From the Guidelines
Infants taking formula feeds are more likely to experience constipation due to the difficulty in digesting formula compared to breast milk. The main reasons for this include the higher levels of casein protein in formula and the lack of natural digestive enzymes found in breast milk, which can make stools firmer and harder to pass 1. Some key factors contributing to constipation in formula-fed infants are:
- Higher casein protein levels in formula
- Lack of natural digestive enzymes
- Iron content in formula
- Less frequent bowel movements compared to breastfed babies
- Stools that are more formed and darker in color To manage formula-related constipation, parents can consider:
- Switching to a different formula brand
- Ensuring proper formula preparation
- Offering additional water between feedings for babies over 6 months
- Using a formula with lower iron content if recommended by a pediatrician
- Gentle tummy massage, bicycle leg movements, or warm baths to stimulate bowel movements It is essential for parents to consult their pediatrician if constipation persists or is accompanied by other symptoms like vomiting or blood in stool.
From the Research
Constipation in Infants Taking Formula Feeds
- Constipation is a common issue in infants taking formula feeds, with several studies investigating the relationship between formula composition and stool characteristics 2, 3, 4, 5, 6.
- The composition of infant formula, including the type of protein, fat, and carbohydrates, can affect stool consistency and frequency 3, 5.
- Formula-fed infants tend to have harder stools than breastfed infants, which may be due to the differences in fatty acid composition and absorption 3, 6.
- The use of palm olein oil in some formulas may contribute to harder stools, as the palmitic acid in palm olein is poorly absorbed and can form insoluble soaps with calcium, leading to harder stools 3.
- Formulas with high levels of lactose and magnesium may help to soften stools and improve symptoms of constipation in infants 4.
- The type of formula consumed can affect stool characteristics, with some formulas resulting in harder or softer stools than others 3, 5.
- Parental education on the range of normal stool characteristics and the common occurrence of spitting, gas, and crying may help to alleviate concerns about formula intolerance and underlying gastrointestinal disease 5.
Factors Contributing to Constipation
- Fatty acid soaps, particularly those formed from saturated fatty acids, can contribute to harder stools and constipation in formula-fed infants 6.
- The level of calcium in the formula can also affect stool hardness, as calcium can form insoluble soaps with fatty acids 6.
- The type of carbohydrate in the formula, such as lactose, can affect stool consistency and frequency 4.
- The presence of nucleotides in some formulas may also affect stool characteristics, although the evidence is limited 3.
Management of Constipation
- The use of formulas with high levels of lactose and magnesium may be considered to help soften stools and improve symptoms of constipation in infants 4.
- Thickened formulas or anti-reflux formulas may be considered in specific cases of regurgitation, but their use is not recommended for constipation without medical supervision 2.
- Parental reassurance and education on normal stool characteristics and the common occurrence of spitting, gas, and crying may help to alleviate concerns about formula intolerance and underlying gastrointestinal disease 2, 5.