Watching a little one struggle with constipation can be heartbreaking - I see it almost daily in my practice. Constipation happens when a baby's stools become hard, dry, and difficult to pass, often causing discomfort and fussiness. It's especially common in formula-fed babies and those starting solids.
This guide will help you understand:
✔ What causes constipation in babies
✔ Signs to watch for (red flags)
✔ Safe and effective treatment options
✔ Answers to frequently asked questions from parents
How Often Should Babies Poo? What’s Normal & When to Worry
There is a wide range of what’s considered normal when it comes to how often babies poo. Some newborns may pass stool after every feed, while others may only go once every few days.
A healthy baby can poo seven times a day or once every seven days, and as long as they are growing well, passing soft stools, and seem comfortable, this is normal.
Breastfed Babies vs. Formula-Fed Babies
✔ Breastfed babies are rarely constipated because breast milk is easily digested and absorbed. This is why they may poo less often but still pass soft stools.
✔ Formula-fed babies may have firmer stools due to the composition of formula, making them more prone to constipation.
Straining Does NOT Always Mean Constipation
It’s normal for babies under six months to strain and cry before passing soft stools—this is called infant dyschezia (Grunting Baby Syndrome) and is not a sign of constipation. It happens because babies are still learning to coordinate their muscles to pass stool. Despite the effort (and lots of grunting!), they still pass soft, normal stools, meaning it’s not constipation.
👉 If your baby’s stool is hard, dry, or causing distress, they are constipated.
Signs and Symptoms of Constipation in Babies
Constipation in babies can present in several ways. Here are some signs that your baby might be constipated:
✔ Hard, dry, or pebble-like stools – This is a key sign of constipation.
✔ Infrequent bowel movements – Going more than 7 days without a poo.
✔ Straining excessively – Your baby may arch their back, cry, or appear distressed when trying to poo.
✔ Firm or bloated belly – A hard-feeling tummy may indicate backed-up stool.
✔ Reduced appetite – A constipated baby may refuse feeds or eat less than usual.
✔ Anal fissures (small tears in the bottom) – These may cause discomfort and streaks of blood in the stool.
✔ Passing large, bulky stools – This can make pooping painful and lead to further stool withholding.
Now that we've identified the signs of constipation, let's explore what might be causing these uncomfortable symptoms in your baby.
What Causes Baby Constipation? Common Triggers & Dietary Factors
Constipation in babies can result from various factors, including diet and underlying medical conditions.
Dietary Causes of Constipation
✔ Switching from breastmilk to formula – This transition can cause transient constipation, so try a slow introduction and ensure adequate hydration.
✔ Frequent formula changes
✔ Starting solids – Some foods may slow digestion.
✔ Low-fibre diet – Not enough fruits, vegetables, or whole grains.
✔ Low fluid intake – Not drinking enough breastmilk, formula, or water (if age-appropriate).
✔ Incorrect formula preparation – Always add water before formula powder and follow exact measurements. Incorrect mixing can affect hydration and digestion, leading to constipation.
✔ Certain foods in large amounts – Low-fibre rice cereal, bananas, apple puree, processed foods, and iron-rich foods may contribute to constipation.
Functional Constipation
Functional constipation is a common cause of constipation in babies. It occurs when stools become hard, dry, and difficult to pass, even though there is no underlying medical condition. It can be triggered by:
✔ Diet – Low fibre or certain constipating foods
✔ Dehydration – Not enough fluids
✔ Withholding stools – Baby avoids pooping due to previous discomfort.
Functional constipation often improves with dietary adjustments, hydration, and stool-softening strategies.
Medical Conditions That Can Cause Constipation
Food Intolerances & Allergies
✔ Sensitivity to certain proteins, such as cow’s milk, can cause chronic constipation, especially when accompanied by other symptoms like blood in the stool, severe reflux, severe colic, or skin rashes.
✔ Coeliac Disease: An immune reaction to gluten that can cause digestive issues, but only in older babies who consume gluten-containing foods.
Hormonal & Metabolic Conditions
✔ Hypothyroidism – A rare cause of constipation(screened for at birth).
✔ Cystic Fibrosis (CF) – Affects mucus production, making stools thick and hard to pass (screened for at birth).
✔ Electrolyte Imbalances – High calcium levels or other mineral imbalances can slow digestion.
