Baby Constipation: Signs, Causes, and Remedies

Few things concern new parents more than what's (or isn't) coming out of their baby. Is my baby pooping enough? Is that normal? Why hasn't she gone in three days? Before you panic about constipation, it helps to understand that "normal" varies wildly in infants—and what looks like constipation often isn't.

This guide will help you understand normal infant bowel patterns, recognize true constipation, and know what to do when your baby is genuinely struggling.

What's Normal? It Varies... A Lot

Here's the surprising truth: there's no single "normal" when it comes to baby poop frequency. AAP

Breastfed babies:

• First weeks: Multiple poops per day (often with every feeding)
• After 4-6 weeks: Can range from several times daily to once every 7-10 days
• Both extremes can be completely normal
• Breast milk is so efficiently absorbed that some babies produce little waste
• As long as stool is soft, infrequent doesn't mean constipated

Formula-fed babies:

• Typically poop more regularly than breastfed babies
• Usually once or twice daily
• Less variation in frequency
• Stool is typically firmer and darker than breastfed baby poop

After starting solids:

• Stool becomes more formed
• Usually once or twice daily
• Color and texture change based on foods

The key point:
Frequency alone doesn't define constipation. A breastfed baby who poops once a week with soft stool is not constipated. A formula-fed baby who strains and produces hard pellets every day may be. AAP

Signs of True Constipation

Constipation is about consistency (how hard the poop is) more than frequency. Look for these signs: AAP

Stool characteristics:

• Hard, pellet-like poops (like rabbit droppings)
• Very firm or dry stool
• Large, hard masses
• Streaks of blood on outside of stool (from straining)

Baby's behavior:

• Straining and turning red for more than 10 minutes without producing stool
• Crying during bowel movements
• Arching back or stiffening legs during attempted bowel movements
• Seeming uncomfortable or refusing to eat
• Hard, distended belly

What's NOT constipation:

• Going several days without pooping (if stool is soft when it comes)
• Grunting, straining, turning red briefly (newborns often do this—it's learning)
• Soft stool, even if infrequent
• Different colored poop (unless white/gray, which needs medical attention)

Why Babies Get Constipated

In young infants (0-4 months): AAP

Formula-related:

• Some formulas may cause firmer stools
• Not enough water in formula mix (always follow mixing instructions exactly)
• Switching formulas

Medical causes (rare):

• Anatomical problems
• Thyroid issues
• Hirschsprung disease (very rare but serious)

*Note: True constipation is uncommon in exclusively breastfed babies*

After starting solids (4-12 months): AAP

Dietary:

• Too many constipating foods (bananas, rice cereal, applesauce, toast—the "BRAT" foods)
• Not enough fiber
• Not enough fluids

Transition issues:

• Body adjusting to digesting solid food
• Temporary until gut adapts

In older babies and toddlers:

Behavioral:

• Holding it in
• Too busy playing to stop
• Fear of pain from previous hard stool

Dietary:

• Not enough fiber or fluids
• Too much dairy
• Processed foods

Home Remedies That Work

For formula-fed babies: AAP

*Offer water:*

• Small amounts of water between feedings (1-2 oz)
• Only after 4 months unless directed by doctor
• Don't replace formula feeds with water

*Consider formula change:*

• Some babies do better with different brands
• Talk to pediatrician about "gentle" or partially hydrolyzed formulas
• Don't switch too frequently—give 1-2 weeks

For babies eating solids: AAP

*"P" fruits are your friends:*

• Prunes (or prune juice—1-2 oz)
• Pears
• Peaches
• Plums
• Purees or cut appropriately for age

*Increase fiber:*

• Whole grain cereals (oatmeal instead of rice)
• Vegetables (peas, beans, broccoli)
• Fruits (except bananas)

*More fluids:*

• Water between meals
• Can offer small amounts of diluted prune or pear juice (1:1 with water)
• Continue breastmilk/formula as primary fluid

*Reduce constipating foods:*

• Limit bananas, rice cereal, applesauce
• Too much dairy can be binding in older babies

Physical techniques: AAP

*Bicycle legs:*

• Lay baby on back
• Gently move legs in bicycle motion
• Helps move gas and stimulate bowels

*Warm bath:*

• Relaxes muscles
• May help baby pass stool
• Often triggers bowel movement

*Tummy massage:*

• Gentle clockwise circles around belly button
• Follow the direction of the colon
• Use gentle pressure

