Breastfed babies and their pooping habits has been a subject of much debate.
New moms often worry that their breastfed babies aren’t pooping enough…or that their poop looks weird…or that there’s something else wrong. Typically, these mothers are assured — “If baby is not uncomfortable, it’s fine to go up to two weeks without pooping! Breastmilk is the perfect food so it’s all used up and there’s just no waste left!”
Unfortunately, although this bit of advice has been passed around for years, there is not one shred of evidence to back it up.
Since how often a breastfed baby poops — and how often s/he should poop — actually affects long-term gut development (and therefore, long-term health), it actually matters a lot if this is true or not.
How often should a breastfed baby poop, really?
What is Poop Made Of?
First, we need understand what poop is, and what it means for gut health.
Most of us know that poop is “waste” from our food. That’s likely where the idea that breastfed babies don’t need to poop came from — it’s literally designed for each individual baby, so it seems to make sense that it would all just be absorbed. (Except, no.)
But, that’s actually not really what poop is — exactly.
Poop is about 75% water, on average, and 25% solids. Of those solids, a good portion of it is live bacteria from the gut — bacteria that helps to digest, extract, and synthesize important nutrients (among other things). There’s also fiber, possibly undigested food, some fat, and various other things. (source)
So, a breastfed baby’s poop is mostly water and bacteria. That’s important to recognize, because it’s not entirely the “waste” products from breastmilk; it’s actually a sign that the gut is moving along the way it should. We all know that this is true in adults, and we look for “regularity” as an important sign of health. The only reason we think that breastfed babies are different is because of that pervasive myth that mixed foods have a lot of waste, and breastmilk doesn’t. Only this isn’t true, either.
But…poop is all about gut health! And this is especially important in a breastfed baby whose gut is still immature.
What Does Breast Milk Do in the Gut?
This is a really important question, too. Does breast milk actually have anything to do with the gut? Or is it “all used up” in digestion, as many claim?
Actually, breast milk contains a substance called oligosaccharides, which are a special kind of milk sugar that a baby can’t digest (yes, really!). This milk sugar is there to feed the bifidobacteria in the gut, to promote normal flora development. In fact, although it’s by far the only factor, it’s considered the most important factor in infant gut development (source).
Bifidobacteria makes up about 75% of the gut flora in a healthy breastfed infant, specifically the strains B. longum, B. infantis, B. breve, and B. bifidum (source).
Of course, this is not all that breast milk does in the gut. Several other factors, including immunological factors, growth hormones, etc. help to protect a baby, form baby’s immune system (while their own ‘actual’ immune system is still immature), promote normal growth and development, and more.
Breast milk is not just food. So, even if the ‘food’ parts of it were “all used up,” the other parts are not — on purpose. Because they’re present to specifically nourish budding bacteria and develop the gut.
This is why it doesn’t make sense that breastfed babies pooping infrequently is “normal!”
How Often Should a Breastfed Baby Poop?
Breastfed babies can vary from “every feeding” (8+ times per day) to 1 – 2 times per day and both ends can be normal. There is not a universal answer to this. (source)
But, breastfed babies should not be going several days in between poops. If that’s happening, then bifidobacteria isn’t as prevalent as it should be. Something’s missing. The factors in breastmilk that promote normal gut function and development aren’t working right.
Basically, regular poop is a sign that things are working as they should in the gut…and a lack of it means something’s not right.
Many parents can tell you that their babies get kind of uncomfortable or fussy on “poop day” when it has been awhile since they went. Usually, the poop comes in massive quantities, too. This means it was all sitting in the gut, backed up…it’s not that there “wasn’t any poop,” it just wasn’t moving through as it should have!
The bottom line here is that going several days in between poops is not normal, and is a sign that gut health isn’t the way it should be. Remember, if you, as a breastfeeding mother, do not have healthy gut flora, you are passing this on to your baby. This means that your own health needs to be addressed!
Other Abnormal Variations in Breastfed Babies’ Poop
Besides infrequent pooping, babies may have an issue if you see any of these:
- Very watery poop
- Thick, pasty poop
- Green poop
- Brown poop
- Frothy, foamy poop
- Very stinky poop
- Poop that causes diaper rashes easily
A normal breastfed baby should be pooping 2 – 6 times per day (and while they may poop less frequently after the first 6 weeks or so, should still be going 1 – 2x per day). The poop should be soft but not runny, a yellow-orange color, may contain ‘seeds’ (milk curds) and should have a mild, sour-milk kind of smell.
