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Constipation

Is this your child's symptom?

  • Can't pass a stool or pain when passing a stool
  • Crying when passing a stool (bowel movement or BM) or
  • Can't pass a stool after straining or pushing longer than 10 minutes or
  • 3 or more days without passing a stool (Exception: Breastfed and over 1 month old)
  • Caution: any belly pain from constipation comes and goes. Most often, it is mild. Use the Abdominal Pain (Stomach Pain) care guide if there is constant belly pain.

Causes of Constipation

  • High Milk Diet. Milk and cheese are the only foods that in high amounts can cause constipation. It causes hard pale stools. This is why you want your child to eat a well-balanced diet.
  • Low Fiber Diet. Fiber is found in vegetables, fruits and whole grains. Fiber keeps stools soft, bulky and easy to pass. A low fiber diet causes hard, small stools.
  • Low Fluid Intake. This can also cause stools to be dry and harder to pass. It's rarely the only cause of constipation.
  • Lack of Exercise. Exercise also keeps the bowel from slowing down. Not a cause in children unless they are confined to bed.
  • Holding Back Stools Because of Pain. If passing a stool causes pain, many children will hold back the next one. This can happen with a Strep infection around the anus. It can also occur with a bad diaper rash or anal fissure (tear).
  • Holding Back Stools Because of Power Struggles. This is the most common cause of recurrent constipation in children. Most often it's a battle around toilet training. If they are already trained, it may begin with the start of school. Reason: some children refuse to use public toilets. Some children postpone stools because they are too busy to sit down.
  • Slow passage of food through the intestines. Most often, this type runs in families. Called slow transit time.

Stools: How Often is Normal?

  • Normal Range: 3 per day to 1 every 2 days. Once children are on normal table foods, their stool pattern is like adults.
  • Kids who go every 4 or 5 days almost always have pain with passage. They also have a lot of straining.
  • Kids who go every 3 days often drift into longer times. Then, they also develop symptoms.
  • Passing a stool should be free of pain.
  • Any child with pain during stool passage or lots of straining needs treatment. At the very least, the child should be treated with changes in diet.

Imitators of Constipation: Normal Patterns and Stools

  • Breastfed and Over 1 Month Old. Stools every 4-7 days that are soft, large and pain-free can be normal. Caution: before 1 month old, not stooling enough can mean not getting enough breast milk.
  • Straining in Babies. Grunting or straining while pushing out a stool is normal in young babies. They are learning to relax their anus after 9 months of keeping it closed. It's also hard to pass stool lying on their back with no help from gravity. Babies also become red in the face and draw up their legs during straining. This is normal. Key: they continue to pass normal size stools every day. Just not every time they have some straining.
  • Brief straining under 10 minutes can occur at times at any age.
  • Large Stools. Size relates to the amount of food eaten. Large eaters have larger stools.
  • Hard or Dry Stools. Also can be normal if passed easily without too much straining. Often, this relates to poor fiber intake. Some children even have small, dry rabbit-pellet-like stools.

When to Call for Constipation

Call Doctor or Seek Care Now

  • Stomach pain goes on more than 1 hour (includes crying) after using care advice
  • Rectal pain goes on more than 1 hour (includes straining) after using care advice
  • Vomits 2 or more times and stomach looks more swollen than normal
  • Age less than 1 month old and breastfed
  • Age less than 12 months with recent onset of weak suck or weak muscles
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Age less than 2 months. Exception: normal straining and grunting.
  • Bleeding from anus
  • Needs to pass a stool but afraid to or refuses to let it out
  • Child may be "blocked up"
  • Suppository or enema was given but did not work
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Leaking stool
  • Suppository or enema was needed to get the stool out
  • Infrequent stools do not get better after changes to diet. Exception: normal if breastfed infant more than 1 month old and stools are not painful.
  • Stool softeners are being used and have not been discussed with your doctor
  • Toilet training is in progress
  • Painful stools occur 3 or more times after changes to diet
  • Constipation is a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Mild constipation

