How to treat constipation in newborns

Constipation in babies (0 to 6 months)

This page provides information about constipation in babies from 0 to around 6 months. For information for older babies on solid food and children, see constipation in children.

Constipation is when it is difficult for your baby to poo or when they are not pooing as often as normal.

Some babies have several poos each day. Others poo only once a day or once every second day. What is important is that the poos are soft and that they are easy to pass.

Your baby may be constipated if their poo looks like firm dry pellets that do not soak into the nappy.

Your baby is not constipated if the poo is soft, even if they have not had a dirty nappy for 1 or 2 days.

Straining when passing poo can be normal. Straining with crying is often a sign of constipation. When a baby is straining, their face will often become red and they may grunt or make other noises.

Breastfed babies rarely get constipated because breast milk contains a natural laxative. They tend to have yellow-coloured seedy poos that are often quite soft.

Newborn breastfed babies may poo after every feed. Older breastfed babies may go up to a week without pooing. This is not constipation if the poo is soft.

Formula-fed babies tend to have bulkier poos and need to poo more often than breastfed babies.

If you are formula feeding, make sure you use the correct number of scoops of formula to water.

Don't

• • do not swap scoops between different types of formula - they may not be the same size
  • do not dilute formula milk - always follow the instructions on the packaging
  • do not add solid foods such as rusks or baby rice to a baby's bottle - these can be a choking hazard and make your baby more likely to become constipated

Give your baby a warm bath to relax their bowel.

Gently massage your baby’s tummy in a clockwise direction. Make firm but gentle circular motions from the belly button outwards.

Lie your baby on their back and gently move their legs backwards and forwards in a 'bicycle' motion.

Never give your baby laxatives unless a doctor or public health nurse advises you to.

Make sure your baby is getting their daily fluid needs. Babies from 0 to 6 months should take in 700 ml of fluids per day, from breast milk or formula milk.

Talk to your GP if your baby:

• does not poo in 2 to 3 days
• is very distressed
• shows the signs their constipation may be due to other medical conditions

Contact your GP urgently if your baby:

• is in severe pain and distress when doing a poo
• has bleeding after a hard poo
• has a fever
• is vomiting
• has bloody diarrhoea
• has a bloated tummy
• is not gaining weight or is losing weight

In rare cases, your baby may be constipated due to an underlying illness.

These include:

• some neurological conditions (problems with your baby's nervous system)
• problems affecting your baby's thyroid gland
• cystic fibrosis (usually detected by your baby's heel prick test shortly after birth)
• very rare diseases of the bowel

Signs include:

• your baby does not pass their first poo in the first 2 days of life
• weight loss or if your baby is not gaining weight well
• vomiting a lot
• a very swollen tummy
• seeming to be in severe pain
• any abnormalities of their bottom (anus) - for example, if it is closed over
• poos that are very pale in colour

Important

Bring your baby to your GP urgently if they have any of these signs. If your baby seems very unwell or you are unable to get an urgent appointment, bring them to the nearest hospital emergency department.

Constipation in babies has many possible causes. But often, there's no obvious reason or cause.

Doctors call this 'idiopathic constipation' when the cause is unknown. Idiopathic constipation can happen for short periods or longer periods.

It is common for babies and small children to have short bouts of constipation that settle after 1 or 2 days. You do not usually need to get medical help. There are things you can do to help relieve your baby's constipation.

This is where your baby is constipated for more than 1 to 2 days. Or where your baby has constipation that comes back often.

Page last reviewed: 31 October 2021
Next review due: 31 October 2024

Symptoms, Treatment and When to Call a Doctor

Nationwide Children’s Hospital

Constipation (con-sta-PA-shun) in infants can worry parents. Most of the time, your baby is not really constipated. They may not have developed a routine for pooping yet. Some babies do not develop a bowel movement (BM) pattern for a while.

An infant’s BM pattern can change if their diet changes, like switching from breastmilk to formula, starting solid foods, or drinking less formula than usual. If your baby’s stool (poop) is not soft or easily passed, then they may be constipated.

In rare cases, constipation may be caused by a lack of nerves going to the intestines or by a problem with the way the intestine formed at birth. Your baby can be tested for these conditions if your health care provider feels it is needed.

