Baby Formula and Constipation: What You Need to Know

Pediatricians get a lot of questions about poop. A big one: Is my baby constipated?

After all, it's hard to know. Healthy babies can go days between bowel movements and be totally fine or go No. 2 every day, have trouble passing their stools, and be constipated, explains Joanna Dolgoff, M.D., a pediatrician and spokesperson for the American Academy of Pediatrics (AAP).

Regardless, if you're concerned about your baby's digestion, it's only natural to wonder if nutrition is playing a role (the foods you get as an adult play a big role in how well things, well, move along, right?). To some extent, the same is true with babies — and breastfed babies are less likely to experience constipation than formula-fed babies, doctors say.

What causes constipation in babies on formula? Here's one thought:

"Formula is thicker than breast milk, so it can take longer to pass through the GI tract." says Katherine Williamson, a board-certified pediatrician at CHOC Children's in Orange, CA. "Sometimes the molecules are harder to digest, which can lead to other GI issues in addition to constipation."

But spotting constipation in babies isn't always the easiest task — and alleviating formula-fed baby constipation isn't as simple as switching formulas (read: there's no best formula for constipated babies).

Here, pediatricians myth-bust the information that's out there and iron out how to spot (and treat) a digestion issue with your little one.

It's easy to think that if your baby hasn't gone, they're constipated, but 'constipation' means firm stool, explains Williamson.

"Some parents think constipation means less frequent stool or straining." And straining or getting red in the face passing a stool can actually be quite normal assuming the texture of the stool is soft. "The baby is learning to use their muscles," she says.

That said, babies with constipation generally do have less frequent bowel movements than normal, says Dolgoff. What's normal?

A breastfed baby might go once every five days. Formula-fed babies can go anywhere from one to three times a day to every few days, she says. Constipated babies also tend to have large, difficult, painful bowel movements that often look like pellets; and arch their backs, tighten their buttock, and cry while going.

But keep this in mind, too: "Most babies aren't constipated," says Rachel Dawkins, M.D., a pediatrician at Johns Hopkins All Children's Hospital in St. Petersburg, FL. Formula-fed baby constipation is certainly a possibility, but your baby might actually just be straining or suffering from colic, which can cause crying and discomfort. A milk protein allergy, lactose intolerance, or, rarely, other underlying medical conditions could also be at play, she says.

If you think your formula-fed baby is constipated, a slew of questions are likely going through your head: 'Does powder formula make babies constipated?', 'does changing baby formula cause constipation?', 'can ingredients like palm olein oil contribute to constipation?'

First: There's no *one* formula that's been shown to decrease or prevent constipation and there's no best baby formula for constipation, says Dolgoff. "According to the AAP, changing the formula is not necessarily what's going to help treat constipation."

By switching sips unnecessarily, you might just be honing in on a solution that's not all that effective, too, says Bhavana Arora, M.D., a pediatrician and medical director of the CHLA Health Network, a group of more than 160 L.A.-based community pediatricians. Or worse: Changing baby formula could potentially cause constipation, contributing to abdominal discomfort as the baby's GI system has to adjust to the change, says Dawkins.

That's why doctors don't usually suggest changing formula without knowing exactly what's causing symptoms.

In these specific situations, pediatricians might suggest a formula change for constipation:

Your child has a milk allergy. Signs of one might include blood or mucus in your baby's stool or an extremely fussy baby, says Williamson (though you always want to get a milk allergy confirmed before switching formulas). In the case of one (it's rare — only about 5 to 7 percent of formula-fed babies have a cow's milk protein allergy), a doctor might recommend a lactose-free formula or a hypoallergenic option such as Nutramigen.

It's not always enough to switch to a soy formula either. Many kids who are allergic to milk are also allergic to soy, says Arora. And it's probably worth noting that if you're wondering if a soy formula is making baby constipated, barring an allergy, it's likely not, experts say.

Your child has acid reflux. Almost all babies have some amount of reflux or spitting up, says Dawkins (often it's a result of over-feeding or not keeping the baby upright after feeds). That said, there is baby formula for reflux. These formulas usually have added rice proteins that thicken the formula up.

"The idea is that it's harder for the formula to go down and come back up," explains Williamson. "This won't help all babies, but trying a specialized formula, under the supervision of your pediatrician, won't cause harm."

Here's another question pediatricians get every so often: Can iron in baby formula cause constipation?

The worry makes sense — after all, when adults take iron supplements, they can get constipated as a side effect. But iron is extremely important for growth and brain development, so you don't want to switch to a low-iron formula, says Dawkins.

"The American Academy of Pediatrics has recommended again and again that all infants getting formula and not breast milk, receive iron fortified formula to prevent iron deficiency anemia."

First, it's always best to consult your pediatrician if you suspect constipation. This way, you can ID potential allergies, rule out other underlying causes, determine that the issues is indeed constipation, and find a solution that works for your baby.

There are things you can do at home (under the guidance of your baby's doc) to help the problem, too. Start here, suggests Dolgoff: