Gas, poop and starting solids
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Steven M. Schwarz, MD, FAAP, FACN
Need some advice? Ask our experts here.
Your question:
I started my 4 1/2 month old on rice cereal for a few days two weeks ago. He
seemed more gassy than usual so I stopped giving it to him for about a week.
Then a few days ago I began giving him oatmeal, a little squash and apple
juice. My question is regarding his gas and lack of poop. He has only
pooped twice in eight days. Is this normal when babies are started on
solids? His gas really smells, too, which is not normal for him. He is
exclusively breastfed except for the cereal, etc. recently. Is there
something I can or should do for him?
The expert answers:
Let me assure you that everything you describe may be perfectly normal. First, in breastfed infants the intestinal bacterial count is low; and, this bacterial flora does not produce the noxious gases generally associated with stool (that's why BMs in breast-fed infants have a sweet-sour, yogurt-like odor).
With the initiation of dietary solids, the intestinal flora rapidly converts to "adult-type" bacterial species, hence the change in smell. Second, the gas may also be the consequence of bacterial breakdown in the large intestine of unabsorbed starches from the cereal. Complete development of starch absorptive function is not achieved until approximately six months of age, when pancreatic function reaches maturity.
Finally, breastfed infants commonly experience a significant reduction in stool frequency by three to four months of age (another normal event). This fact, along with the production of a more formed BM (because of the addition of solid foods in the diet), may explain your baby's reduced stool frequency.
In the summer months, reduced stool frequency may also indicate the need for increased fluid intake. You might try adding more breastmilk to the cereal. Of course, if you are still concerned, check with your pediatrician.
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About the author: 
Steven M. Schwarz, MD, FAAP, FACN, a graduate of Yale College, served on the faculty of the Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine from 1980-1984, and at New York Medical College from 1984-1985, where he was the recipient of the Charles H. Revson Foundation Career Scientist Award, and subsequently served both as Chief of the Division of Pediatric Gastroenterology and Nutrition and as Director of the Graduate Program in Nutrition. In 1995, he was named Distinguished Lecturer in the Graduate School of Health Sciences at New York Medical College. In 1998, Dr Schwarz was listed in both New York Magazine's "Best Doctors in New York" issue and in the Castle Connolly NYC Metro Guide "How to Find the Best Doctors." In addition to his memberships in the Academy, the American Gastroenterological Association and the North American Society for Pediatric Gastroenterology and Nutrition, Dr Schwarz is chairman of pediatrics at Long Island College Hospital and is a senior member of The Society for Pediatric Research, a Fellow of the American College of Nutrition, and serves on the Scientific Advisory Board of the Pediatric Crohn’s and Colitis Association. He has published more than 100 original papers, abstracts and book chapters on a wide array of both basic research and clinical topics in pediatric gastroenterology and nutrition.
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