In this article:
- Constipation is a prevalent problem among children of all ages.
- A normal bowel movement does not necessarily mean that the baby defecates at least once a day. It differs greatly from up to three defecations every day to one defecation in 2 days.
- The condition can be managed and prevented with dietary and lifestyle changes.
- While it is common for adults to use over-the-counter drugs, avoid giving stool softeners, laxatives, or enema to children without consulting a doctor.
Babies communicate their needs through crying in the early months of their life. Crying may indicate hunger, a wet diaper, or sleepiness. As parents, it is important to understand these signs, as well as understand your child’s growth.
With time, the baby develops motor skills, and activities such as crawling, walking, and trying to talk which are a sign of healthy growth.
Another important indication of your baby’s development is their bowel movements, which change when switching from breastmilk to formula or from formula to a semisolid or solid food diet.
With growth, the intestines work hard to absorb increasing amounts of nutrients, widening the gap between defecations. Constipation is characterized by irregular and hard-to-pass bowel movements for more than 2 weeks.
It may cause irritation and discomfort to the baby, and also raises serious concerns among the parents. However, constipation is mostly a common, natural phenomenon.
Normal Bowel Movements
The frequency of excretions varies widely among babies, depending on their age and type of diet. Healthiness is rather indicated by regularity and consistency in bowel movements.
They may defecate anywhere between once a day to once in 4 days, but if the stools are soft and firm, it is indicative of a healthy condition. The general patterns of bowel movements are:
- Breastfed newborns: Generally, they excrete after every feed up to 1 month of age and have yellower, runny, or pasty stools in comparison to formula-fed babies.
- Formula-fed newborns: They may have around five bowel movements daily in the first week, which gradually decreases to two defecations by the end of the first month.
- Infants: Two- to three-month-old babies can have one or two stools each day or even have one bowel movement in a week, regardless of being on breastmilk or formula.
As the child grows, their daily defecations decrease progressively, from four to five times in newborns to one to two by the time they turn four. Around this time, 98% of children develop the ability to control their sphincter muscles.
Therefore, normal bowel movements vary with age and development. (1)
What Causes Constipation?
It is common for toddlers to get constipated during the following events:
- Starting processed foods or formula
- Potty training
- Starting school
The following factors contribute to constipation in toddlers:
- Lack of fluid: When transitioning into a diet based on semisolid or solid foods, the infant may get dehydrated due to an inadequate intake of fiber and fluids. Rarely, breastfed babies can also get constipated because of the lack of fluid.
- Inactivity: Insufficient movement or exercise can also lead to constipation.
- Illness: Irritation and discomfort caused by any ailment can make a baby a fussy eater, bringing changes in their eating habits and diet. The digestive system may be unable to adjust to this, resulting in constipation.
- Loss of water: This may occur due to:
- Hot weather
- Medications: Constipation can be a side effect of certain medicines.
- Premature birth: The gastrointestinal tract of a premature baby may not be fully developed, leading to digestive problems.
- Non-suitable diet: Giving solid foods such as cereals to infants below 4 months or improper preparation of the baby formula, such as using excessive or less water, can cause constipation.
- Withholding: Toddlers might consciously hold back bowel movements if they experience pain while passing hard stools, especially when having a diaper rash.
A reluctance to use the toilet or discomfort arising from changes in dependency and control may also lead them to withhold stool. This is generally known as functional constipation.
- Medical conditions: Constipation can also occur due to underlying problems such as:
- Hirschsprung’s disease – This congenital disability is a major cause of pediatric constipation and needs a thorough diagnosis, followed by surgical treatment.
- Food allergy
- Metabolic disorders
Signs and Symptoms of Constipation
An irregularity in a baby’s bowel movements in comparison to the usual routine and texture could be indicative of constipation. You may consult your doctor if your child experiences the following symptoms:
- Dry, smelly, and firm stools
- Irregular bowel movements
- Painful defecation
- Tight belly
- Blood in the stool, toilet paper, or diaper
- Fecal impaction, which is characterized by spots of liquids or stool in the child’s underwear due to involuntary leakage
- Not more than three defecations in a week in infants
- Excessive spitting up by neonates
- Irritability and refusal to eat
- Difficulty in passing stool
Newborn children often strain during bowel movements due to weak abdominal muscles. While this is normal, it may be indicative of constipation if accompanied by pain, crying, or a taut belly.
