Does Formula Milk Cause Constipation?

We might think that “regular bowel movement” for our baby is the same as that for adults, which is usually once a day; however, our babies are not simply little adults. Their physiology is entirely different from ours, which means that what could be normal for adults may not necessarily be true for infants and children. Before diagnosing an infant or child as constipated, there are certain things we must consider like age, diet including source of milk (breastfeeding or formula feeding), and their normal bowel movement pattern. Real constipation occurs when the baby's stools cause significant difficulty and discomfort when being passed, because they are very dense and hard. This definition excludes the baby who has soft, easy-to-pass stools once a week, even if he seems to strain a lot in the process.

A common misconception about constipation concerns the use of iron as multivitamins or iron-fortified formula milk. This is probably because of the side effects of iron taken during pregnancy which causes constipation and dark-colored stools. However, the daily recommended dose of iron for adults is 18mg/day for non-pregnant females, and up to 27mg/day for pregnant women, which is over and beyond the dose for children. The usual dose of iron as multivitamin supplement for infants 0-6 months old is only 0.27mg/day and 11mg/day for babies 7-12 months old. While the content of iron is not the same for all formula milk, surely, it will follow the recommended daily dosages for it to be approved by the Bureau of Food and Drugs (BFAD).  

Studies have shown that iron in formula milk does not actually cause constipation. Based on studies submitted to the American Academy of Pediatrics, babies who were given low-iron formula had the same rate of constipation as that of babies who were given high-iron formula; therefore, iron does NOT have a significant effect on constipation.  

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Another study is by the New England Journal of Medicine which hypothesized that cow’s milk in itself causes constipation, as observed against soy milk. They have concluded that constipation may be a symptom of cow milk intolerance, but they come forward to clarify a few things: first, intolerance to cow’s milk and lactose intolerance are NOT the same thing. Intolerance to cow’s milk is the body’s immune system reacting to the proteins in milk (an immune system reaction), while lactose intolerance is the absence of or a decrease in lactase, an enzyme which digests the milk proteins (a digestive system reaction). Second, an allergy to cow’s milk is usually manifested by hives or patches of redness, swelling, and itchiness, or diarrhea and vomiting, although constipation may also be an occasional sysmptom. If you have tried switching milk formulas and the poop has become softer in consistency, you baby may have had some form of milk protein intolerance.  

Of course, many believe that breastfed babies have a much lesser chance of being constipated than formula-fed babies. This is true. Breastmilk is often called the “perfect food” for a human infant’s digestive system because all of its components are in exact proportion to baby’s needs and it is easily digestible. Breastmilk also contains the right amount of vitamins and minerals that adjust according to baby’s needs and age. The most important part is the immunoglobulin content of breastmilk, which is absent in all cow’s milk formula.   

In truth, the benefits of breastfeeding exceed that of formula feeding. However, it is still a personal choice for each mother. There are many valid reasons for a mother to choose not to breastfeed, some may be medical, emotional or just plain practical. Whatever the reason may be, formula feeding is a good alternative to breastfeeding if the latter is not possible. Breastfeeding is supported and encouraged by both the American Academy of Pediatrics (AAP) and the Philippine Pediatric Society (PPS).

If you find your baby’s pooping pattern to be of concern, don’t hesitate to ask your pediatrician about it.  It may be as easy as changing the milk formula, but your pediatrician should be able to detect signs of a more serious diagnosis that present as constipation.  


Footnotes:
1.     National Institute of Health
2.    American Academy of Pediatrics
3.    New England Journal of Medicine
4.    Pediatric Allergy and Immunology


Photo by legendarymonkey via flickr creative commons