Seattle Children's Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

  • Bellevue
  • Everett
  • Federal Way
  • Seattle
  • Virtual Urgent Care

Care Advice for Constipation

  1. What You Should Know about Constipation:
    • Constipation is common in children.
    • Most often, it's from a change in diet. It can also be caused by waiting too long to stool.
    • Passing a stool should be pleasant and free of pain.
    • Any child with pain during stool passage or lots of straining needs treatment. At the very least, they need changes in diet.
    • Here is some care advice that should help.
  2. Normal Stools:
    • Normal range: 3 per day to 1 every 2 days. Once children are on a regular diet, their stool pattern is like adults.
    • Kids who go every 3 days often drift into longer times. Then symptoms start.
    • Kids who go every 4 and 5 days almost always have pain with passage. They also have lots of straining.
  3. Diet for Infants Under 1 Year Old:
    • Age over 1 month old only on breast milk or formula, add fruit juice.
    • Amount. Give 1 ounce (30 mL) per month of age per day. Limit amount to 4 ounces (120 mL).
    • Pear and apple juice are good choices. After 3 months, can use prune (plum) juice. Reason for fruit juice: approved for babies in treating a symptom.
    • Age over 4 months old, also add baby foods with high fiber. Do this twice a day. Examples are peas, beans, apricots, prunes, peaches, pears, or plums.
    • Age over 8 months old on finger foods, add cereals and small pieces of fresh fruit.
  4. Diet for Children Over 1 Year Old:
    • Increase fruit juice (apple, pear, cherry, grape, prune). Note: citrus fruit juices are not helpful.
    • Add fruits and vegetables high in fiber content. Examples are peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes, or dates. Offer these foods 3 or more times per day.
    • Increase whole grain foods. Examples are bran flakes or muffins, graham crackers, and oatmeal. Brown rice and whole wheat bread are also helpful. Popcorn can be used if over 4 years old.
    • Limit milk products (milk, ice cream, cheese, yogurt) to 3 servings per day.
    • Fluids. Give enough fluids to stay well-hydrated. Reason: keep the stool soft.
  5. Stop Toilet Training:
    • Put your child back in diapers or pull-ups for a short time.
    • Tell him that the poops won't hurt when they come out.
    • Praise him for passing poops into a diaper.
    • Holding back stools is harmful. Use rewards to help your child give up this bad habit.
    • Avoid any pressure or punishment. Also, never force your child to sit on the potty against his will. Reason: it will cause a power struggle.
    • Treats and hugs always work better.
  6. Encourage Sitting on the Toilet (if toilet trained):
    • Set up a normal stool routine, if your child agrees to sitting.
    • Have your child sit on the toilet for 5 minutes after meals.
    • This is especially important after breakfast.
    • If you see your child holding back a stool, also take to the toilet for a sit (if cooperates).
    • During sits, stay with your child and be a coach. Just focus on helping the poop come out.
    • Do not distract your child. Do not allow your child to play with video devices, games or books during sits.
    • Once he passes a normal size stool, he doesn't need to sit anymore that day.
  7. Warm Water to Relax the Anus:
    • Warmth helps many children relax the anus and release a stool.
    • For straining too long, have your child sit in warm water.
    • You can also put a warm wet cotton ball on the anus. Vibrate it side to side for about 10 seconds to help relax the anus.
  8. Flexed Position to Help Stool Release for Babies:
    • Help your baby by holding the knees against the chest. This is like squatting for your baby. This is the natural position for pushing out a stool. It's hard to have a stool lying down.
    • Gently pump on the lower belly with your fingers. If no stool release in a few minutes, stop.
  9. Squatting Position to Help Stool Release for Older Children:
    • The squatting position gives faster stool release and less straining.
    • Squatting means that the knees are above the hips.
    • For most children who sit on the toilet, a foot stool is needed.
    • It is an important part of treating constipation.
  10. Stool Softeners (Age Over 1 Year Old):
    • If a change in diet doesn't help, you can add a stool softener. Must be over 1 year of age.
    • Use a stool softener (such as Miralax). It is available without a prescription. Give 1-3 teaspoons (5-15 mL) powder each day with dinner. Mix the powder in 2 to 6 ounces (60-180 mL) of water.
    • Fiber products (such as Benefiber) are also helpful. Give 1 teaspoon (5 mL) twice a day. Mix it in 2 ounces (60 mL) of water or fruit juice.
    • Stool softeners and fiber should produce regular soft stools in 1 to 3 days.
    • Discuss dosage and how long to use with your doctor.
  11. What to Expect:
    • Most often, changes in diet helps constipation.
    • After your child is better, be sure to keep him on high fiber foods.
    • Also, have your child sit on the toilet at the same time each day.
    • These tips will help to prevent the symptoms from coming back.
  12. Call Your Doctor If:
    • Constipation lasts more than 1 week after making changes to diet
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 04/24/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.

