Some Solutions for the Problem of Infant Constipation

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With the birth of a child, new parents em­bark on a steep learning curve. One of the first bodily mysteries that inexperienced parents must rapidly learn to decode involves the baby’s elimination patterns. Most crucially, parents want to know whether their baby is peeing and pooping normally.

Unfortunately, it appears that constipation in the young is not only frequent but often begins in the first year of life.¹ One study estimates that up to half of all infants may experience gastroin­testinal symptoms (including colic and “spitting up” as well as constipation).² Systematic reviews assessing constipation prevalence worldwide have estimated that the affliction affects from 1 to 31 percent of infants and toddlers,³ and anywhere from 0.5 to 87 percent of children and adolescents.⁴

Pediatric constipation may be common, but it is not innocuous. Researchers observe that while it can start out as a “simple complaint,” constipation that is ignored can lead to fecal impaction and eventually even affect a child’s growth and development.⁵

Constipation is also highly uncomfortable for children, “characterized by infrequent bowel movements, hard and/or large stools, painful defecation, sometimes in combination with fe­cal incontinence, and. . . often accompanied by abdominal pain.”⁶ Indicators of constipation in babies include straining to pass stools, painful stools, and large, hard stools accompanied by straining or pain.⁷

The vast majority of published studies on pediatric constipation focus on the condition known as “functional” (or “idiopathic”) constipation—so-called due to the absence of any structural or biochemical explanation for its occurrence.⁶ Most researchers remain at a loss to say why this form of mystery constipation is so widespread in the young.

BREAST VERSUS BOTTLE: WHAT IS “NORMAL”?

In infants, researchers quite reasonably point out that understand­ing “abnormal defecation” and constipation requires first knowing what normal pooping looks like.⁸ Ascertaining what is “normal,” in turn, requires knowing what the baby is eating, because breastfed and formula-fed infants do not have the same stools or pooping patterns. In fact, as parenting websites put it, “The stool of [a] formula-fed baby is totally different from the stool of [a] breastfed baby.”⁹

Thanks to the digestibility and “natural laxative” properties of breast milk,¹⁰ constipation in breastfed babies seems to be rare, at least initially. Infants who are exclusively breastfed in the first few months of life produce stools that are more frequent, softer and of a different color and smell compared to the stools of conventionally formula-fed babies (see Table 1).¹¹ A Dutch study published in 2014 found that the feeding approach (breast, formula or a mixture of the two) could explain up to 24 percent of the observed differences in how often babies defecate.⁸

The Dutch researchers also proposed that “green-coloured stools in standard formula-fed infants. . . be considered normal”; however, some medical websites flag green stools as a possible sign of slow digestion, food allergies, food intolerances or other problems.¹² This should come as no surprise to readers of Wise Traditions, as digestive difficulties and allergies are well-known problems associated with commercial soy formula—an “abnormal” baby food if ever there was one. Typical soy formula not only contains high levels of unhealthy soy phytoestrogens but may also feature fluoride, aluminum, cadmium, glyphosate residues, hexane-extracted soybean oil and other toxic ingredients.¹³ In addition to digestive distress, researchers have linked soy formula to seizures, autistic behavior and other neurological symptoms.¹⁴

LIKE MOTHER, LIKE BABY?

A study conducted in rural Turkey, pub­lished in late 2019, found that half the number of infants whose first food was breast milk suffered from constipation compared to non-breastfed infants (15.4 percent versus 32.1 percent).⁵ Twenty-one percent of the constipated infants defecated twice or fewer times per week, and 5 percent “had stools that were like goat droppings.” Interestingly, sales of breast milk “substitutes” have skyrocketed in Turkey in recent years, growing by 72 percent between 2008 and 2013.¹⁵

In addition to a decline in breastfeeding, factors that increased the Turkish infants’ risk of constipation included starting on supplementary foods before the age of six months, being mildly or fully obese (a likely proxy for a diet high in processed junk foods) and having a mother who also suffered from constipation.⁵ In fact, fully half of the constipated infants had constipated mothers, and the presence of constipation in the mother was statistically significant at the p<0.0001 level, reflecting a 4.7-fold increased risk.

Dr. Natasha Campbell-McBride, author of Gut and Psychology Syndrome,¹⁶ observes that constipation is “always a sign of deficient gut flora.” In her estimation, the majority of babies in the modern world have an imbalanced gut microbiome. Thus the link between maternal and infant constipation demonstrated by the Turkish study is an important warning to mothers-to-be to get their microbial house in order. Unfortunately, factors such as industri­alized foods, birth control pills, antibiotics and glyphosate can make this extremely challeng­ing. A new study from Finland (in the Journal of Hazardous Materials, no less) reports that 54 percent “of around 101 species of bacteria com­monly found in our guts could be damaged or killed if exposed to glyphosate in high enough quantities.”^17,18

