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Constipation in babies is a hot topic and in my experience, remains heavily overdiagnosed.
In this blog we’ll discuss that many babies who poo infrequently are NOT constipated. For some it’s mechanical, not stool related. For babies with genuine constipation – that is – stools that are hard, dry, and difficult to pass, I’ll talk through foods that may be driving constipation and foods that can help relieve this uncomfortable condition.
It’s important to remember this blog isn’t medical advice and if you’re worried about your baby’s constipation, or the tips and changes to diet below aren’t working, you should always talk to your baby’s paediatrician or local doctor – you may need a stool softener or suppository to help relieve the discomfort.My recommendation is to follow these simple steps first but don’t delay seeing a healthcare professional if things don’t improve.
If you take nothing else from this article, remember for babies, kids and adults:
Eat the rainbow
- Colour is a really simple way of thinking about variety and variety is what healthy guts (and butts) need
If it doesn’t go off on the bench – think twice about it
- if you can leave food on the bench for a couple of days and it doesn’t spoil …it probably means it doesn’t have enough natural biome to keep little (or big) guts healthy
Fibre and hydration
- Keep reading for more …but these are crucial for nice, soft poo!
What causes constipation in babies?
Sometimes constipation simply happens because a child’s solid food intake increases rapidly and their digestive system isn’t quite ready to manage it all. Other times it can be caused by inadequate fibre or fluids. It can also be caused by excessive fructose intake. If the constipation coincides with the introduction of specific foods (e.g. yoghurt in a breastfed baby) then it can sometimes be a residual intolerance to cow milk protein.
In general, I recommend a balance of foods for your baby, not just focusing on one food group and making sure that there is adequate fluid intake. This means there’s no need to introduce pumpkin for a week, then chicken for a week, etc. Just mix things up from the very beginning of solids exposure.
Frequency of bowel actions does not define constipation in babies:
Lots of parents come to me panicking that their baby or child is constipated because they haven’t poo’d in a week …but when they do poo, it’s a soft consistency and passes easily. These babies are perfectly healthy and not constipated. Constipation is about the consistency of poo, not the frequency necessarily.
The range of what’s normal for the number of bowel movements in babies is exceptionally broad.
NORMAL is anything from one poo every seven days to seven poos in one day. Yes, there’s that much variability in what’s normal
Watch for consistency of baby poop (soft is good) and comfort rather than frequency. See my blog on baby poo colours for more on the specifics of poo colour and poo types.
If your baby passes a soft bowel action, even as infrequently as weekly, this is not constipation.
Here are signs that your baby may be constipated:
- Hard, pebble like or dry stools
- Very infrequent bowel movements (over 7-10 days without a poo)
- Their belly feels firm or hard
- Decreased appetite
- Straining to pass stools
- Looking pained, arching their back or crying when attempting to poo
- Streaks of blood from anal fissures (small tear in the bottom)
- Large stools
- Unusually smelly gas and stool
Breastfeeding babies are almost NEVER constipated! See more on this below.
Remember that constipation refers to the consistency of the poo, not the frequency.
Can starting on solids change a baby’s poo?
One common question I get a lot relates to constipation and the changes in a baby’s stool after starting solids.
It should come as no surprise that stools change with the introduction of solids, just as anybody’s stools would change – at any age – when their diet changes; think travelling abroad.
While it’s wise to avoid foods that tend to constipate, it’s not because the poo is particularly hard. The large bowel hasn’t learned to move through harder stools, not to mention possible low water intake. The solution here is to remove offending foods and use softening ingredients, not to delay solids entirely.
Sometimes babies simply find it difficult to coordinate the muscle changes required to pass a poo.
It’s common when a baby starts solids that the stool changes and your babies body needs to learn how to pass this new type of poo.
If you can see your baby is having trouble pooing but the stool itself is soft it may be a sign they are finding it difficult to coordinate the muscle changes required to poo.
When this occurs, your baby may show signs of discomfort and you can help them focus their attention to their bottom (anus) by using the spike of a twisted tissue to ‘tickle’ their anus while they try to push.
Hydration: Your Baby’s Best Friend
We can’t talk about constipation relief without mentioning the importance of hydration. Even after you introduce solids, breastmilk or formula will remain your baby’s primary source of hydration for a long period of time.
But…once you have introduced solids I recommend offering small sips of cooled, boiled water to help alleviate and prevent constipation.
Just like all other foods, it can take some time to figure out how to drink water as it has a different viscosity to breastmilk or infant formula. I encourage water to be offered in a sippy cup of some sort (lots of parents like the straw cups) but I recommend trying a few different sippy cups to find the one that suits the child best. As dexterity improves, you’ll move towards an open cup – get ready for all the splashes and spills!
Just a few sips can make a difference!
