I have been interested in the recent discussion of the frequency and texture and quantity of stools of healthy breastfed babies.  Some time ago I tried to find published material on this, without success.  

My interest in the issue was sparked by my memories of my own experience with my four children (in the '70s).  While exclusively breast fed, three of the four settled into an early pattern of one amazing large mustard coloured soft stool (as described by Dr Jack so clearly in his Lactnet post of 7-8 August) every 7 to 10 days.  The longest interval was 14 days.  Passing the stool did not seem to be difficult.  This began at about 4 weeks of age, and abruptly ended when they began to eat other foods at about 5 or 6 months.  They never displayed symptoms of constipation (pain, straining, hard stools &c), did not appear to have distended abdomens prior to bowel movements, and 'normal' bowel movements became a regular daily event as soon as other foods were included in their diet as well as breastfeeding. 
The first time this phenomenon presented itself to me was when my second child was about one month old.  (My first child had been at the other end of the spectrum - many loose actions every day, until her diet included solids).  I was living in Michigan at the time, and phoned the paediatrician who had seen her at birth.  I was advised to give her (my 4-week old, exclusively breastfed baby who was happy and thriving and obviously healthy) prune juice and / or corn syrup in boiled water.  I did not even know what corn syrup was then - I'm an Australian!  I tried it once and did not like the effect it had on my baby.  She had pains in her tummy for the first time ever.  Then another mother who had been in LLL told me that I did not have to do anything.  Thankyou Janet Tinning.  I learned to leave well alone.

I recently tried to discuss the issue with a friend who is a medical doctor currently employed as a bowel cancer researcher at a major US university medical school.  I described the great variability in frequency of stools while exclusively breastfed, and he was horrified that any baby could be "allowed" to go without a bowel action for more than 24 hours.  He insisted that intervention was essential for the baby's wellbeing.  He did not seem to have any understanding of breastfeeding, and in his opinion the method of feeding was irrelevant.

I wonder if knowledge of normal bowel habits in infancy was 'lost' to the health care professions, in the generations when exclusive breastfeeding was the exception rather than the rule.  My mother breastfed all her children (in the 1950s), but she probably would not have seen infrequent stools because the advice she followed was to supplement breastfeeding with boiled cows milk by the time the baby was about one month old.  She knew all about dealing with infantile constipation (!), and she had a little paediatric enema in the bathroom.

We have much to learn.

Joy Johnston, Independent midwife, FACM IBCLC
Melbourne Australia
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