It is recommended to seek medical help if your baby has prolonged constipation or related symptoms. The condition may be diagnosed after:
- Physically examining the child, which may include a rectal exam
- Evaluating the child’s dietary and bowel routines
- Studying the child’s medical history
Organic causes of constipation are identified with the help of diagnostic tests. On the other hand, functional constipation, the most common diagnosis for toddlers over 1 year, can be confirmed by studying the child’s medical history.
Large stools with irregular bowel movements are also indicative of functional constipation.
After a careful diagnosis, the doctor will suggest a suitable treatment plan according to the child’s age, which may include:
- Laxatives: Medicines that soften the stool or add weight to it
- Stimulants: Drugs that boost the activity of the gut, increasing the bowel movement
- Disimpaction therapy: Treatment that involves clearing of the gut in one week
If the condition is persistent after standard or prescribed treatments, it is recommended to consult a specialist, such as a pediatric gastroenterologist, at the earliest. Prolonged constipation might cause discomfort to your baby and should not be overlooked.
How can Constipation be Prevented?
The following measures may help prevent your child from being constipated:
- Fix a schedule: Getting your toddler into a habit of defecating daily may prevent them from trying to hold in the poop. Additionally, developing a schedule for meals may help develop this routine since eating is a natural stimulant for the bowels.
You may give your toddler an early breakfast so that they have enough time to relax and defecate before leaving the house for preschool.
- Reassure them: Most babies get constipated because they are uncomfortable with the idea of visiting the bathroom. Therefore, it is important to have an open conversation with them to make them comfortable.
You may try asking them if they pooped at school or how their bowel movements look like.
- Inculcate a habit of defecation: Make your child understand that having a bowel movement whenever they feel the urge is a good habit, even when at their preschool. Teaching them how to ask permission at school for the same may boost their confidence and help prevent constipation when they start school.
If they resist their bowel movements, make them sit on the toilet for around 10 minutes at the same time daily, preferably after a meal.
Avoiding the following factors can help in preventing the condition from getting worse, including:
- Consumption of a diet rich in starchy, sugary, or fatty foods, which can slow down bowel movements
- Addition of malt extract, rice cereal, or any sugar to formula
- Feeding apple sauce, cooked carrots, bananas, and rice to the toddler
- Giving solid foods to babies below 6 months of age
- Intake of cow milk by constipated babies
- Use of medications without a doctor’s recommendation
Ways to Manage Infant Constipation at Home
People have been using home remedies to provide relief from constipation to babies for long. These easy and reliable strategies, varying from tummy massages for neonates to increasing the fluid and fiber uptake of toddlers on a solid-food diet, have been passed through generations.
They might also help in preventing your child from getting constipated.
Regular physical exercise aids digestion and bowel movement. Therefore, it is important to help your baby be physically active. This can be done by:
- Helping your baby do leg bicycle exercises. Make them lie down on their backs, and hold their legs in a half-bent position, then make circular motions, like riding a bicycle.
- Encouraging your infant to crawl more if they have reached that stage.
- Help your toddler to walk after eating.
It has been observed that active babies have lesser complaints of gas, pain, and constipation. (2)
Note: Do not lay your baby down on their stomach immediately after feeding.
Massaging your baby’s stomach area can help stimulate bowel movements and also relieve colic pain and gas.
A study published in the Journal of Child Health Care revealed that children who were massaged twice a day, 15 minutes each, for 14 consecutive days, had an increased number of defecations. (3)
A review paper assessed different case reports, clinical trials, and observational studies to evaluate the role of massage in alleviating constipation.
Results showed that massage is an effective therapy for constipation resulting from various physiological causes. It is a self-treatment method that has no side effects. (4)
Additionally, a warm bath can help in digestion and also reduce any pain caused by gas.
