Baby constipation is common and usually caused by a change in diet, dehydration or lack of fibre.
To help parents recognise the signs of baby constipation and know what to do to help their constipated baby to poop, we spoke to Dr Sanjeev Kalia, a GP who is the lead in newborn baby health screening at his NHS practice, and Dr José Costa, a senior consultant paediatrician, who shared their expert advice, tips for treating baby constipation at home and answered some frequently asked questions about the issue to reassure and assist parents.
While constipation isn’t usually a cause for concern - and can be eased using home remedies recommended by doctors - in certain circumstances you may need to see your GP so they can double-check that your child's constipation isn't being caused by any underlying medical conditions.
If your baby has not pooed in the past 24 to 48 hours, speak to your midwife or health visitor, or if your baby hasn’t passed a stool for 48 hours make an appointment to see your GP as soon as possible. Seek urgent medical attention if your baby is in pain as they poop, if there is blood, or if your newborn has not pooped in 48 hours.
The NHS also has specific guidance on baby constipation for babies who are breastfeeding and babies who are bottle fed.
What are the signs of baby constipation?
One of the most obvious signs that your baby might be constipated will be that they stop pooing or poo less regularly than normal. This is why it’s important to be aware of your child's bowel movements and regularity so that you can identify anything unusual or changes to their normal routine. Usually, if a child is pooing fewer than three times in a week, it is a sign they are constipated.
The type of poo that your baby passes can also be a sign that they may be struggling with constipation. "If your baby is having difficulty passing a stool, and it is pasty or hard, then they may be suffering from constipation," notes Dr Costa. Similarly, Dr Kalia adds, "You should also look out for whether they are pooping fewer than three times per week, as well as if the stool is smelly and larger than usual, as well as dry, lumpy and pellet-like."
Dr Costa notes that, "the signs of baby constipation will vary," depending on what is normal for your child. "It is common for babies to open their bowels daily, often several times in a 24-hour window, but doing so every two to three may also be normal for them - as long as the stool is not pasty or hard, and they are not having difficulty passing it."
Dr Kalia agrees that, "what is most important is ‘what is normal for them?’ - any increase or decrease in frequency might indicate that something is different," he explains. "Importantly, if your baby has not pooped in the past 48 hours, you should speak to your midwife, health visitor or doctor as this may mean they are not getting enough milk."
There are also some other constipation indicators that have nothing to do with the regularity of your child's bowel movements. "Your baby may be less hungry than usual and their tummy might feel firm," adds Dr Kalia. "Additionally, you may notice that your baby is lacking energy and being a bit grumpy."
What causes constipation in babies?
"Firstly, constipation in newborns is quite common," points out Dr Kalia. "Simply put, while inside their mother the child has all its excretory needs taken care of, after birth their bowels are still learning to digest and excrete for themselves." He explains that this is especially the case when children are changing from breast to bottle-fed milk, with the different types impacting on their bowel habit.
Additionally, Dr Costa notes: "Sometimes babies who aren’t getting enough milk may become constipated, because there is not enough intake to produce frequent, loose motions. This can happen with breastfed babies whose mother isn’t producing enough milk." This is one of the reasons why it is important to consult with a healthcare professional if you think your baby might be constipated.
"Babies can also suffer from constipation if they are dehydrated for any reason, since a normal bowel habit requires a good amount of fluids. This can be due to a simple lack of oral intake, if they are teething or if they are unwell and unable to have a regular fluid intake due to pain or fever symptoms. A lack of fibre in the diet can also have an impact once they have been weaned."
How can parents help ease baby constipation at home?
There are a number of remedies that you can try at home to help your child if you suspect they might be constipated. It can take a few days for things to get moving again, but Dr Kalia advises that, "if at any stage these measures [listed below] are not working, or your child seems distressed, ensure you speak to your health visitor or GP."
1. Keep your baby hydrated
"Making sure their baby’s fluid intake is adequate is the main thing parents can do," explains Dr Costa, and Dr Kalia siggests, "try giving extra fluids between feeds so they remain as hydrated as possible." According to the NHS, for babies that are exclusively breastfed no additional water is needed, but formula-fed babies up to six months might need extra water in hot weather. Meanwhile, those from six to 12 months should be given a small cup of water for sipping on at mealtimes.
2. Give a gentle tummy massage
"Gently massage your baby’s tummy using a little bit of oil and a clockwise motion can to help them pass a stool," suggests Dr Kalia.
3. Try this position to help baby poop
Dr Kalia also suggests that you can lie your baby down on their back and move their legs as though they are riding a bicycle – this position is known to help get things moving.
"Lie your baby on their back and move their legs back and forth towards their chest," explains Dr Kalia. "This stimulates the bowel - but just make the movement slow and gentle to ensure the youngster doesn’t become uncomfortable."
4. Ensure your child is getting enough fibre
If your baby is old enough to be eating solids, the doctors recommend introducing more fibre-rich foods into their diet. The NHS suggests foods such as apples, pears and prunes, as these are particularly good for constipation.