*Rectal stimulation (use sparingly):*

• Can use lubricated rectal thermometer or cotton swab
• Insert slightly and gently
• Often triggers immediate bowel movement
• Don't make this a habit—baby can become dependent

When to Call the Doctor

Contact your pediatrician if: AAP

Immediate concerns:

• No bowel movement in first 48 hours of life
• White or gray stools (at any age)
• Blood in stool (more than a streak)
• Vomiting with constipation
• Distended, hard belly
• Baby seems in significant pain
• Fever with constipation
• Not gaining weight

Ongoing concerns:

• Constipation that doesn't improve with home remedies
• Constipation in an exclusively breastfed baby
• Pattern of recurrent constipation
• Needing rectal stimulation regularly to have bowel movements

Talk to the doctor before:

• Giving any over-the-counter laxatives
• Using suppositories
• Using enemas
• Trying any "remedy" you've read about online

Medical Treatments

If home remedies don't work, your pediatrician may recommend: AAP

Glycerin suppositories:

• Insert into rectum
• Stimulates bowel movement within 15-60 minutes
• For occasional use, not regular

Prune or pear juice:

• Doctor may recommend specific amounts
• Works as an osmotic laxative

Osmotic laxatives (for older babies, by prescription):

• Miralax (polyethylene glycol) may be prescribed
• Draws water into stool
• Generally safe but use only as directed by doctor

What the doctor will check for:

• Physical exam of belly and rectum
• Ruling out anatomical problems
• Checking for underlying conditions
• Growth and weight check

Preventing Constipation

During the early months:

• Breastfeed if possible (constipation is rare in breastfed babies)
• Follow formula preparation instructions exactly
• Don't over-concentrate formula

Once solids start: AAP

• Introduce a variety of fruits and vegetables
• Include high-fiber foods regularly
• Offer water with meals
• Don't over-rely on rice cereal
• Balance "binding" foods with "loosening" foods

Daily habits:

• Adequate fluid intake
• Regular meal times
• Opportunity for bathroom without rushing
• Physical activity (for older babies and toddlers)

The "Infant Dyschezia" Phenomenon

Here's something many parents don't know about: newborns sometimes cry, strain, turn red, and seem very uncomfortable before passing completely soft stool. This is called infant dyschezia—and it's not constipation. AAP

What's happening:

• Baby hasn't learned to coordinate relaxing the pelvic floor while pushing
• Everything works fine; they just haven't figured out the process
• Can last up to 20-30 minutes of straining
• Stool comes out soft

What to do:

• Nothing! Baby will figure it out
• Avoid rectal stimulation—it prevents them from learning
• This typically resolves by 4-6 weeks
• Different from constipation because the stool is soft

Common Questions

Can I give my baby water for constipation?
Small amounts (1-2 oz) can help babies over 4 months. Under 4 months, consult your pediatrician first. Water should supplement, not replace, formula or breast milk. AAP

Is rice cereal causing constipation?
Possibly. Rice cereal is binding. Try oatmeal cereal instead, or reduce rice cereal and increase fruits and vegetables.

My baby seems to poop more easily with rectal stimulation—should I keep doing it?
Use sparingly. If baby comes to depend on stimulation, they won't learn to pass stool independently. Talk to your pediatrician if you find you're doing this regularly.

Can breastfed babies get constipated?
Rarely. If an exclusively breastfed baby has hard, pellet-like stools, contact your pediatrician—this warrants investigation.

Will switching to a different formula help?
Sometimes. Different formulas have different effects. Your pediatrician can recommend formulas known to produce softer stools.

The Bottom Line

Baby constipation is common but often over-diagnosed by worried parents. Remember:

Normal varies widely:

• Breastfed babies may go days between poops
• Frequency matters less than consistency
• Soft stool = not constipated, regardless of frequency

True constipation signs:

• Hard, pellet-like stool
• Straining with no result
• Pain during bowel movements
• Blood from hard stool

What helps:

• "P" fruits (prunes, pears, peaches)
• More fluids
• Bicycle legs and tummy massage
• Reducing binding foods

When to call the doctor:

• No improvement with home remedies
• Blood in stool
• Baby under 4 months with constipation
• Any concerns about weight or growth

Clara can help you sort through what's normal for your baby and when to seek help—just ask!