Signs of Constipation

• less stools than their usual pattern
• straining more than normal to have a bowel movement
• a change in how the stool looks from soft and mushy to:
  
  • small, hard pebbles, or like a large, round golf ball
  • loose and watery
• abdomen (belly) bloated or swollen with gas
• painful cramps

Treatment

• If your baby is not eating baby food yet, you may give 1 to 2 ounces of 100% fruit juice (pear, prune, cherry, or apple) once a day. Stop the juice if their stools become too loose.
• If they are old enough to eat baby foods, feed them pureed pears, peaches, or prunes instead of giving them juice.
• If your baby eats cereal, it may help to give oatmeal, wheat, or barley cereal. Rice cereal can cause constipation in some children.
• Sometimes giving your baby a warm bath to relax them or exercising their legs, like riding a bicycle, will help stimulate the bowels to move (Picture 1).
• If it has been a few days since your baby has pooped and the juice or pureed food has not worked, then you can try a glycerin suppository. Place your baby on their back. Gently push the suppository into their anus (bottom). Suppositories are meant for occasional use.
• Contact your baby’s health care provider before giving them laxatives, baby mineral oil, or enemas to treat constipation.

Medical Therapy

Your child’s health care provider may order the following treatments:

• Give your child medication.
• Check your child’s temperature using a digital, rectal thermometer. Put a small amount of petroleum jelly (Vaseline®) on its tip before inserting into the rectum. Taking a rectal temperature may stimulate the baby to pass stool.

When to Call the Health Care Provider

Call the health care provider if any of the following occurs:

• Your baby is irritable and seems to be having stomach pain. Infants will pull their legs up to their stomach and cry when they are in pain.
• Your baby has constipation and develops vomiting, and their belly looks like it is bloated or filled with gas.
• You see blood in their stool.
• Their constipation does not get better with treatment.

If you have any questions or concerns, call your baby’s health care provider.

Constipation: Infant (PDF), Spanish (PDF), Somali (PDF), Arabic (PDF), Nepali (PDF)

HH-I-14 ©Copyright 1984, Revised 2022, Nationwide Children’s Hospital

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Articles

Constipation in infants: causes and treatment For this period (at least the first 6 months), breastfeeding is recommended, which is able to fully meet the needs of the infant until the introduction of complementary foods. However, for various reasons, breastfeeding can be replaced with artificial.

There have been many comparative studies of breastfeeding and artificial feeding. Most pediatricians still insist on breastfeeding the baby, but, as experience shows, it does not guarantee complete health, and even with breastfeeding, problems with the digestive system can be observed. One of the most common problems parents face is constipation in babies. The causes of this condition can often be due to the physiological characteristics of the infant's digestive system, but are often pathological. Therefore, it is very important to pay attention to constipation in infants in time and consult a doctor.

Further in the article, we will consider such issues as: the causes of constipation in infants, the treatment of constipation, as well as the symptoms and why constipation occurs with different types of feeding.

Causes of constipation in babies

Before listing the causes of constipation in infants, you should familiarize yourself with the features of the structure and functioning of its digestive system. This will help you better understand why a baby is constipated.

The first feature of the digestive system of infants is the small size of the stomach (in the first month of life its volume is about 100 ml, and then gradually increases) and its horizontal arrangement . Food in infants is delayed for about 2.5-3 hours, and with artificial feeding - a little longer. But the main feature that contributes to the development of such a problem as constipation in an infant is a long intestine and weak abdominal muscles.

So, normally, the frequency of stool in infants of the first year of life can coincide with the frequency of feeding (up to 6 times). With age, it decreases and by the time of the introduction of complementary foods it is approximately 2 times a day, and in children on artificial feeding - 1 time per day. Normally, babies have mushy feces.

Constipation is considered to be: if the interval between defecation acts in an infant increases, if the emptying is systematic, but insufficient, and the feces themselves are not mushy, but dense, fragmented.

It is customary to talk about constipation in children under 3 years old if the number of bowel movements is less than 6 times a week.

The most common causes of constipation in infants are as follows:

• Genetic predisposition.
• Perinatal encephalopathy, for example, as a result of hypoxia, or trauma (cerebral palsy).
• Incorrect daily routine and nutrition of a nursing mother.
• Violation of feeding and drinking regimen.
• Congenital pathology and developmental anomalies.
• Immaturity of the digestive system of the baby.
• Violation of intestinal microbiocenosis.
• Use of certain medications.
• Metabolic disorders.
• Diseases of the spinal cord.
• Grischsprung's disease, etc.

What causes constipation in babies with different types of feeding

Above were listed the main reasons why the baby has constipation. As you can see, such a problem can arise regardless of the type of feeding - constipation is often found in infants on breastfeeding, on mixed and even on completely artificial.

Constipation can occur during breastfeeding due to various causes, including:

• Excess consumption of animal fats by a nursing woman (butter, pork and other fatty meats) and lack of fermented milk products, dietary fiber in the diet.
• Underfeeding or overfeeding a child.
• Maternal hypogalactia.
• The presence of defects in the oral cavity of the baby, sluggish sucking, regurgitation.
• Dehydration (non-compliance with the drinking regime, fever, etc.).
• Lactose intolerance.
• Breastfeeding mother taking certain medications.