✔ Iron Supplements: High doses of iron may lead to firmer, less frequent stools.
Nerve & Structural Issues
✔ Hirschsprung’s Disease – Missing nerve cells in the bowel cause severe constipation from birth (suspected if a baby does not pass meconium within 48 hours).
✔ Spinal Cord Issues – May affect nerve control of the bowel, leading to constipation. These may be identified through signs like weakness in the legs, changes in bladder control, or skin abnormalities in the lower back.
✔ Anatomical Differences – Some babies are born with an anus that is too small, incorrectly positioned, or blocked.
👉 If constipation is frequent or comes with other symptoms, consult a healthcare provider.
When to See Your Paediatrician or Baby’s Doctor
Constipation in babies is usually temporary, but medical attention may be needed if:
✔ No meconium within 48 hours of birth –This could signal an underlying condition.
✔ Constipation began at birth or early infancy – Persistent early constipation may require evaluation.
✔ Hard or dry stools despite treatment – If dietary changes haven’t helped, seek advice.
✔ Ribbon-like or pencil-thin stools – This may indicate a structural or nerve-related issue.
✔ Blood in the stool – Can be due to a food intolerance, an anal fissure, or another cause.
✔ Developmental delays or poor growth – May signal an underlying medical issue.
✔ Firm or bloated stomach – A swollen belly can indicate stool buildup or other concerns.
✔ Severe pain – If your baby is extremely uncomfortable when passing stools.
✔ Fever, vomiting, or general illness – These symptoms alongside constipation warrant urgent care.
👉 In some cases, your doctor may recommend further tests, such as blood tests, an abdominal X-ray, or an ultrasound, to help determine the cause of constipation.
How to Relieve Constipation in Babies
For Breastfed Babies
✔ Ensure your baby is getting enough milk to stay hydrated.
✔ If constipation persists alongside other signs of cow’s milk protein allergy, your healthcare provider may recommend eliminating dairy and soy from the maternal diet to assess for improvement.
For Formula-Fed Babies
✔ Ensure proper formula preparation – Always measure the water first before adding the formula powder to ensure the correct water-to-formula ratio. Incorrect mixing can lead to dehydration, which may contribute to constipation.
✔ Offer extra fluids – If your baby is old enough try offering boiled, cooled water in small amounts to help soften stools.
✔ Consider changing formula – Some formulas are easier to digest and can be a good solution for constipated babies who do not have an underlying medical issue. If chronic constipation occurs alongside other signs of cow’s milk protein allergy, your healthcare provider may recommend switching to a formula suited for milk allergy.
👉 Please do not change your baby’s formula without consulting your healthcare provider.
✔ Stage 1 vs. Stage 2 Formula – Some babies get constipated after transitioning to stage 2 formula due the increased iron content and change in Whey: Casein ratio. It’s safe to continue Stage 1 if Stage 2 causes constipation.
For Babies on Solids
✔ Increase high-fibre fruits – Offer prunes, pears, peaches, and plums as purees or soft finger foods, depending on your baby’s age and feeding stage. These fruits are naturally rich in fibre and sorbitol, which help draw water into the intestines and soften stools. Prunes and diluted prune juice (half prune juice, half water) are particularly effective due to their high sorbitol content.
✔ Add high-fibre vegetables – Include peas, broccoli, carrots, and sweet potatoes. Serve them steamed and mashed or as soft finger foods for older babies.
✔ Boost hydration – Offer small amounts of water or diluted prune juice to support digestion and prevent stools from becoming too hard.
✔ Introduce whole grains – Swap refined grains for oatmeal, barley, and brown rice to add fibre and promote regular bowel movements.
✔ Limit constipating foods – Avoid excessive intake of rice cereal, bananas, processed foods, and iron-rich foods, as these can slow digestion and contribute to constipation when eaten in large amounts.
Other Helpful Strategies
✔ Tummy massage – Gently rub your baby’s belly in a circular motion to help stimulate bowel movements.
✔ Bicycle legs – Moving your baby’s legs in a cycling motion can encourage bowel activity.
✔ Warm bath – A soothing bath relaxes abdominal muscles, making it easier for your baby to pass stools.