HOMEMADE FORMULA: TROUBLESHOOTING CONSTIPATION

When breastfeeding is not possible (for whatever reason), feeding baby one of the two types of nutrient-dense homemade formulas rec­ommended by the Weston A. Price Foundation is by far the best option (see sidebar below). Many families report considerable success giving their young ones either the raw milk formula or the liver-based formula.¹⁹

However, some parents who turn to the raw milk formula report that their babies be­come constipated. For a constipated infant, the first explanation to consider is dehydration. Campbell-McBride instructs parents to care­fully monitor baby’s urine, making sure it is pale yellow; dark yellow (or even brown) urine is a sure sign of dehydration. In addition, the baby should be producing normal amounts of urine—as indicated by a diaper that is full of urine and requires changing after a feeding. The AskDrSears website describes the colon as the body’s “fluid regulator” and points out that dehydration can cause the stools to harden and become “water-deprived.”²⁰

If the baby is dehydrated, Campbell-Mc­Bride recommends adding more water to the baby’s milk formula. In situations where the baby is producing only small amounts of very dark urine, the formula initially can be diluted almost by half; after the urine normalizes, the parents can then experiment with different amounts of water to find the correct ratio for their baby. (She notes that every child has differ­ent requirements for water, depending on factors such as metabolism, activity level and weather.)

Sometimes, dehydration is not the trigger­ing factor for infant constipation. Some babies on the raw milk formula find high levels of dairy protein constipating. (Formula based on raw goat milk is more likely to be constipat­ing that formula based on raw cow’s milk.) In these cases, Campbell-McBride recommends switching the infant to the liver-based formula and when the baby is old enough (no earlier than four months of age), carefully starting to introduce appropriate solid foods (see “Avoid the Rice Cereal”).

Large amounts of high-protein dairy—such as whey, yogurt, kefir and cheese—can also aggravate constipation in some older children and adults.²¹ Deemphasizing these high-protein dairy foods and replacing them with more high-fat dairy—butter, ghee and homemade sour cream—can help resolve the issue by lubricating the gut wall and softening the stool. Campbell-McBride also recommends increasing animal fat consumption overall as well as prioritizing gelatinous meats over muscle meats.

SOLUTIONS THAT ARE NO SOLUTION

When hydration and dietary changes do not do the trick, or fecal impaction has become a concern, it may become necessary to perform enemas (for children who will tolerate them) or more occasionally, to resort to glycerin sup­positories. Disturbingly, one of mainstream medicine’s top recommendations²² for disim­paction—and often, its enthusiastic recom­mendation for ongoing “maintenance”—is to administer an “osmotic laxative” featuring a highly problematic active ingredient called polyethylene glycol (PEG) 3350. One of the leading PEG-3350-containing products is the Bayer-owned, over-the-counter drug Miralax; the fact that Miralax has never been approved by the FDA for pediatric use has not stopped health care providers from promoting it as the “go-to” remedy for constipated children. In fact, across all age groups, Miralax is the second leading “digestive remedy” in the U.S.²³

Horror stories abound about PEG 3350’s propensity to cause extreme neuropsychiatric side effects, including rage, anxiety and para­noia. Between 2007 and 2017, the FDA received reports of over fifteen hundred different adverse reactions to PEG 3350 in children, of which nearly three in five were neurological.²⁴ A parent group called Parents Against Miralax has tens of thousands of members, many of whom have joined class-action lawsuits.

There is growing evidence that PEG-3350-based drugs may alter the microbiome and even increase the risk of antibiotic resistance. A 2018 study in mice showed that the laxative could cause “a long-lasting perturbation to the gut microbiota” as well as immune system alterations.²³ As the researchers concluded, “These unintended consequences of PEG treat­ment are particularly important in light of the increased use of osmotic laxatives in pediatric populations, where the long-term health impact of PEG-related immune response is currently unknown.”²³ Suggesting that this research may explain the troublesome connection between Miralax and neuropsychological symptoms, one group of lawyers has remarked that “When the gut is ‘off’ per-say [sic], many other things in the body can, in turn, be ‘off’ as well.”²⁵

Consumers should be aware that PEG is a common component of many other drugs and cosmetic products (as well as some of the Covid-19 messenger RNA vaccines under de­velopment). Its use is increasingly controversial due to a wide range of documented adverse PEG-related immune reactions, including life-threatening anaphylaxis.²⁶

AVOID THE RICE CEREAL

For the infant who is ready to embark on some solid foods, Campbell-McBride points to the critical importance of introducing foods in such a way as to create healthy gut flora and a healthy digestive function. When adequate care is not taken, the transition from exclusive breastfeeding (or even formula) to solid foods can actually be the catalyst for constipation to develop.

Children under one year of age are not fully equipped to digest grains, which makes the widespread practice of feeding cereal grains to infants particularly ill-advised.²⁷ Some main­stream nutritionists are belatedly conceding this point and are also admitting that processed cereals are a leading constipation culprit.²⁸ Ac­cording to the Dr. Sears website, the main reason that so many babies become constipated when initiating solid foods is that health care profes­sionals tend to recommend the very foods (such as rice cereal) that they know to be constipat­ing!⁷ “The truth is,” Dr. Sears confesses, “there is nothing special about these foods that makes them better to start out with,” and “babies don’t actually even need rice cereal.”