Probiotics are highly beneficial in managing digestive disorders as they contain live strains of bacteria similar to those living in the intestines.
A double-masked, randomized, placebo-controlled study was conducted in 2008 to study the use of Lactobacillus reuteri on 44 chronically constipated infants above 6 months of age. (5)
Results showed that administration of the bacterial strain improved frequency of defecation, but did not affect the fecal consistency or discomfort. The study also suggested that the probiotic might be a safe treatment option for functional constipation. (5)
Another similar study was conducted in 2014 using the same strain on 589 infants up to 3 months of age. They were administered with either the bacteria or placebo for 90 consecutive days. The babies who received antibiotics showed a decreased risk of having gastroesophageal reflux, colic, and constipation. (6)
Therefore, you can add probiotics to your baby’s diet by using available infant formulas that contain probiotics upon consulting your doctor.
4. Fluid intake
Healthy bowel movements are highly dependent on the fluid intake of an individual since an adequate amount of liquids facilitates the movement of the bowels within the intestine. The required liquid intake varies with the age and weight of the child.
Consumption of milk is advised for infants as it contains all the necessary nutrients and around 80% of water as well. For children above 18 months, it is advised to limit the consumption of cow’s milk to 500 ml per day, and they should be encouraged to drink plenty of water.
Refraining them from consuming drinks before meals can help improve the appetite. Toddlers on a solid-food diet should be given adequate water throughout the day.
They can also be given diluted fruit juices (1-part juice, 3-parts water) such as prune juice. Prunes are rich in fiber and have laxative properties that help in relieving constipation. (1)
However, they should not be given to children under 6 months, as they contain bowel irritants. Fruit juices, such as prune, pear, and apple juice, contain water, several phytochemicals, fructose, sorbitol, and even fiber.
Therefore, they are highly beneficial in treating constipation, especially in toddlers with a developing digestive system. (7)
However, as suggested by the American Academy of Pediatrics (AAP), refrain from giving juices to infants below 1 year of age. If suggested by the doctor, use a cup to feed juices to your child above 6 months.
Moreover, the consumption of mashed fruits is recommended over juices. If the child is older than a year, fruit juice may be given as a snack or with a meal, and not throughout the day. The reason is repetitive exposure to sugary juices is a known risk factor for dental caries. (8)
Fibers cannot be digested and, therefore, are essential for adding bulk to the stool and for absorbing water, making the stools soft and promoting healthy and natural bowel movements. (9)
Consumption of fiber-rich foods such as fruits (apples, prunes, pears, ripe bananas) and soft-cooked vegetables (2-4 ounces each in a day), cereals, whole-grain bread and muffins, oatmeal, popcorn, and yogurt may be beneficial.
Encourage your child to eat fiber by presenting it in appetizing forms, such as homemade fruit smoothies with flax meal or bran.
Increase the fiber content in your child’s diet gradually over a few weeks, accompanied by increasing fluid intake, rather than doing it at once. However, introducing your infant to solid foods while they have constipation might not be suitable.
It is advised to ask your doctor about switching to solid foods for infants younger than 1 year. Some doctors advise giving 1-2 teaspoons of corn syrup, such as Karo, every day to soften the stools.
6. Potty training
While potty training helps in setting up a routine for your toddler, it may cause problems if they are not ready to be trained. According to the guidelines published by the American Academy of Pediatrics, potty training should start any time after the child turns two.
Most children attain suitable physical development and readiness for training between 1.5 and 2.5 years of age. (8)
A few toddlers get constipated when they start potty training. The reason can be reluctance in using the toilet due to anxiety or being in a new environment such as a preschool or a house.
Therefore, it is important to be patient when training your toddler to use the toilet. It is recommended to set a proper routine and teach the correct position for defecation to the child.
Complications Associated with Constipation
Constipation may become chronic if left untreated for long. In rare cases, this condition may lead to complications such as:
- Rectal prolapse
- Anal fissures
- Fecal impaction
Defecation may cause pain if the lining of the anus gets damaged due to hard stools, leading to anal fissures. These cracks can also bleed at times. The toddler might try to hold back his bowel movements to avoid pain, thus aggravating the condition.