Constipation in babies - causes, signs and treatments

Constipation in babies - causes, signs and treatments | Pregnancy Birth and Baby beginning of content

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What is constipation?

Constipation is when your baby’s poo is hard and dry, making it difficult for them to poo. Sometimes, doing a hard poo can be painful. It’s common for babies to have constipation when they are changing from formula or breast milk to solid foods.

What is normal?

All babies are unique, and this includes how often they poo. There is a very wide range of ‘normal’. Some babies poo after every feed. Others will only poo once every few days. When it comes to how often they poo, once in 7 days, or 7 times in one day are both fine, so long as your baby is happy and well. But while the number of poos is not critical, if your baby seems to have pain when trying to poo or has a very hard, dry poo, you can speak with their doctor or child health nurse for advice.

Why is my baby constipated?

One of the main causes of constipation in babies is a change in diet. A change in diet may include:

  • changing from being formula-fed
  • changing from being breastfed
  • exposure to new foods and flavours
  • not drinking enough liquids (breastmilk, formula or water)

It is more common for bottle (infant formula) fed babies to have constipation than breast-fed babies.

If your baby has started eating solid food, a lack of fibre in their diet may also potentially cause of constipation. Some babies simply have a natural tendency towards constipation, even when they have a good diet and drink enough fluids. This doesn’t mean they are unhealthy or unwell.

In extreme cases, rare illnesses can cause constipation such as:

  • problems with nerve endings in the bowel
  • problems relating to the spinal cord
  • thyroid deficiency
  • other metabolic disorders

Baby poo guide

Learn more about your baby's poo.

All babies are checked for these conditions, so this is usually not something you need to be concerned about. But if you are worried about your baby or are notice that pooing is painful for them, seek medical advice.

How to recognise the signs of constipation

The main signs of constipation are hard, dry poos. The following are other signs of constipation:

  • Your baby may show signs of straining when trying to pass a poo.
  • Your baby may be unsettled, may seem fussy or irritated.
  • Your baby may be eating less or feeding less well than usual.
  • A tear or crack might appear in the skin around the anus, which may at times bleed.

In some cases, if your child is constipated, they may look bloated or their stomach may appear larger than usual. It can be possible to feel their poo (hard, solid lumps) while pressing softly on their stomach.

How to treat constipation at home

Try these tips to help babies who have difficulty passing poos:

  • If your baby has infant formula, always measure the water first before adding the formula powder — this helps ensure that the ratio of water-to-formula is correct.
  • If your baby is old enough to drink water, offer extra drinks (boiled and cooled first).
  • Gently rub their stomach to help stimulate the bowel — your baby might also feel better with gentle massage to help manage the pain of constipation.
  • A warm bath can help calm and settle your baby and relieve discomfort.

If your baby is older than 6 months, add some extra fruit and vegetables to their diet to boost their fibre intake.

If your child is older than 9 months, adding stewed prunes or apricots to their meal may help. They can have up to 3 tablespoons, 3 times a week. Cereal that has bran may also help mild constipation. Older babies can try prune juice diluted with water (half prune juice and half water). Start slowly, with 10 millilitres. Increase as needed until they can do a soft poo.

Does my child need to see a doctor?

Constipation is common. Often it will pass without intervention, or with the help of the strategies listed above. If you are worried that your baby has constipation, is uncomfortable or is in pain, their doctor can assess them and recommend baby-safe strategies. There are medical treatments for constipation that your doctor may consider, based on your baby’s circumstances.

If your baby was previously treated for constipation but still struggles to poo, it is important to go back to your doctor for a review. There are several treatments they can try.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

Sources:
The Royal Children’s Hospital Melbourne (Kids Health Information 2020 - Constipation), Queensland Health (Constipation in children), Perth Children’s Hospital (Constipation in children)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: September 2021


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Related pages

  • Your child's health
  • Poos and wees
  • Baby poo guide

Need more information?

Constipation in babies and children | Raising Children Network

Children with constipation have hard poo that’s difficult to push out. A high-fibre diet and regular toileting usually helps. Some children need laxatives.