections of the medical public, together with grandmothers and nurses, are still unaware, to the detriment of the child, of the normal bowel rhythm of infants. In fact, because of the popularity of Spock (1947) many modern mothers are better informed on the matter than their medical advisors.”4
Then there was this wide range of normal found in a 1988 study conducted in England:
“The frequency of defecation ranged from eight stools per day in breast-fed infants of 2 weeks to no stools passed for 27 days in a breast-fed infant between 7 and 11 weeks, who remained perfectly well, displayed no clinical signs of gastrointestinal or systemic disease and passed a vast soft stool at the end of this period. She had only 14 bowel actions during the first 16 weeks of life.”2
Although the baby described above might have been otherwise normal, this still sounds like a remarkable case. Most sources I found said that anything up to about a week between bowel movements could be normal. Beyond that, it is definitely worth talking with your pediatrician to be sure there isn’t an underlying cause.
Formula-fed or mixed-fed infants tend to poop less frequently than exclusively breastfed babies. Formula-fed babies also usually have a similar poop frequency across the first few months of life, while breastfed babies seem to poop with decreasing frequency from the first month until starting solids. Formula-fed babies are also more likely to have harder stools. Once solid foods are added, breastfed and formula-fed babies have a similar frequency of pooping, but the consistency of breastfed baby poop remains a bit looser.1,2,5,6
There are several possible explanations for the differences in poop between breastfed and formula-fed babies. Breast milk is more easily digested so may just have a faster transit time with less waste. Breastfed babies may feed more often, which means more frequent stimulation of the gastrocolic reflex that causes increased activity in the large intestine after a meal.7 Finally, human milk contains a ton of oligosaccharides that, unlike the other nutrients in milk, are not digested in the baby’s small intestine. Instead, they serve as prebiotics, passing on to the large intestine to be fermented by the gut bacteria. These human milk oligosaccharides may impact the frequency and consistency of breastfed babies’ poop by their effect on the gut microbiota, by stimulating gut motility, and by binding up water, an effect similar to dietary fiber.8,9
How does starting solid foods change poop patterns?
BabyM has been an infrequent (~2-3x/week) but dramatic pooper since he was about a month old, but I didn’t really worry until the last few weeks. He was exclusively breastfed from birth, adding small tastes of solids around 4.5 months. However, around 6 months, he showed a lot more interest in eating more solids, and when his solid food intake went up, his poop became less frequent and more solid, and he started straining more. These same changes that I observed in BabyM’s poop patterns upon eating more solid foods have been observed in the research literature as well. I’m sure most parents notice the same changes in their own babies.
Why does this happen? Simply put, you’re shifting from a liquid diet to a diet with more solid foods, and that causes the stool to bulk up. Gradual introduction of small amounts of solid foods and some water to drink can help ease this transition, but it can still be an upset to a baby’s system. With the introduction of solid foods also comes shifts in infants’ gut microbiomes, which can alter poop patterns.9,10
The changes in defecation patterns that come with starting solid foods are a good reminder to pay attention to fiber and fluid intake from the start to avoid issues with constipation (more on this in my next post). Starting solids is the first common trigger for constipation in childhood.11 (Other common triggers later in childhood include potty training and starting school.) So, when BabyM didn’t poop for 7 days, was he constipated?
How do you know if your baby is constipated?
Because of all the things we just discussed, normal frequency of pooping is really variable so on its own is not a good indicator of constipation. Most health professionals use something called the Rome III criteria to diagnose “functional constipation” in infants and children [PDF]. Functional constipation just means that it has continued for a while and has no evidence of an anatomic or biochemical cause. The Rome III criteria lists the following factors for infants and toddlers, and if at least two of these are present for one month, then your child might be diagnosed as functionally constipated:
- 2 or fewer defecations per week
- History of excessive stool retention
- History of painful or hard bowel movements
- Presence of a large fecal mass in the rectum
- At least one episode of incontinence after being potty trained
- History of large-diameter stools that may obstruct the toilet.
