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Newborn and Infant Care

Bowel movement

03/29/2007

Question:

My baby is 4 and a half months old, she is exclusively on breast milk. She has been passing loose (watery) green stools for the past 10 days, the frequency is about 8-10 times a day (quantity varies during the day). Once in a while the stools are yellow in color but most of the time its green. As per my pediatrician I am giving SPORLAC powder twice a day for the last 6 days, but it has not helped. Is it normal for a baby to have loose stools for so many days, should I be worried ?

Answer:

Happily, watery green stool is not a serious problem and is relatively common in breastfed babies. The SPORLAC powder is a probiotic of lactobacilli that help to populate the small intestine with beneficial bacteria. SPORLAC has been shown to be effective  80-100% of the time in stopping diarrheal stools in essentially healthy people in a variety of studies treatment trials. Only a few studies have examined its effectiveness in infants. 

In view of its lack of effectiveness in your baby, it may well be that the problem is not one of an imbalance in normal intestinal digestive bacteria, but rather a problem called foremilk-hindmilk imbalance. As you probably know, foremilk is thinner than hindmilk and richer in milk sugar rather than fat. Hindmilk is thicker and richer in fat. Babies need both types of breastmilk. In foremilk-hindmilk imbalance, babies get too much foremilk with its rich load of milk sugar leading to green diarrhea. Now that your breast milk supply is well established, the best strategy if this is the problem, is to allow the baby to nurse exclusively on one breast per feeding, thus assuring complete emptying of the breast.

If the other breast becomes uncomfortably full before the next feeding, express some breastmilk and store it for later us in the freezer or refrigerator. Also, nursing more often will limit the build up of foremilk. There is absolutely nothing wrong with your breast milk, it's just a matter of achieving a balance in the proportions of the foremilk and hindmilk at feedings. A certified lactation consultant is a great guide in addressing this issue. They can be found at hospitals with maternity centers or through your local La Leche League.

Another potential cause of the diarrhea is sensitivity to a medication or supplement you are taking or to a food in your diet. Everything a nursing mother consumes appears in her breast milk, including herbal supplements. Ask yourself if you have started a new medication, herbal or other type of supplement when the diarrhea first appeared. If so, this may be the culprit and you should discuss the need for this medication or supplement with your doctor.

Dairy products are often a culprit in provoking diarrhea in nursing babies, particularly if lactose intolerance or allergy run in your family. You can test this by eliminating all dairy products from your diet for at least 3 weeks. If the diarrhea disappears, you have found the source of the problem.

I hope this information helps you!

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University