Baby Formula Feeding Concerns

Constipation

Constipation in infants is frequently defined as difficulty in passing hard, dry (like small pellets) poo. If your baby has infrequent bowel movements, it doesn’t necessarily mean they are constipated. There can be big differences between babies when it comes to the duration between bowel movements, some being daily, some being weekly. You also can’t rely on your baby’s facial expression while doing a poo to conclude constipation either, this can be a very normal response. 

With formula-fed babies, generally their poos are thicker and pastier and sometimes less frequent than breast-fed poo but this also doesn’t mean your baby has constipation.

Your baby’s bowel motions can be affected by several factors, including:

• Fluid intake
• Introduction of solid foods
• Age (as age increases the stool characteristics change)
• Illness and infections
• Medications

If you have any concerns about your baby’s bowel motions, it never hurts to seek the advice of your doctor or health care nurse.

Diarrhoea

Diarrhoea is characterised by very frequent, runny, liquid stools. Diarrhoea in children is fairly common, especially during and following gastroenteritis, or “gastro”. Diarrhoea results in a significant loss of water and mineral salts from the body and therefore presents a serious risk of dehydration. In extreme cases, it can even result in your baby having to be hospitalised to receive fluids. If your baby is less than 6 months old, it’s recommended you take them to see a doctor immediately if they experience 3 or more watery poos over the day. In older children it’s also important to see a doctor if symptoms persist.

There are rehydration solutions and particular probiotics available for babies that may be appropriate. A healthcare professional will be able to advise which one is best for your child.

Poo Colour

If your baby is happy and thriving on the formula they are on, the colour of their poo should not necessarily be a cause for concern. You should however consult healthcare professional advice if your baby’s poo is ever red, black or white in colour.

Changes in your baby’s stool colour may be due to several reasons, not all of which require medical intervention:

• The colour of baby’s stools on intact-protein formulas are usually light yellow/green to brown. 
• The colour of baby’s stools on a formula that has the protein broken up (hydrolysed protein formulas) can range from yellowish mustard to dark green.
• If you are using a combination of breastfeeding and baby formula, your baby’s poo will vary from the descriptions above depending on the ratio of breast milk to baby formula. Generally, a breastfed baby will have more yellowish to slightly green colour poo.

Changes in your baby’s stool colour may be due to several reasons:

• If you are moving your baby from breastfeeding to baby formula or between formulas, it is normal for there to be changes in bowel motions, and the colour of your baby’s poo. 
• If your baby has started solid food, their poo colour can also be affected by the colour of recent food choices, so keep this in mind.
• If your baby has pale yellow, white or grey coloured poo you should see a doctor immediately.  

At the end of the day, if you are worried about the colour of your baby’s poo, then it doesn’t hurt to see your doctor or health care nurse to get some reassurance. 

Poo Smell

This should come as no surprise, but everyone’s poo smells… including your baby’s. 

Formula fed babies tend to have more pungent smelling poos compared to breastfed babies. Unfortunately, there is not much you can do about that.

It’s also useful to note that if you are moving your baby from breastfeeding to baby formula or between formulas, or starting solids, it is normal for there to be changes in bowel motions, and this can include colour and smell.

Colic

Colic is an unexplainable unsettled period where your baby is crying for a long time, sometimes for hours, and is inconsolable. The true definition is crying for more than 3 hours a day, at least 3 times a week for more than 1 week, yet otherwise growing normally. Approximately 20% of babies, both breast and formula fed, between the ages of two weeks and six months suffer from colic. There can be several causes of crying but when there is no obvious cause, and no growth concerns, fever or illness, the inconsolable periods of crying are labelled colic.

Ruling out some common discomforts (listed below) may help identify whether or not you might be dealing with baby colic. For example, are you:  

• Responding to hunger and fullness cues;
• Responding to tired signs and regular sleep patterns to ensure they are getting enough sleep;
• Changing dirty nappies to keep them comfortable;
• Burping your baby after feeding to ease built up pressure in the tummy; 
• If formula feeding, preparing the bottle using the correct scoop and quantities of powder and water.

If you have ruled out the above possible causes, it’s likely time to visit your health care professional for more advice. There is some good evidence that specific probiotic strains might help reduce crying in colicky babies. Discuss with your doctor about possible treatment options.

Lactose Intolerance

Lactose intolerance is a clinical condition which is due to the intestine’s inability to digest lactose, the main carbohydrate, or sugar, found naturally in milk and milk products. This inability to digest lactose is because there is not enough lactase enzyme in the intestine, which is needed to digest and breakdown lactose.

There are generally two forms of lactose intolerance:

1. Primary Lactose Intolerance: An extremely rare genetic condition which requires medical intervention. This is when the body doesn’t produce enough of the lactase enzyme.
2. Secondary Lactose Intolerance: This is much more common. It occurs when the small intestine cell lining is damaged, occurring commonly after gastroenteritis. The cell lining is where the lactase enzyme lives, damage to these cells can mean an interruption and reduction of lactase activity.

If your formula fed baby suffers from lactose intolerance, an infant formula suitable for lactose intolerance would be the alternative to a standard infant formula. Speak to your health care professional before changing any infant formula.

Regurgitation

Regurgitation (or mild reflux) is when stomach contents flow back up into the oesophagus. This may or may not include vomiting and is harmless in many cases so there is often no particular need to worry, but if you are concerned, please consult your doctor.

For formula fed babies, there are infant formulas that are suitable for infants with regurgitation. You should always check with your doctor before changing your current infant formula to ensure you choose the most appropriate one for your baby.

Bottle refusal

Feeding your baby from a bottle for the first time doesn’t always happen easily. Suckling from an artificial teat is different from suckling from the breast, so your baby may need to learn how to do this. Persistence is usually the key, however trying different teats, or different shaped bottles to hold, may help your situation.

If you are still having difficulty, discuss this with your health care professional who can offer you personalised advice.

IMPORTANT NOTICE: Breast milk is best for babies and provides ideal nutrition. Good maternal nutrition is important for the preparation and maintenance of breastfeeding. Introducing partial bottle feeding could negatively affect breastfeeding and reversing a decision not to breastfeed is difficult. Professional advice should be followed on infant feeding. Infant formula should be prepared and used exactly as directed or it could pose a health hazard. The preparation requirements and cost of providing infant formula until 12 months of age should be considered before making a decision to formula feed.