Q: My 6-month-old son only has a bowel movement every 2-3 days. He doesn't seem to be uncomfortable. Should I be worried? Is he constipated?

A: It is not unusual for an infant to have infrequent bowel movements, especially if the child is being breast-fed. The definition of constipation is tied to the consistency of the stools, not the frequency. A normal stool should not be hard pellets nor should it be persistent squirty water.

Breast-fed infants tend to have looser stools than babies who are formula fed, but they often have more variable frequencies of movements, ranging from several stools a day to one every 3-5 days. Both extremes are in the normal range.

When solid foods such as rice cereal and bananas are added (usually between 4-6 months of age), the stools become firmer and, in some cases, tend to contribute to harder stools. If the infant truly develops hard stools and has difficult bowel movements, the introduction of pear juice or even prune juice will usually alleviate the problem. Rice cereal should be replaced with oatmeal and bananas discontinued.

The development of constipation (hard or large stools) after one month of age in an otherwise healthy infant should not be a reason for undue concern since it can usually be rectified with increased fluids and diet.

If a child has persistent constipation, a physician should be contacted for guidance in the use of bowel movement aids such as mineral oil, increased fiber, and safe laxatives.
Kenneth R. Keer, M.D., is a board certified pediatrician who has been practicing medicine in Southern California for more than 35 years. The information provided in his columns is general information that is not intended as individual advice for a particular child. Please consult your own pediatrician for advice on treating your child. To send questions to Dr. Keer, write to drkeer@familymanonline.com.