Dr Kalia suggests, "Fruits such as prunes, plums and pears can be really useful at getting things moving. Of course, these need to be crushed to the correct consistency to avoid choking hazards."
When to see the doctor if your baby is constipated
If you think your baby might be constipated, or you're not sure, you should make an appointment to see your GP straight away. Not only can a doctor properly diagnose what is wrong with your baby, but they will also be able to rule out more serious medical conditions and prescribe a treatment to help your baby get back to normal.
"A doctor might prescribe medication to loosen a baby’s stools after more serious conditions have been ruled out through an examination," notes Dr Costa. "Medication given for acid reflux - like Gaviscon - can also lead to constipation, while a lack of bowel movement may also be a sign of a non-IgE cow’s milk protein allergy." So eliminating these can help. He explains that a bottle-fed baby with this allergy will need a special formula, and a breastfed baby will need a mother to cut dairy and soya from her diet - but it is important this is done under the guidance of a registered dietitian, so you will need to see your GP first.
Dr Costa urges parents to get newborns with constipation assessed as soon as possible if they haven’t pooped within 48 hours. "It’s important to get your concerns checked out by a doctor as soon as possible to rule out any serious health problems," he explains.
"If your baby has not passed a stool for up to 48 hours it is best to get them reviewed by a GP," says Dr Kalia. Particularly if this is the neonatal period - meaning the first four weeks of life - and none of the home remedies seem to be working.
Even if your baby is no longer in the newborn stage, if they show signs of constipation it is best to make an appointment to see your GP. "What’s more, if the stool is very hard, the baby is in pain or straining too much, or even if blood is seen being passed along with the stool, your doctor should review your baby as soon as possible," advises Dr Costa.
There can be underlying medical conditions causing your baby to be constipated, which is why it's important to get medical advice if your child shows signs of constipation. “Rare conditions, such as hypothyroidism or gut obstructions, should particularly be checked for in the neonatal period – especially if older siblings have had similar problems or there is a family history of hypothyroidism," explains Dr Costa. 'Hypothyroidism' is also called an underactive thyroid, according to the NHS, it is where your thyroid gland does not produce enough hormones.
Answers to frequently asked questions about baby constipation
How often should a baby be pooping?
It depends on your newborn’s age. "Breastmilk is known for acting like a natural laxative, therefore breastfed babies aged between four days and six weeks should pass at least two poos a day," explains Dr Kalia. "Breastfed babies aged six weeks or older may poo less often."
Why is my baby passing gas but not pooping?
"This can be another sign of constipation," points out Dr Kalia. "Sometimes this gas may be more smelly than usual for your child, but it can be normal under the circumstances."
Indeed, there’s an ordinary explanation. "Large bowel bacteria will continue to produce gas as long as there are carbohydrates in the bowel to feed on," says Dr Costa. "This gas can easily bypass the stool present in the bowel and be pushed forward by regular bowel contractions."
Should I stop solids if my baby is constipated?
"You should continue feeding your baby solids once they are weaned - unless you have identified a particular food that is making the symptoms worse," notes Dr Costa.
"If your baby becomes constipated while taking solids, this might merely suggest you need to concentrate on different high-fibre foods as opposed to stopping food intake," explains Dr Kalia.
Dr Costa adds that fluid intake is also really important. How about apple juice for baby constipation? "Some juices can also stimulate gut motility, which can help with constipation," he explains. "Normally, this is juices that contain sorbitol, which acts as a laxative - however, this will not work for every baby and it is always best to consult a registered dietitian for advice on the best options for your baby."
What foods make constipation worse in babies?
"As with cow’s milk, occasionally soya, egg and wheat might cause a non-IgE allergy, leading to constipation," notes Dr Costa. "A registered dietitian can advise you if your baby is diagnosed with this type of allergy.”
If you believe that certain foods may be causing constipation, it is important to consult with your doctor before eliminating anything from your baby’s diet.
Are peas good for baby constipation?
Dr Kalia says that peas can be helpful for getting the bowel moving again. "It is a high-fibre food, meaning it can help with constipation," he explains.
Whole individual peas can be a choking hazard, so make sure they are mashed, pureed, or squashed. Dr Costa adds: "It is always best to consult a registered dietitian for advice on the best options for your baby."
Are grapes good for baby constipation?
"Since grapes are a high-fibre food, they can also help ease constipation," notes Dr Kalia. However, according to the NHS, you should cut them into quarters to stop them becoming a choking hazard.
Additionally, Dr Costa adds: "In order to get the best nutrition advice for your baby, consult with a registered dietitian."
What should I eat to help my baby poop if breastfeeding?
"There is no hard evidence to suggest that changing a mother’s diet will have a significant impact on breastfed baby constipation," says Dr Kalia.
Dr Costa also cautions against simply cutting out foods without guidance. "Always consult with a registered dietitian," he insists. According to the NHS, the best diet for breastfeeding women is a regular, healthy one.
