Constipation in Babies and Toddlers

Key points

1. Constipation relates to the consistency of poo, not the frequency of pooing.
2. There’s a big variation of normal when it comes to pooing habits. Some babies poo many times each day, others only every few days.
3. Constipation is commonly caused by low water intake, low fibre intake, or a combination of both.
4. Constipation in very young babies can be a sign of bowel problems.
5. Constipation is uncommon in breastfed babies. It is more common in formula fed babies.

What are you so worried about? 

It’s easy for people who’ve never had a baby to be dismissive when it comes to a baby’s bowel habits. But for loving parents, like so many other aspects their baby’s well-being, how and when they poo can become a point of endless discussion and even concern.

As a general guide, breastfed babies don’t become constipated. In the early weeks and months after birth, breastfed babies tend to poo a lot.  A breastfed baby’s poo is generally soft, a mustard or yellow colour and may contain small, white ‘fat’ curds, which look like sesame seeds. As they get older, breastfed babies may not poo for several days.  Even up to a week without pooing can be quite normal for healthy, breastfed babies.

Breastfed babies can pass very smelly wind if they’ve not pooed for a couple of days. When they do poo, it is still soft and looks normal.

Formula fed babies tend to have poos which are firmer and more pasty than breastfed babies. Their poo can range in colour from yellow to khaki green. 

Constipated babies pass poo which is dry, hard, pebbly and they will often cry when they’re doing a poo.

Some facts about poo!

Pooing requires two coordinated processes – the pelvic floor needs to relax and there needs to be an increase in intra-abdominal pressure (pushing).  It can take babies some time to develop the coordination skills to poo easily.  In the meantime, crying, rather than ‘bearing down’ is a way of increasing intra-abdominal pressure.  In this situation, they’re not crying because they’re in pain, it’s their body’s unconscious solution to helping them pass a poo. The formal name for crying in this situation is Infant Dyschezia.

Other reasons why some babies struggle to pass their poo is because if they’re lying down, they don’t have gravity to help them poo.  Also, because the poo can be so soft it doesn’t create much pressure against in the baby’s rectum.

But what’s normal? 

Every baby and child will have their own, individual pattern of pooing. Some babies poo every day and others every few days. What’s important about pooing is the consistency of the poo, not the frequency. The longer poo sits in the large intestine, the more water is absorbed.  Dry, hard, pebbly poo is a sign that it contains little water. 

When is constipation is more likely?

Constipation is very common in infancy; it’s estimated that one in five babies will be constipated at any one time.  It can be reassuring to know that constipation is generally not caused by a medical condition and is easily fixed with a few dietary changes.

1. Changing from breast milk to formula. Often, it’s the addition of iron in formula which causes constipation. Make sure you’re using the correct formula for your baby’s age, e.g., under or over six months.
2. Introducing solid foods. Even though you may be offering your baby solids with increased fibre, this won’t help their poos to soften unless they have extra fluid as well. Fibre only works to help constipation if it’s combined with extra fluid intake.
3. When a baby has been sick and/or vomiting. Having an elevated temperature can also increase the risk of constipation.
4. Dietary factors - some foods are more likely to cause constipation, e.g., highly processed foods, such as white bread and pasta.
5. When a baby isn’t getting enough nutrition. Poo is a sign that the gut is working and that food and fluid is passing out of the gut. Babies who are failing to thrive or who have ‘faltering growth’, can be underfed.
6. When a baby is constipated and their poo is dry, hard and pebbly. This can cause a small tear in their anus, which leads to them ‘holding on’ to their poo, causing it to be even harder to push out.

What to do if your baby is constipated

Offer more frequent feeds. Extra fluid generally helps to soften poos. Although constipation is uncommon in breastfed babies, if you feel your baby is constipated, offer extra breastfeeds.

If your baby is formula feeding, offer some extra cooled, boiled water between their feeds. Small sips of water from a cup can be helpful. Make sure you don’t give more than a few mls; more than this can fill them up so they’re not as hungry for their milk feeds.

If your baby is formula feeding, make sure you’re preparing the formula exactly as the manufacturer recommends. Don’t heap or pack the scoop with formula power and ensure you’re using the correct number of scoops to water ratio. Put water into the bottles first, then add the formula powder.

Try giving your baby a gentle tummy massage, in a clockwise direction. Bicycle their little legs and give them some time to kick freely with their nappy off.

Sometimes it’s necessary for children aged two and older to be prescribed a stool softener, which helps the poo as it’s sitting in the bowel, to absorb more water. These are not recommended in babies aged less than one year.

If your baby is old enough to eat solid foods, e.g., around six months, offer them more vegetables and  pureed fruits – especially  pear and apple. Rice cereal can cause constipation, so make sure you’re mixing it with plenty of water/expressed breast milk or formula. Our Newborn Feeding Guide covers introducing solids to your little one and what to expect during this transition from liquids.

What not to do if your baby is constipated

Give them any medicine, such as laxatives or stool softeners unless you’re been advised to by a health professional.

Put anything in their bottom or try to prise out the poo. If you think your baby has hard poo stuck in their bottom, take them to see a doctor. 

Make big changes in their feeding management. Too many changes all at once can sometimes overload a baby’s gut.  It’s often better to make one change at a time and see if that helps before moving onto something else.

When to see a doctor about your baby’s poos

1. If you are worried about them, or have a sense that ‘something’ isn’t right.
2. If there is blood in your baby’s poo.
3. If your baby seems to be in pain when they’re pooing.
4. If their poo is still hard and pebbly after you’ve increased their feeds and fibre intake.
5. If they are vomiting, have an elevated temperature, or don’t seem well.

About the Author:

Written for Nourish Baby by Jane Barry. Jane has qualifications in general, paediatric, immunisation, midwifery and child health nursing. She holds a Bachelor Degree in Applied Science (Nursing) and has almost 35 years specialist experience in child health nursing. She is a member of a number of professionally affiliated organisations including AHPRA, The Australasian Medical Writer’s Association and Australian College of Children and Young People’s Nurses.

References

Constipation in babies and children | Raising Children Network

Infant Dyschezia - About Kids GI

Managing number twos in under ones - Healthed