Bowel movements: Could breastfed newborn be constipated?

My sister just brought her three week old home from the hospital two days ago. He was born seven weeks early but he seems to be doing well. He is getting breastmilk from a bottle. We are concerned becaue he has gone 24 hours without having a bowel movement. Should we be concerned?

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

When a newborn breastfeeding baby is not stooling I look at this as a red flag. This baby should be closely watched and taken in to her health care provider's office for a weight check.

The concern with absence of bowel movements in the premature or the full-term newborn is inadequate caloric intake. He may simply not be taking in enough milk. (It is not usually until the age of five or six weeks of age, that a breastfed baby's stooling pattern transitions from several times or more each day, to larger, though possibly more infrequent bowel movements.)

Since your sister's baby is being fed his mother's milk by bottle, it is easy to figure out the baby's intake. What may be of concern is the pattern of feeding. While some premature babies are in the hospital they have been fed on a four hour schedule. The reasoning behind this spacing of feeds with preemies is that they need a longer period of sleep to feed well. Now that your sister and her baby have been released from the hospital, I would recommend going from scheduling of the feeds to feeding the baby on cue.

Her baby may still be very sleepy. Watch for his signs of readiness to feed, such as rapid eye movement as he sleeps, sucking on his fists or fingers, body movements during sleep, and soft sounds. I wouldn't advise waiting to feed a baby, especially a preemie, until they're crying from hunger. Breastmilk is digested in less than two hours, and regular and frequent feeds are important to all newborns.

Constipation is not normally a problem in the healthy breastfed baby. I would advise, increasing the number of feeds to approximately 12 per day, allowing the baby at least one four to five hour period of sleep each day.

If the baby is not feeding at the breast, I would still advise lots of skin-to-skin contact during feeds. She will want to keep her baby close so she can watch for his feeding signals. Your sister also might like to begin transitioning her baby to the breast, and this close contact will help make this easier. As the baby relaxes during a feed, she can offer her breast. A possible concern with never putting the baby to the breast is a reduction of the milk supply over a period of time.

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