There are many misconceptions about poop out there, especially for babies. I constantly treat constipation issues for my pediatric patients. Aside from crying, babies can’t vocalize their discomfort, yet parents are often told by their allopathically-trained pediatrician that not pooping every day -- especially for breast-fed babies -- is “normal”. Many parents leave with an uneasy feeling about this and others go on believing that their baby is defecating normally.
In Asian medicine, we emphatically disagree with this notion. Though a culturally taboo topic, physicians of Asian medicine often speak to their patients about bowel movements because we know of its singular importance for the body.
We have 4 major pathways of detoxification in our body: sweating, breathing, urinating, and defecating. Defecation is where most of the toxic substances from the liver and intestines coalesce and are removed from the body. All living things are hardwired to sleep, drink and defecate when they are born. Babies release their very first poop, in the form of meconium, from the moment they are born. And this meconium will quickly turn into feces once breast milk or formula is introduced. Babies, if they have a relatively healthy GI system at birth (stemming from a healthy gut of the mother’s and father’s DNA and inoculated with mom’s bacteria through vaginal birth or introduction of probiotics immediately after C-section birth), will normally continue to defecate even after breast milk or formula is introduced.
This is my unscientific theory, but common sense tells me that the introduction of processed foods made it common for babies to not poop every day because of the difficulty in digesting chemically processed foods. Once processed foods became mainstream for families (within the last 2 generations), normal physiology went out the window. This is where many allopathic pediatricians, along with modern moms isolated from the wisdom of our parents and grandparents, have come to say that constipation is “normal” for babies. My point is that just because there are now a lot of babies that don't poop daily (including breast-fed babies), does not mean this is normal. Physiologically-speaking (and from an Asian medicine perspective), we know the body should have bowel movements daily if food is consumed and the bowels are working optimally.
Everything You Didn't Want to Know About Poop (But Should)
The difference in bowel movements between a breast-fed baby and formula-fed baby is in the quantity, color and odor. Though breast milk is the most natural food a baby can consume, there are still byproducts in it the baby has to remove from its system. Healthy breast-fed babies will poop every day, but in lesser quantity, as the body can better absorb and utilize much of mom’s milk. The smell should be sweeter and color will be closer to yellow or slightly green and have a mushy texture. Formula-fed babies will manufacture poop that's more pungent and will be closer to brown with a pasty texture resembling nut butter. Formula-fed babies have a tendency to skip bowel movements because it is more difficult for a baby to absorb and process the formula's nutrients. Once solids are introduced, this will change with both types of babies, making the stools more stinky, browner, and thicker than nut butter, but still mushy. (If you want to learn even more about baby poop, go here.)
So we talked about what poop should look like. What about poop that doesn’t happen, a.k.a. constipation? First of all, let’s define constipation: bowel movements that occur once every 2 days or more and tend to be dry, hard and difficult to evacuate.
Did you know there is more than one kind of constipation in Asian medicine?
In our medicine, we differentiate constipation in 5 ways, along with the patterns that are associated with the constipation:
1. “Classic” or Yangming Heat constipation: difficult to push out and the stools are hard and dry, perhaps itty bitty pellets. Bowel movements occur only once every two or more days/week. Hard poop (either itty bitty or log-like) is usually the classic sign of dried intestines/not enough gastrointestinal hydration, preventing poop to travel smoothly through the intestines and out. The child tends to run hot, likes to be down to their diapers/underwear, may have outbursts of anger, a large, distended tummy, have a huge appetite, sweat easily, and have red cheeks. They don’t like to have their stomachs touched.
2. Spleen Deficient constipation: difficult to push out, but once the stools come out, they are soft, even diarrhea like, often with food particles in them. May have bowel movements every day, or less than once day. Child may be a picky/slow eater, low energy, forgetful, have weak muscle definition, a distended stomach, sensitive to sounds and sights, and may suffer from food allergies. Loves to consume cow dairy and wheat products predominantly. May have clammy hands and/or feet. Most children/babies fall under this pattern of constipation.
3. Liver Qi Stagnation constipation: a sensation of fullness above the stomach with difficult to push out stools, possibly itty bitty pellets, and there may be pain upon defecation. More likely to have a blue tinge of vein or coloring on the bridge of their nose or on the temples. Child may be type-A type who never rests, have possible extreme mood swings with anger being a major emotion, exposed to an environment of high stress (early trauma, parental discord, classroom setting that doesn’t work with the child’s personality, clashing personalities between parents and child, etc.)
4. Yin Deficient constipation: occurs after a febrile disease(s) with difficult bowel movements. Child may have dry skin, mouth and scanty urination with possible low grade fevers in the afternoon, run hot and thirsty, particularly at night. May be sensitive to sounds and have difficulty falling or staying asleep.
5. Cold constipation: often seen in children who have had antibiotics, eat mostly cow dairy, wheat products, and cold/frozen/raw foods with possibly severe stomach pains that are relieved with warmth, distended stomach, blue vein/coloring on bridge of nose, runny nose, prone to ear infections with cold or damp hands and feet. If antibiotics are not part of the child’s history, this is a progression of Spleen Deficient constipation due to excessive cow dairy/wheat/cold/raw food consumption.
Individual Poop Protocols
One of the outstanding beauties of Asian medicine is this exquisite notion of differentiating conditions based on patterns and accompanying symptoms and characteristics of an individual. Instead of identifying constipation and just prescribing fiber or a laxative, in our medicine, we can prescribe very specific treatments: customized herbal medicine, food as medicine, and specific exercises that stimulate the organ and channel systems that are out of balance in that individual. Asian medicine is truly custom made for each patient that walks (or is carried) in the door. By prescribing these custom protocols, we have the ability to target the unique set of patterns and conditions present in the patient, making the medicine highly effective to the needs of the patient, as opposed to a one-size-fits-all medicine that may or may not work.