Very often there is constipation in infants on mixed feeding. The reasons for this may lie in the following:

• Mixture too thick.
• Incorrect mix.
• Non-compliance with the drinking regime, etc.

Very often, constipation develops after the introduction of complementary foods, especially if the first complementary foods were introduced abruptly and in large quantities.

What foods can cause constipation in babies? The development of constipation can provoke the introduction of cereals and solid foods, applesauce, pear puree, pasta, eggplant, fatty meats, eggs, caffeinated foods, etc. into the baby's diet.

Symptoms of constipation in an infant

Constipation in a baby for a long time may not attract the attention of parents. First of all, this may be due to the lack of ideas about how many times a day a baby should have feces and what kind of character it should be. With a problem such as constipation in infants, the symptoms may be mild, and often accompanied by non-specific symptoms. So, when can you suspect constipation in the baby?

The symptoms of constipation are as follows:

• Decrease in the number of bowel movements (less than 6 times a week).
• The baby often cries for no apparent reason and pulls his legs up to his stomach;
• Stool formed, hard, fragmented, dry;
• The child is not gaining weight;
• Stone anointing.
• Rumbling in the abdomen, increased flatulence.
• Signs of inflammation or irritation around the anus.
• Sleep disturbance.

If defecation occurs less frequently than usual, but the child eats well, is not naughty, none of the above is observed, then the infant is most likely not constipated. But what if the baby is still constipated?

What should I do if my baby is constipated?

Many parents do not know what to do if the child has constipation, although they can recognize it on their own. First of all, it is necessary to review the diet of the baby and the nursing mother, exclude foods that contribute to constipation, adjust the frequency and volume of feedings, and establish a drinking regimen.

If this does not help, then you should definitely seek the advice of a pediatrician, and not treat constipation in infants on your own.

How and how to treat constipation in infants

Before treating constipation in infants, you should definitely consult a doctor, undergo the necessary examinations to exclude organic pathology.

So, how to treat constipation in infants? In most cases, constipation in infants is physiological, that is, due to the anatomical and physiological characteristics of the digestive system of the baby, the nature of his feeding. With this in mind, the treatment of constipation in infants is as follows:

• Correction of the diet of a nursing woman and baby.
• Correction of the baby's drinking regimen.
• Prescription of probiotics.
• Appointment of a course of massage and gymnastics, which improve intestinal motility.

In the absence of effect and as directed by a doctor, osmotic and volumetric laxatives, as well as emollients, may be prescribed.

What to do with constipation in a newborn?

Constipation in a newborn or infant is an extremely unpleasant problem for parents. And it is not always possible to quickly determine what is the cause of constipation in an infant. Most often, problems with bowel movements in babies are functional in nature and are directly related to the nutrition of the child.

Signs of constipation in a child of the first year of life

• Infrequent dry and hard stools
• Sleep disorder
• Restless state
• Pungent odor of feces and flatus

Causes of constipation in a newborn child

Causes of constipation in newborns and infants, as a rule, are not associated with a serious pathology of the internal organs or the central nervous system. The main cause of constipation in a baby is malnutrition, early transfer of a child to supplementary feeding with infant formula, frequent changes in products during artificial feeding.

When breastfeeding, the formation of constipation in children of the first year of life is affected by poor nutrition of the mother, for example, the use of large amounts of animal fats and a lack of fiber in the diet. One possible cause of constipation in newborns is dehydration.

What to do if a child has problems with stool

1. If a child under one year old has acute constipation and has anxiety, straining and arching, we actively massage the abdomen in a clockwise direction so that hand marks remain on the skin (but not bruises!) . We spread it on the stomach, do the exercise - legs to the head, children under one year old can massage the anus, if all this does not help - a children's candle with glycerin from the refrigerator.
2. If such situations are repeated often - a mandatory consultation with a pediatrician.
3. When introducing complementary foods to a baby with a tendency to constipation, first introduce fruits and vegetables into the diet.
4. If the child is older than a year and the process is chronic - evaluate nutrition - whether there are the necessary 5 servings of vegetables and fruits per day (portion - from the palm or fist of the baby). Estimate - how much water does the child drink per day? Is there enough physical activity during the day? What is the psychological climate in the family and the attitude - not to demand a chair from the child, not to swear and not to shout, not to discuss problems with other people in his presence, not to force him to sit on the potty, not to scold him for dirty panties when anointing.
5. It is better to choose laxatives based on macrogol or lactulose with the help of a doctor.
6. In parallel with laxatives, we conduct psychological work with the child at home and with a specialist - books about defecation, toilet games, etc.