Baby-Safe Constipation Medications: When & What to Use
If dietary changes, hydration, and comfort measures do not relieve constipation, consult your healthcare provider about safe medical options, which may include:
Stool Softeners & Laxatives:
✔ Coloxyl drops – Gradually softens stools.
✔ Lactulose – Draws water into the bowel.
✔ Macrogol 3350 - Increases water in stools (e.g., Movicol Junior, Osmolax, Macrovic).
Rectal Treatments (For Occasional Use Only):
✔ Glycerol suppository (infant dose) – Stimulates a bowel movement.
✔ Microlax enema – Provides rapid relief.
👉 Always consult a healthcare provider before using any laxatives, stool softeners, or rectal treatments for your baby.
Final Thoughts: Managing Baby Constipation
Constipation is common in babies, especially during dietary transitions like starting solids or switching formula. Fortunately, most cases respond well to simple interventions.
Start by focusing on dietary adjustments, proper hydration, and comfort measures as discussed earlier.
To help prevent constipation, ensure your baby stays well-hydrated, offer a variety of fibre-rich foods once solids are introduced, and create a balanced diet that supports their developing digestive system.
Remember, every baby is different—what works for one may not work for another. If your baby's constipation persists despite your best efforts, or if you're unsure about the best approach, don't hesitate to consult your paediatrician for personalised advice tailored to your baby's needs.
👉 Looking for guidance on older children? My upcoming article on constipation in older children will cover this topic in detail.
FAQ: Common Questions About Baby Constipation
1. How often should my baby poo?
It is normal for babies to poo up to seven times a day or as little as once every seven days. As long as stools are soft and your baby is comfortable and content, this is considered normal. Some newborns poo after every feed, while others may go days without a bowel movement.
2. Can my baby be constipated even if they poo daily?
Yes. Constipation is about stool consistency, not frequency. Hard, dry, or painful stools indicate constipation, even if they occur daily.
3. Can certain foods cause constipation in babies?
Some foods can contribute to constipation, depending on quantity and overall diet. A balanced diet supports digestion, but certain foods - when eaten in large amounts - may slow bowel movements. These include rice cereal, bananas, high-iron foods, low-fibre foods, and processed foods.
To promote healthy digestion, incorporate fibre-rich options such as prunes, pears, and whole grains into your baby’s diet.
4. When should I give my baby water?
Once solids are introduced, you can start offering small amounts of cooled, boiled water in a cup at meal times and throughout the day as needed. This helps keep your baby hydrated and can prevent constipation.
5. Should I change my baby’s formula to relieve constipation?
In some cases, switching formulas may help, but not all formulas are the same. Consult a healthcare provider before making any changes, as some formulas are designed to be gentler on digestion and may be more suitable for your baby.
6. My baby is constipated after switching from Stage 1 to Stage 2 formula. What should I do?
Many formula brands recommend transitioning to Stage 2 formula at six months due to higher iron content, but this switch is not always necessary. If your baby experiences constipation after switching, try the following:
✔ Stick with Stage 1 formula – It’s perfectly safe to continue Stage 1 formula beyond six months, as it provides complete nutrition.
✔ Slow transition – If you prefer switching, try mixing Stage 1 and Stage 2 formula gradually over a few days to allow your baby’s digestive system to adjust.
✔ Increase fluids – Offer small amounts of cooled, boiled water (if age-appropriate) to promote hydration.
✔ Monitor diet – Ensure your baby is eating fibre-rich solid foods to support digestion.
👉 If constipation persists, consult your healthcare provider for further guidance.
7. Can probiotics help with constipation?
Probiotics may help some babies, but research on their effectiveness for constipation is still emerging. Speak with your healthcare provider before introducing probiotic supplements to ensure they are suitable for your baby.
8. How long should baby constipation last before seeing a doctor?
If your baby has hard stools, discomfort, or hasn’t pooped in over 7 days, consult a paediatrician for advice.
9. Can constipation be a sign of a serious condition?
In rare cases, constipation may indicate an underlying medical issue. Seek medical advice if your baby has:
- Chronic constipation that does not improve with dietary changes
- Poor growth or weight gain
- Severe bloating, vomiting, or blood in the stool
👉 Looking for guidance on older children? My upcoming article on constipation in older children will cover this topic in detail.
Written by Dr Samuel Heitner