Constipation in Infants on Formula Milk: A Guide for Parents

Formula milk and bowel movement issues?

The child is currently 4 months and 15 days old, weighing 6 kg, measuring 61 cm in height, and having a head circumference of 39 cm.
They have been drinking Enfamil A+ formula and are on their third can.
The milk intake is 150 ml, approximately 4-5 times a day.
They have bowel movements once every 7 days, which is concerning.
The stool is greenish-yellow and thick, with little to no sour smell, and it does not seem to be difficult for them to pass.
The child receives daily clockwise abdominal massages, and sometimes the abdomen feels hard and swollen (as if they are straining).
Last week, they consumed rice water once a day for a week, taking only 3-5 spoonfuls each time.
Today, they had 15 ml of apple puree and drink about 10-30 ml of water per day.
Is this normal? Should the formula be changed?

Xun, 30~39 year old female. Ask Date: 2020/05/21

Dr. Pei Rensheng reply Pediatrics

Hello! For a baby over four months old, the daily food intake is approximately 100-200 gm/kg/day.
Currently weighing 6 kg, this translates to a daily intake of 600-1200 gm of food.
Formula milk accounts for about 600-750 mL, and along with other complementary foods, it seems the nutrition is sufficient, with room for increased intake.
The characteristics of Enfamil A+ formula are: 1.
The only formula that adds probiotics; 2.
Hydrolyzed protein.
If bowel movements are not difficult, just continue to observe and there is no rush to change the formula; alternatively, you can add banana puree to see if it helps with bowel movements.
Wishing everyone good health! Sincerely, Ren Sheng.

Reply Date: 2020/05/21

More Info

When it comes to understanding constipation in infants, especially those on formula milk, it is essential for parents to recognize the signs, dietary influences, and appropriate responses to ensure their child's health and comfort.
In your case, your child is 4 months and 15 days old, weighing 6 kg and measuring 61 cm in height. You mentioned that your baby has been consuming Enfamil formula and has had bowel movements only once a week, with the stool being greenish-yellow and thick. While it is common for infants on formula to have less frequent bowel movements compared to breastfed infants, a week without a bowel movement can be concerning, especially if the stool is hard or the baby appears to be straining.

Understanding Constipation in Infants:
1. Normal Bowel Movement Frequency: Infants can have varying bowel movement frequencies. Some may go several times a day, while others may go once every few days. However, if your baby is only having a bowel movement once a week, it may be a sign of constipation, especially if the stool is hard or difficult to pass.

2. Signs of Constipation: Signs that your baby may be constipated include infrequent bowel movements, hard stools, straining during bowel movements, and discomfort or crying during the process. If your baby’s abdomen feels hard and distended, this could also indicate constipation.

3. Dietary Factors: The introduction of solid foods, such as rice water and apple puree, can affect bowel movements. While rice can sometimes lead to constipation, apple puree is generally considered a good option to help alleviate it due to its fiber content. However, the amount you are offering (15 ml of apple puree) may not be sufficient to have a significant impact.

4. Hydration: It is crucial to ensure that your baby is adequately hydrated. The amount of water you mentioned (10-30 ml) is relatively low for a 4-month-old. While formula provides hydration, offering small amounts of water can help, especially when introducing solids.

5. Massage and Movement: You mentioned performing clockwise abdominal massages, which can be beneficial. Additionally, gentle leg movements (like cycling) can help stimulate bowel movements.

6. Formula Considerations: If your baby continues to experience infrequent bowel movements, it may be worth discussing with your pediatrician the possibility of switching to a different formula. Some formulas are designed to be easier on the digestive system and may help with constipation.

7. Consulting a Pediatrician: Given the current situation, it would be advisable to consult with your pediatrician. They can assess your baby's overall health, review their dietary intake, and provide tailored advice. They may recommend changes to the formula, dietary adjustments, or other interventions to help alleviate constipation.

In conclusion, while some variation in bowel movement frequency is normal for infants on formula, a week without a bowel movement can be a concern. Monitoring your baby's diet, hydration, and comfort level is essential. If constipation persists, seeking medical advice is the best course of action to ensure your child's health and well-being.

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