My criteria in evaluating infrequent stooling in an older baby is to ask the
mother is the child still growing (gaining weight) and is he happy.  In my 23
years as an LLL Leader and 5 years in private practice and staff LC for a
busy ped practice, I have observed this in many babies. It has not been my
experience that the stooling of the baby who has infrequent stools has a foul
smelling or explosive stool.  But, he does have a dump truck load when he
does decide to go.  In the 100% breastfed baby, it is a normal soft, runny
breastfed stool, only very large.

I think we unnecessarily add to a mother's anxiety if we become concerned
about a phenomenal that is as well documented as infrequent stooling in the
older 100% breastfed baby.  In the ped office where I am on staff, we have
had one baby go 16 days without a stool and one 23 days.  These babies were
around 3-4 months above the 75 percentile, very health and happy.  Their
anxious moms brought them in for weight checks to be sure they were still
growing.  They were having lots of very heavy wet diapers and when they
finally went, it was a diaper load.  My son, now 25, was famous for going
once per week on Sunday, AM I was ready to leave for church.  He still lives
at home and has never had any type of constipation problem or digestive
problems.  We also must keep in mind that constipation is not the frequency
of the stooling, but the consistency of the stool (dry, hard, formed stool,
not soft stool).

Breastfeeding and Human Lactation gives the record for not stooling in the
older breastfed baby as 28 days.  When the baby in our office went the 23
days, the mother called me every other day concerned.  I read from Auerbach
book.  The mother ask what happens if we get to 28 days and their is no
stooling, I told the mother we then write Auerbach and tell her to change the
record.  Mom's have enough to worry with without us giving them more to worry
about.

Warm regards,
Pat Lindsey, IBCLC - Lactation Services
Pediatrics Plus Staff LC & Private Practice
Orlando, FL

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