Constipation in babies

If your baby goes bright red, strains or even cries when she does a poo, it doesn't necessarily mean that she's constipated (Henderson 2016a,b, Sood 2018). Before long, you'll recognise your baby's particular grimaces and grunts as she works on her bowel movements. You’ll also become very familiar with what looks normal (or not) in your baby’s nappy.

How can I tell if my baby is constipated?

When it comes to a baby’s bowel movements, there is a wide range of what’s considered normal. Similar to adults, babies’ bowel movement patterns vary (Henderson 2016b). Poo can also change in texture from day to day (Henderson 2016b).

Breastfed babies may poo after every feed (Sood 2018), or they may go up to a week without doing a poo (Sood 2018) – both are perfectly normal. If your baby's formula-fed, or has started solids, anything from three times a day to three times a week is also completely normal (Henderson 2016a,b).

If you’re concerned that your baby may be constipated, look out for these signs:

• More than usual crying and discomfort, irritability or pain while doing a poo (Henderson 2016a,b, Sood 2018). You may notice your little one arching her back and clenching the muscles in her bottom (Sood 2018).
• Dry, hard, poo in your baby's nappy. This may be large and painful for your baby to pass, or it may come out in lots of little bits, like rabbit droppings (Henderson 2016a,b, Sood 2018).
• Blood in your baby's nappy. This can happen if hard stools cause tiny tears in the skin around your baby's bottom (Henderson 2016a,b, Holland and Gill 2018).
• Loss of appetite (Henderson 2016b, Holland and Gill 2018). If your baby's constipated, she may feel full quite quickly, and not want to eat as much (Holland and Gill 2018).
• A hard belly. Constipation can cause bloating, which may make your baby's tummy feel firmer than usual (Holland and Gill 2018).

As odd as it sounds, very runny poo can be also be a sign of constipation. If hard poo is blocking your baby's bowels, liquid poo can slip past it and end up in your baby's nappy (Henderson 2016b).

What causes constipation in babies?

Constipation is common in children and babies and it’s not always clear why your baby may be constipated. However, your baby may be struggling to poo for one of the following reasons:

• Formula milk. Formula-fed babies tend to be more prone to constipation (NCT nd) because formula can be harder to digest than breastmilk, causing poo to be firm and bulky. In particular, when you first move from breastmilk to formula, it's not unusual for your baby to become constipated for a short time as her system adjusts (Sood 2018). If you formula-feed your little one, it's important to follow the instructions on the pack when making up a bottle. Adding too much powder can make your baby dehydrated, which can contribute to constipation (NHS 2018a).
• Introducing solids. Babies often become constipated when they start solids, as their bodies learn how to manage new foods (Sood 2018).
• Dehydration. Babies can become dehydrated much quicker than adults, particularly if they're not drinking enough, getting too warm, or ill with fever or vomiting (NHS 2017a). If your little one's dehydrated, this can make her poo dry and hard to pass, leading to constipation (Henderson 2016b). Learn how to tell if your baby is dehydrated.

Less commonly, constipation can be a sign of a medical condition, such as problems with your baby's digestive system (Sood 2018). Try not to worry, though – this affects less than five per cent of babies, and it's usually easily diagnosed by a doctor (Sood 2018). It's much more likely that your baby's constipation is caused by one of the above issues, and can be easily treated.

How can I treat my baby's constipation?

The following tips may help to relieve your baby’s constipation:

Massage and movement

Try gently moving your baby’s legs in a bicycling motion. This can help to relax her muscles, making it easier for her to do a poo (Sood 2018). You can also try gently massaging her tummy a few times a day to stimulate her digestive system (Holland and Gill 2018).Extra fluids

If your baby's constipation is caused by a lack of fluids, offering her extra drinks may help (Sood 2018). If you breastfeed your baby, just offer more breastfeeds throughout the day (NHS 2016a). If she's formula-fed, offer extra water in a separate bottle or cup between feeds (NHS 2017a). Don't add extra water to her formula (NHS 2016a,2017a), as this could mean she doesn't get all the nutrients she needs (NHS 2016a).

If your baby's over six months old, offering well-diluted fruit juice (one part juice to 10 parts water (NHS 2015)) may help (Henderson 2016b). You may have heard some people recommending orange juice as a constipation cure. But actually, prune, pear (Holland and Gill 2018) or apple juices are more likely to help (Henderson 2016b, Sood 2018).

Dietary changes

If your baby's under six months old, always check with your health visitor before giving her anything other than breastmilk, formula or water (NHS 2018b).

If your baby's formula-fed, you could ask your health visitor about switching to a different type or brand of formula (Holland and Gill 2018, NCT nd).

If you breastfeed your baby, changing your own diet is unlikely to help (Holland and Gill 2018). However, there is a small chance that your baby could be sensitive to something you've eaten (Holland and Gill 2018), such as cow's milk (NICE 2015a). So if you've tried everything else, it could be worth talking to your GP or health visitor about cutting certain foods out of your diet.

Don’t remove any foods from your diet, or your baby’s diet, without talking to your GP first. She can recommend vitamin and mineral supplements to make sure that you still get all the nutrients you need (NICE 2015a).

If your little one's on solid foods, be sure to include plenty of fibre in her diet (Holland and Gill 2018). Fruits such as apricots, pears, prunes and peaches, and veg such as sweet potatoes, peas, broccoli and spinach are all great options (Sood 2018). You can also opt for wholemeal bread (Henderson 2018) and wholegrain cereals, which contain more fibre (Holland and Gill 2018).

Laxatives

If the above tips don't help, see your GP. He may recommend medication to ease your baby's constipation (NICE 2015b), most likely a laxative containing macrogol or lactulose (NICE 2015b). Your GP will explain how and when to use the medicine to help ease your baby’s constipation.

In general, try not to worry too much if your baby becomes constipated. It's likely to happen now and then, especially if she's formula-fed or eating solids (Sood 2018). With your attention, time, and help from your health visitor or GP, she'll soon have easier, regular bowel movements again.

More information and tips

• Take a look at our baby poo photo gallery for a visual guide to what’s normal and what’s not in your baby's nappy.
• Find out what to do if you think your baby could have a food allergy.
• Learn how to tell the difference between constipation and diarrhoea.