I really need some help and advice. My 4 week old daughter has real trouble pooing. She has been formula fed since birth and can go a couple of days without pooing. She is constantly grunting and pushing but nothing happens. When it does its normal consistency. I’ve tried going back to comfort formula but still no luck. She is in pain and screams when trying to go. I’m thinking she might be lactose intolerant. Can anyone help?

Jane Responds

Constipation refers to the consistency of the bowel motion not the frequency. So even though she can go a couple of days without pooing, this doesn’t mean she is constipated. The normal consistency (you’re describing) of her poos means that she isn’t constipated. If she was, her poos would be dry, hard and even pebbly. The normal consistency of poo for formula fed babies is like plasticine.

Her behaviour sounds fairly common in this newborn period. At four weeks of age her gut and digestion are still in the early stages of becoming used to feeding and eliminating. How she’s behaving now is unlikely to be a permanent state. As she matures she’s likely to become more settled and her behaviour follow more of a predictable pattern.

The grunting and groaning when pooing is, again, fairly common behaviour at this age and stage. It may be because babies’ don’t have gravity to help because of lying down when they’re pooing or the poo itself is so soft it doesn’t create alot of pressure on their anus.

It’s important that you make up her formula exactly as the manufacturer recommends. Too much formula or packed/heaped scoops and not enough water can all cause constipation.

Switching formulas generally doesn’t make much difference in terms of improving behaviour. Unless, of course, there’s a genuine medical reason to do so.

Let her have some time each day with her nappy off to kick freely. Bicycle her little legs and massage her tummy in a clockwise direction. Perhaps even some cooled, boiled water to drink between her feeds may help.

It’s unlikely she’s lactose intolerant. If she was having frequent, frothy poos and was unsettled and not thriving then this is a possibility. But without a firm diagnosis it’s doubtful. There’s value in taking your baby to see a child health nurse and receiving support and guidance.