新生宝宝小豆豆一直是母乳喂养，她每天会拉3-4次便便。可是刚满月后的一天，她一整天都没有排便。妈妈有点担心，她记得在育儿书上看过，宝宝每天应该至少排便一次。

但是，小豆豆除了不排便之外，其他一切都表现得很正常。她依然吃得好，睡得香，肚子也是软软的，没有一点不适的迹象。

到了第二天，小豆豆还是没排便，妈妈焦虑了。她在网上查阅了很多资料，也咨询了几位有经验的妈妈朋友。大家都告诉她，这可能是宝宝在“攒肚”，在母乳喂养的宝宝中比较常见。

第5天，小豆豆终于排便了，而且大便是黄色的糊糊便。妈妈感觉压在心上的石头终于挪开了，不过，她还是有一些疑问：超过几天还没有排便需要担心呢？要到多大宝宝才会大便规律呢？要不要用蜂蜜栓促进排便呢？怎样判断是攒肚还是便秘呢？

并不少见的攒肚

攒肚是咱们民间的叫法，这种情况没有一个专有的医学名词，在一些研究中称之为“Infrequent stools”，也就是大便次数减少。

攒肚描述的是宝宝连续几天甚至十多天才排便，但是精神状态良好，肚子柔软，体重增长正常的情况。排便的时候大便形状正常的，并没有干结，宝宝排便也没有痛苦。这和伴有大便干结和排便费力的便秘截然不同。

37%的纯母乳喂养的宝宝会出现攒肚，很常见的。宝宝平均是在1个半月大的时候开始出现攒肚，有早到生后1周就出现，也有晚到8月龄才出现。

在攒肚出现之前，宝宝平均每天大便三次。第一次出现的攒肚，平均是4天才排便，还有长达10天才排便的。

之后的攒肚平均6天排便，甚至有长达4周才排便的。排便的那天，宝宝们平均会拉两次便便，有的甚至会拉4次。便便是软软的，通常金黄的，量比较多。

攒肚平均持续两个半月，大多数在添加辅食后排便渐渐规律。但也有攒肚持续时间长达7个多月的宝宝。

了解“攒肚”，妈妈才不焦虑

如果不了解宝宝攒肚居然可以这么多天都不拉便便，不知道攒肚居然可以持续到那么大月龄，家长容易焦虑。

我在门诊有遇到妈妈说自己的情绪完全由宝宝的便便控制，不拉的那些天忧心忡忡，拉的那天就是全家的节日；有遇到妈妈每次到了第5天就扛不住，给宝宝用上开塞露或者蜂蜜栓刺激宝宝排便；也有带宝宝去医院灌肠、拍腹部片，做B超检查的。

纯母乳喂养出现攒肚的原因并不很清楚，有的推测是母乳中脂肪的消化比配方奶更好，有的推测是宝宝肠道中有更多能够降解未吸收糖分的糖解细菌。但是，公认的是攒肚是生理现象，会自己好转的。

攒肚没有被认为是水喝少了、肠道菌群失调了、妈妈吃了不该吃的食物……等等原因导致的。所以不需要因此给宝宝喝水、吃益生菌和让妈妈忌口。

使用开塞露来促进排便虽然立竿见影，用了就拉，但是这干扰了宝宝的排便反射，让宝宝不舒服，并不建议用。一定不要给婴儿使用蜂蜜栓，因为一岁内的宝宝肠道菌群发育不完善，使用蜂蜜栓有肉毒杆菌中毒的风险。

什么时候应该看医生？

如果宝宝出现了下面这些情况，有可能并不是生理性的攒肚，需要及时就医。

1. 尿量不充足，达不到每天换4-6块尿布至少有一块是比较满的水平。

2. 体重增长变慢，或食欲减退（如何判断孩子体重增长是不是慢了？）

3. 宝宝表现出不舒服，如发热、哭闹、烦躁不安、疼痛、呕吐的迹象。

4. 宝宝的肚子变硬或者腹胀。

5. 宝宝排便时痛苦，且大便干硬、难以排出。

6. 宝宝的大便颜色异常，如黑色或带血。

7. 任何你觉得不放心的表现。

| 审稿专家

王萍

卓正儿科医生

北京中医药大学硕士

| 参考文献

1.Courdent M, Beghin L, Akré J, Turck D. Infrequent stools in exclusively breastfed infants. Breastfeed Med. 2014 Nov;9(9):442-5.

2.Moretti E, Rakza T, Mestdagh B, Labreuche J, Turck D. The bowel movement characteristics of exclusively breastfed and exclusively formula fed infants differ during the first three months of life. Acta Paediatr. 2019 May;108(5):877-881.

3.Mouterde O, Marie-Cardine A, Thiron J M, Mallet E. ["Constipation" caused by maternal milk] [Article in French]. Arch Pediatr. 1999 Feb;6(2):229.

| 团队

医学/luka 

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#c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) .wx-root:not([data-weui-theme=light]),body:not(.pages_skin_pc) body:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: 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div.autoTypeSetting24psection > p,div.autoTypeSetting24psection > section{margin-bottom: 24px;}