This differentiation then explains -- and I often see posts on mommy forums and mommy blogs asking about constipation in babies and kids -- why fiber doesn’t always work for their child. A lot of wonderful tried-and-tested suggestions are given by moms with a lot of success in these platforms. Although fiber can be very helpful for constipation issues, many times fiber isn't the right answer, especially if your child has loose stools even if constipated, aka the Spleen Deficient constipation type I discussed above. They push a lot, but what comes out aren't itty bitty or hard logs of poop (i.e., the Yangming Heat type constipation), but more like soft poop or loose stools after the initial possible hard poop. Constipation with soft/loose poop is a sign that the GI system of the child is too weak to push out the stool. In this situation, giving heavy fibrous foods can backfire because the stomach needs to work harder to digest the fiber. This taxes the intestines and ends up clogging the stools even more. Another popular suggestion given on mommy sites is giving a lot of fruits to the child, but this too can backfire. Even though fruit is fibrous, it's high in sugars, so fruits can make stools stickier and cause a more candida/yeasty environment in the gut. This can cause other symptoms like eczema, diaper rash, bad breath, addiction to sugar/sweets, etc. Popular laxatives will also only make the child dependent on the medication without helping to strengthen the GI tract, which is really at the root of the problem -- a malfunctioning (in this case hypo-functioning) GI tract. We want the child to poop on her own accord without pain and being on medication -- which is really what all parents want for their kiddos with constipation problems.
Tips to Alleviate Constipation
I will be having a class on how to treat constipation naturally after the holidays (so sign up to my newsletter on my homepage to be notified when I make my class announcement!). Here are, however, some tips I always share with my parents when they come in for constipation problems for their babies or child.
1. Try an elimination diet of removing cow dairy and gluten from the child’s diet for 3 weeks (same goes for breastfeeding moms). From our medical perspective, cow dairy and wheat create a very cloying and “dampening” environment in the gut. Think of cheese melting and how cloying that is. Likewise with wheat products. Leave cereal in milk long enough and it expands and becomes mush. These two things happen in the gut, and if your child a) has a particularly weak gut and/or b) consumes mostly dairy and wheat as primary food groups, all the mushy and cloying foods clog up the digestive tract, making the child a pickier eater and slowing down the bowels. The digestive tracts of babies and children are still very immature and need to develop, so these two food groups really do a number on their system. Just cutting out these two food groups often does the trick with many of my constipated patients.
2. In lieu of wheat and cow dairy products, consider bringing in variety to meals by switching to foods like rice, quinoa, amaranth, cassava flour, and other non-gluten grains and flours. Instead of cow dairy, consider goat, sheep and alternative dairies. If your child fights you on this, a gentle note (with big consequences) that cow milk and gluten are very addictive. Yup, you read that right. Addictive. Here are helpful tips on how to get your picky child to eat.
3. If your child suffers from Liver Qi Stagnation constipation, have her move her body very regularly (i.e., exercise) and if therapy is called for, have the family also go through therapy to help support the child’s emotional needs.
4. If your child is suffering from Yin Deficient constipation, have him eat rice porridge, a.k.a. “okayu” daily for 2 weeks. Okayu is also excellent for children suffering from Spleen Deficient constipation and Cold constipation.
5. If your child suffers from Yangming Heat constipation, fibrous veggies are helpful here, since veggies are mostly cooling in nature and along with the fiber, will cool and push the stools on their way. Hydration of room temperature water or coconut water (or breastmilk for infants) -- not ice cold water -- is very important to moisten the bowels. Gelatinous foods like gelatin, okra and chia foods are also helpful here. A gentle, food-based laxative is also helpful for this kind of constipation: ½ cup prune juice, 1 TBS lemon juice, and 1 cup water. Drink once a day until bowels start to move.
6. Massage: Lightly massaging the belly in a clockwise rotation is helpful for all types of constipation, along with lightly slide pressing down along the outer shin and massaging the toes. Lightly sliding your palm down from the base of the child’s waist (similar to where the top of the diaper sits) to the bottom of the bum is also helpful. Do these massages for 1-2 minutes on each area once or twice daily.
7. Starting on a daily regimen of probiotics is also very helpful.
Incorporating Tips 1, 2, 6 and 7 alone goes a long way, and adding any of the tips based on your child’s presenting constipation pattern will add more to the results. The same goes for breastfeeding moms. Since what you eat affects your baby tremendously, following these tips will help your baby.
I cannot stress the importance of reminding parents that a child’s digestive tract is still very vulnerable to damage from consuming the wrong foods (types of and temperatures) and medicines and doing so will cause imbalances in the gut. Please remember a child’s digestive tract is still weak and developing, and therefore simple food combinations made at home eaten at room temperature or warm is optimal for a child. Cold, raw, frozen foods will squelch the digestive fire of a child, causing Cold constipation and further weakening of the Spleen. Minimal flavorings also help the digestion assimilate foods better without being overwhelmed with strong condiments. Minimizing processed foods and excessive sugars will also help to continue strengthening the gut by preventing toxic buildup in the gut.
Consider also bringing your child to an acupuncturist trained in pediatrics to help break the patterns in the child and jumpstart the child’s metabolic activity in the gut. Acupuncture/shonishin along with Chinese herbs are very effective at resolving constipation. Funny story: I often have babies and children coming to me for conditions other than constipation, but once I start treating them, parents almost always tell me, “My baby/child had a massive poop right after your treatment!” They often tell me their child starts to poop pretty much every day after we start treatments.
Disclaimer: The information here and on the Iyashi Wellness website in general is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information. We encourage you to make your own health care decisions based upon your research and in partnership with qualified health care professionals. These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease.