Mild Diarrhea in Breastfed Infants: Common Concerns

Mild diarrhea in breastfed babies?

Hello Dr.
Hsiao,
My baby is currently 3 months and 13 days old, weighing 7 kg.
On regular days, the elders bottle-feed the baby with breast milk, but they often warm the milk too much.
I mentioned that the milk only needs to be warm, not hot (since freshly expressed milk is only slightly warm).
Heating it too much can destroy the nutrients, but they say they can't feel any heat when they test it on their wrist.
However, I do feel a burning sensation (the baby is impatient and drinks quickly, so I'm worried about the risk of burns).

There were about 1 or 2 times when I fed the baby at what I thought was an acceptable temperature, and the baby happened to have somewhat watery stools (half thick, half watery, not completely liquid).
The elders questioned whether the milk not being hot enough was the reason for the diarrhea.
I would like to ask the doctor if the temperature of the milk can cause watery stools, or if occasional diarrhea is normal.
Since my understanding differs from that of the elders, I would appreciate your guidance.
If my knowledge is incorrect, I would like to correct it as soon as possible.
Thank you for taking the time to respond.

BOBO, 30~39 year old female. Ask Date: 2017/03/21

Dr. Xiao Kaiwen reply Pediatrics

The temperature of expressed breast milk for feeding is close to human body temperature, which is approximately 37.5 degrees Celsius.
If you feel warmth when dropping it on your wrist, it should be above 37.5 degrees Celsius, making it safe for the baby to consume without any adverse effects.
As long as the baby’s stool is not consistently watery, it is considered acceptable.
Older generations often believe that milk should be warmer, which is influenced by the practices surrounding formula milk in the past.

Reply Date: 2017/03/21

More Info

When it comes to breastfeeding infants, particularly those around three months old, parents often have concerns about various aspects of feeding, including the temperature of expressed breast milk and its potential effects on the infant's digestion. In your case, you are observing that your baby has had a few instances of loose stools, and you are wondering if the temperature of the milk could be a contributing factor.

Firstly, it is important to clarify that the temperature of breast milk does not significantly impact the consistency of an infant's stool. Breast milk is naturally designed to be easily digestible for infants, and its composition is tailored to meet their nutritional needs. The idea that milk must be served at a specific temperature to prevent digestive issues is a common misconception. While it is true that milk should not be served too hot (to avoid burns), the temperature at which it is served—whether warm or at room temperature—does not inherently cause diarrhea or loose stools.

Occasional mild diarrhea in breastfed infants can be quite normal. Infants have immature digestive systems, and their stools can vary in consistency from day to day. Factors that can influence stool consistency include the infant's diet (in this case, breast milk), hydration levels, and even minor viral infections. It is also worth noting that breastfed infants typically have softer stools compared to formula-fed infants, which can sometimes be mistaken for diarrhea.

If your baby’s stools are occasionally watery but not accompanied by other symptoms such as fever, irritability, or signs of dehydration (like decreased urination or dry mouth), it is likely not a cause for concern. However, if the loose stools persist or are accompanied by other concerning symptoms, it would be wise to consult with a pediatrician to rule out any underlying issues.

Regarding the concern about the milk being too hot, it is essential to ensure that the milk is warmed gently. The best practice is to warm breast milk by placing the container in warm water or using a bottle warmer, rather than using a microwave, which can create hot spots and potentially scald the infant. The milk should feel warm to the wrist but not hot, as you mentioned. If you feel a burning sensation when testing the temperature, it is likely too hot for your baby.

In summary, the temperature of breast milk is not a significant factor in causing diarrhea in infants. Occasional loose stools can be normal, and as long as your baby is otherwise healthy, there is likely no need for concern. If you have ongoing worries about your baby's stool consistency or feeding practices, it is always best to consult with a healthcare professional who can provide personalized advice based on your baby's health and development.

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