(Those last two factors are obviously not relevant to infants.)
Although the first item on the list is stool frequency, this is not the most important one. The most important indicator of constipation is probably the one that is most likely to cause discomfort in your baby: hard poops that are painful to pass. Note that grunting and straining to pass a soft stool can be normal for a baby, as the muscles and nerves required for pooping are still developing strength and coordination. But if stools are hard and painful to pass, then a baby might start avoiding pooping. That’s when you get into the real problem with constipation, and you definitely want to avoid this.
Because there’s so much subjectivity in these indicators, one of the most important considerations is probably what your baby’s previously normal pattern was and how it has changed. So if your baby normally passes a soft stool just 1-2 times per week and goes 7 days without a bowel movement, that’s probably nothing to worry about. If your baby normally poops once a day and goes 7 days without, then you should be worried. Regardless, it never hurts to bring up your concerns with your pediatrician. They’re used to reassuring parents about poop patterns, and they’ll be able to tell you if there is anything to worry about.
In BabyM’s case, I started to worry a little when he hadn’t pooped for 4-5 days. That was a bit unusual for him, and I knew his increased intake of solids could make him constipated. I started paying closer attention to his diet and offering more poop-promoting foods. In my next post, I’ll give lots of tips on how to help a constipated baby.
I’ve over-shared about my baby’s poop patterns today with the hope that this is helpful to other parents. What was your experience with your baby? It’s not a random or scientific sample, but it would be interesting to see how much variability there is among readers’ babies. There are few public forums where it’s considered socially acceptable to talk about poop, but consider this a safe space!
- Tunc, V. T., Camurdan, A. D., İlhan, M. N., Sahin, F. & Beyazova, U. Factors associated with defecation patterns in 0–24-month-old children. Eur. J. Pediatr. 167, 1357–1362 (2008).
- Weaver, L. T., Ewing, G. & Taylor, L. C. The bowel habits of milk-fed infants. J Pediatr Gastroenterol Nutr 7, 568–71 (1988).
- Hertog, J. den et al. The defecation pattern of healthy term infants up to the age of 3 months. Arch. Dis. Child. – Fetal Neonatal Ed. (2012). doi:10.1136/archdischild-2011-300539
- Gordon, I. Bowel rhythm in the healthy infant. It’s suggested relationship with chronic constipation. Lancet 257, 1203–1205 (1951).
- Quinlan, P. T., Lockton, S., Irwin, J. & Lucas, A. L. The relationship between stool hardness and stool composition in breast- and formula-fed infants. J. Pediatr. Gastroenterol. Nutr. 20, 81–90 (1995).
- Duyan Camurdan, A., Beyazova, U., Ozkan, S. & Tunc, V. T. Defecation patterns of the infants mainly breastfed from birth till the 12th month: Prospective cohort study. Turk. J. Gastroenterol. 25, 1–5 (2015).
- Stewart, M. L. & Schroeder, N. M. Dietary treatments for childhood constipation: efficacy of dietary fiber and whole grains. Nutr. Rev. 71, 98–109 (2013).
- Scholtens, P. A., Goossens, D. A. & Staiano, A. Stool characteristics of infants receiving short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides: A review. World J. Gastroenterol. WJG 20, 13446–13452 (2014).
- Voreades, N., Kozil, A. & Weir, T. L. Diet and the development of the human intestinal microbiome. Front. Microbiol. 5, (2014).
- Thompson, A. L., Monteagudo-Mera, A., Cadenas, M. B., Lampl, M. L. & Azcarate-Peril, M. A. Milk- and solid-feeding practices and daycare attendance are associated with differences in bacterial diversity, predominant communities, and metabolic and immune function of the infant gut microbiome. Front. Cell. Infect. Microbiol. 5, (2015).
- Sood, M. R. Prevention and treatment of acute constipation in infants and children. UpToDate (2015).