Wise Traditions parents know that babies’ first solid foods should be animal foods, which the immature digestive system is best able to handle and thus far less likely to promote con­stipation. This can begin with a daily pastured egg yolk (starting as early as four months of age) and small amounts of grated raw liver (beginning at six months). Pureed meats and simple watery patés, easy-to-digest bone broths, vegetable purees (with plentiful animal fats), fruit purees and small amounts of kefir or yogurt can be gradually added around eight to ten months of age, with new foods introduced one at a time. Properly prepared (i.e., soaked, sprouted or fermented) grains, nuts and seeds should wait until at least one year of age. (See the Weston A. Price Foundation website for more suggestions.²⁹)

DEEPER HEALING

Dr. Campbell-McBride, Dr. Tom Cowan and other wise healers familiar to readers of this journal emphasize that in the long run the best and only solution for constipation is to heal the gut and improve digestion.³⁰ This is the case whether the sufferer is six months old or seventy years old. Eating a Wise Traditions diet—mak­ing sure to include digestible and mineral-rich bone broths, lacto-fermented beverages such as beet kvass and unrefined sea salt—is sure to make a meaningful difference.

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SIDEBARS

HOMEMADE INFANT FORMULA
Breast milk from a healthy mother is usually the best food for baby. However, the quality of a mother’s milk depends on her own diet. Lactating women’s diets should include plentiful animal products and fats, pastured eggs, liver, bone broths, high-quality raw dairy and cod liver oil.

In situations where breastfeeding is difficult or impossible, or if baby is not gaining weight on breast milk or seems always hungry, the Weston A. Price Foundation recommends homemade rather than commercial formula. The foundation’s website provides detailed recipes and instructions for making raw milk baby formula and liver-based formula (westonaprice.org/health-topics/childrens-health/formula-homemade-baby-formula/). Both recipes incorporate a variety of nutrient-dense ingredients, including whole-fat raw milk from pastured cows (for the raw milk formula) and liver and homemade broth (for the liver-based formula), along with cod liver oil, coconut oil, Bifidobacterium infantis and other components designed to mimic the nutrient profile of mother’s milk as closely as possible.

C-SECTIONS AND INFANT CONSTIPATION: AN UNEXPLORED TOPIC
A growing body of research indicates that babies delivered by C-section are more likely than vaginally-delivered babies to experience chronic health problems later in life, including type 1 diabetes, obesity and asthma.³¹ The hypothesis underlying these observations is that infants born by C-section miss out on exposure to the mother’s vaginal and intestinal microbiota, and that during vaginal births this exposure plays an important role in “priming” the infant’s immune system.³² As one researcher describes it, “Every generation of mothers hands over its microbiome to the next, as the baby is coated with beneficial germs while being squeezed through the birth canal—but this doesn’t happen for babies born through C-section.”³³

In 2018, Japanese researchers conducted a first-of-its-kind study assessing the potential correlation between C-section delivery and infant constipation, expecting that infants not delivered vaginally would have higher rates of constipation (as defined by weekly frequency of bowel movements).³² Although the study’s results did not bear out the researchers’ assumptions—instead showing comparable rates of constipation for both modes of delivery—the investigators noted that the low overall rate of constipation in Japanese babies (1.37 percent) may have made it difficult to detect meaningful differences. Suggestively, they found that C-section babies were significantly less likely to be exclusively breastfed. One wonders what such a study might find in the U.S., where constipation and C-sections both occur at alarmingly high levels.

OTHER SUGGESTIONS FOR CONSTIPATED BABIES
1. Try a small amount of diluted, homemade prune juice (the juice from cooking prunes) or some pureed cooked prunes.
2. Make a digestive tea (see Nourishing Traditions, page 604). To make this folk remedy used for constipation and intestinal gas in infants, bring two quarts of filtered water to a boil and pour the water over two cups of fresh anise (fennel) leaves and two cups of fresh mint leaves. Let steep until the water cools, then strain. Give the tepid tea to baby about four ounces at a time. Nursing mothers may also drink this tea and pass along the digestive benefits to colicky babies.
3. For babies who are constipated on the Wise Traditions raw milk formula, try eliminating the nutritional yeast and gelatin and adding more cream (one or two tablespoons). This should be a first step before switching to the liver formula.
4. Consider the possibility of a vitamin B12 deficiency. Vitamin B12—found almost exclusively in animal foods such as meat, liver, fish, shellfish, milk products and eggs—is essential for healthy digestion and intestinal functioning (particularly movement of the bowels) but also requires a sound digestive tract for proper absorption. Soy is a key culprit interfering with the ability to absorb B12—yet another reason to avoid giving babies soy!

REFERENCES

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This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Winter 2020

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