If there’s a variation in this, it can mean all kinds of things!
Disturbed Maternal Gut Flora
This is probably the most overlooked reason for issues.
There are so many things that can impact our gut flora, as mothers. These can include:
- Past/current use of hormonal birth control
- Overconsumption of sugar
- Overconsumption of refined vegetable oils
- Other prescription drugs
If you have taken medication (or currently do), if you struggle with hormone imbalances, if you have trouble controlling your weight, you can assume that your gut flora is not optimal.
This does not mean that all is lost, or that you should not breastfeed. It does mean that if you can reduce or eliminate some of these factors and slowly work to improve your gut health while breastfeeding (there are safe ways to do this), then you should.
This is not blaming mothers, by the way. Many of us were never told how important gut flora is to our health, nor how to protect it. It’s just not a topic that’s been commonly discussed until more recently, and even now is still very confusing to most. I have personally breastfed all my babies, even when I knew that my gut health was not optimal. I have always just tried to do the best I could, which is all we can do.
Allergen in Maternal Diet
If we have less-than-optimal gut flora (most of us), then undigested proteins can bother us…and slip through into our milk, upsetting baby’s gut.
The best thing to do in this case is to eliminate the offending food(s). If they are bothering baby…then they are bothering you! Even if you don’t realize it because you have ‘adjusted’ to it. (Several mothers who eliminate foods for baby, and later reintroduce, suddenly find that they do react to them.)
Look at wheat/gluten, dairy, soy, corn, nuts, and other top allergens as potential issues, especially if baby is fussy during/right after feeding in addition to abnormal poop. Frequent spitting up — even ‘happy’ spitting — is usually a sign of a maternal gut issue/allergen too. Some moms have trouble digesting ‘gassy’ foods like onions, garlic, beans, etc. and these may also bother their babies. Caffeine can be an issue for some, too.
Sometimes, mothers have too much of the watery ‘foremilk,’ which leaves baby without some of the fat in the ‘hindmilk’ that is necessary for balance nutrition. This can happen with oversupply or forceful letdown. Usually, babies will be fussy, gassy, and have green poop if this is the case.
It can often be corrected by popping baby off the breast when letdown occurs to ‘catch’ a little bit of the milk at first, as well as feeding baby on only one side per feeding (so they get the hindmilk in the first breast instead of foremilk from both). Waiting too long in between feedings can also cause more foremilk, so try to feed baby more frequently.
Some babies are unable to latch properly due to a tongue/lip tie, which can lead to inefficient milk transfer. A qualified lactation consultant or dentist can properly diagnose this, as can some midwives. A dentist can correct it.
But, be aware, many in the mainstream do not believe this is a ‘thing’ and may tell you that it doesn’t exist or doesn’t matter. If you hear that, go find someone who at least understands ties!
By the way, ties are a midline deficiency, which can be a sign of an MTHFR gene mutation, which can have a far-reaching impact on health. Other signs include a “sugar bug,” (blue vein across the bridge of the nose), sacral dimple (lower part of the spine), spina bifida, and more. If this is the case, then it’s really important for mom to eliminate any synthetic vitamins from her diet, especially folic acid.
Of course, there’s the possibility of a run-of-the-mill minor illness, too. If baby’s poop is usually normal, but is ‘off’ for a couple days, it’s probably some little bug. No need to worry, just keep nursing and it will pass.
Early Mixed Feedings
Any kind of food besides breastmilk will change the gut flora. This includes using formula, as well as introducing solid food.
While the gut flora naturally will shift in an older baby/toddler, once food is introduced, this isn’t something that we should do prior to 6 months of age. The gut needs to mature properly before introducing anything else!
If you need to supplement, look into donor milk or homemade formulas instead of store-bought formula, especially if you have MTHFR (store-bought formula may harm babies with this mutation).
If you’re interested in learning more about this issue, check out 5 Ways to Help Your Infant Develop Optimal Gut Flora.
So, this may be different than what you’ve heard! But hopefully, it puts to bed the old myth that “it’s normal for breastfed babies to poop rarely.” Allowing this to keep floating around is harming babies’ immature and rapidly developing guts!