Some General Queries
Can my baby be constipated after vaccination?
Several vaccines produce mild constipation as a common side effect. While it is rarely a concern, you may consult a pediatrician if the symptoms cause discomfort to the baby. Seek advice from the doctor for measures you can take to aid relief or prevent these problems.
Can I give water to my newborn for dehydration?
For children on breast milk or formula, refrain from giving them water without consulting a doctor. Dehydration can be corrected using milk itself.
Both breast milk and formula help maintain adequate amounts of electrolytes such as potassium, chloride, and sodium. On the other hand, water might cause dilution of these electrolytes, causing an imbalance.
Small amounts of water may not lead to visible problems, but the kidneys may be unable to manage the electrolyte changes if excess water is given, causing serious concerns.
Does iron in formula cause constipation?
Iron, as a contributing factor to constipation has been a popular myth. However, iron is not a cause of constipation. Therefore, changing the formula to one with low iron content is not required.
Can honey be given to infants for constipation?
Honey, although rarely, may contain a spore of Clostridium botulinum bacteria, which are responsible for botulism (a type of food poisoning) in babies. Therefore, it is highly recommended to avoid giving honey to infants below 1 year of age.
Can teething cause constipation in toddlers?
Constipation may accompany teething at times, despite not having any connection. It is thought that the discomfort associated with teething makes the baby reluctant to consume food or drinks, which can cause dehydration, eventually leading to constipation.
At times, a baby may strain for bowel movements, which is perceived as a sign of constipation. Straining for defecation is, however, normal, as their abdominal muscles are still developing, and pushing helps in toning them.
During a bowel movement, the baby may groan and apply pressure. As a result, the face reddens, and the child might even cry, although eventually passing soft stools. This behavior is known as infant dyschezia, and it usually happens if the child has not yet gained full control of the pelvic muscles.
Also, toddlers often stretch their legs while passing stool, further tightening the pelvic floor and making defecation difficult.
Episodes of infant dyschezia may occur multiple times in a day, eventually tiring the baby. Parents of babies up to 3 months old often get concerned and seek medical help, thinking their child is constipated. (10)
However, if your child passes soft or watery stools, they are not likely to be constipated.
When to See a Doctor
For babies up to 2 months old, medical help should be taken if they are not gaining proper weight or haven’t had any bowel movement in 2-3 days. However, visit a doctor for all cases of constipation in infants less than 1-year-old.
Meanwhile, it is recommended to get your toddler checked if constipation is accompanied by:
- Inactivity or lethargy
- Lack of appetite
- The stomach has swollen with gas
- Blood in stool
If a toddler withholds bowel movements for 3 days or more, medical intervention is recommended. Consult a doctor or a child health nurse if you are unable to determine the cause of your baby’s constipation, as it may be indicative of a health problem.
What your doctor may ask you:
- When did your baby have his/her last bowel movement?
- Is the problem causing changes to the baby’s feeding pattern?
- When did you switch the baby to solid foods?
- Has the baby recently suffered any health problem?
What you may ask your doctor:
- Is my toddler lactose intolerant?
- When will the problem improve?
- What steps can I take when my baby gets cranky?
- Which measures will help prevent my baby from being constipated again?
- What food should I avoid feeding my baby?
Parents may easily get worried if their baby gets constipated since normal bowel movements are indicative of healthy development.
However, constipation is a very common problem that usually occurs with the shift from breast milk to formula and eventually to a solid-food diet. A rise in efforts for a smooth bowel movement is indicative of the healthy development of the baby’s digestive system.
It is advised to feed your infant as often as required if they are younger than 6 months and are breastfed. Avoid giving water or nonprescribed medications. If the condition does not subside, consult a doctor.
Make your toddler’s diet rich in fiber and increase their fluid uptake if they consume a semisolid or solid-food diet.
Your toddler’s constipation can easily be alleviated with the help of dietary and activity changes. However, if the condition does not subside, consult your pediatrician and refrain from using over-the-counter drugs.