Fibre is key for a healthy digestive system:
Dietary diversity (eating the rainbow) and high fibre (both soluble and insoluble fibre) intake seems to have the greatest impact on the gut microbiome and digestive system in general as solids are introduced (Homann, Rossel et al 2021). When in doubt for both babies and adults – offer a range of plant-based fibres.
Constipation Culprits: Foods that cause constipation in babies
Before you keep reading:
This isn’t a message for families to avoid these foods – if they aren’t causing a problem, then don’t worry. This is just a list of foods to review if your baby is suffering from constipation. Lots of times when I review a baby who has just started solids, all they have eaten for the last 4 weeks is rice cereal, bananas and yoghurt, without a sip of water – this combination for a baby whose body is adjusting to the transition to solid foods can cause lots of problems.
While many of these foods listed below are brilliant foods to start with, they are also the top 3 culprits for constipation. Like us, our babies need variety, so it’s important to regularly introduce new foods and flavours, keeping their diet bright and fresh with lots of fibre.
1. Rice Cereal:
- A common first food, rice cereal is low in fibre and can bind your baby’s bowel movements.
- If rice cereal is a staple in your baby’s diet, consider mixing it up with more fibrous alternatives and where possible mix it with breastmilk in the early days of introduction.
2. Bananas & Apple puree:
- While fruits are generally great baby foods, bananas and applesauce contain pectin, a soluble fibre that can slow down the intestines when consumed in large amounts. Moderation is key!
3. Dairy Products:
- In some babies, especially those with a mild intolerance, dairy products like cheese, yoghurt, and cow’s milk can be constipating.
- Keep an eye on your baby’s response to these foods, intolerances will show up as stringy mucus in the poo
4. Iron rich foods:
- Iron rich foods and the commencement of solids can sometimes lead to constipation in babies.
- While iron is vital for your baby’s growth (and sleep), too much of it with not enough fibre can cause constipation. Ensure a balanced diet.
5. Processed Foods:
- These aren’t recommended for babies in any case but any processed foods, including baby snacks, can be low in fibre and high in fats, leading to slower digestion which can cause constipation
Healers: Foods that can help relieve constipation in babies
If your baby is experiencing constipation, these foods might help ease their discomfort and relieve constipation:
1. Pears, Plums, and Peaches:
- These “P” fruits are your pals when it comes to constipation.
- They’re rich in fibre and natural sugars like sorbitol, which help regulate bowel movements.
- Remember fibre is your friend: there is overwhelming evidence that fibre – particularly a range of diverse plant based fibres – is the key to a healthy digestive system.
- Offer them pureed or as a soft finger food, depending on your baby’s age and feeding stage.
2. Prunes:
- Another “P” and a classic remedy!
- Prune juice or pureed prunes are particularly effective because they contain high levels of sorbitol.
- Start with small amounts and adjust based on your baby’s nappies.
3. Vegetables:
- Green peas, carrots, and broccoli are not only nutritious but also packed with fibre, which helps soften stool.
- Sweet potatoes are brilliant because they are high in fibre, offer dense calories …and best of all nearly all kids adore them. They are also easy to puree, mash or serve as chips for older kids
- Introduce them steamed and mashed, or as finger-foods for older babies.
4. Beans and Lentils:
- For babies ready for a variety of textures, well-cooked beans and lentils can provide a fibre boost
- Blend them into purees or add them to soups
- Note: I don’t recommend these for babies under 8 months as they can cause too much gas and upset their tummies
5. Whole Grains:
- Replace white rice and white bread with whole-grain alternatives like barley, oatmeal, and brown rice.
- These contain more fibre and nutrients, promoting a healthier bowel movement.
What should I do if my baby refuses high fiber foods?
Like most things for babies, learning to eat is a new skill, smaller babies are still learning to eat, so getting high volumes of any food into them can be tricky.
All my tips and hints are in my blog – Starting Solids & Testing Allergens. As you introduce food it’s important to offer them over a few days, you’ll probably be pleasantly surprised that a food they didn’t like one day… they then love in 2 days time – consistency and persistence are key, never be disheartened and always offer food in a fun and happy way. Remember, it can take multiple attempts before a baby accepts a new food.
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Older babies can be picky (but this is normally 18 months +, see my Toddler Toolkit for more information on this age group and fussy eaters).
Keep offering a variety of high-fibre foods in different forms and combinations. You can also try mixing them with foods your baby already likes.
Breast milk and constipation:
Breast milk is often called the ‘perfect food’ for a baby’s digestive system. Breastfed babies and nearly never constipated, breast milk is so readily digestible and absorbed. It’s one of the reasons breastfed babies can poo so infrequently and still be perfectly healthy!
Formula-fed babies and constipation:
Formula-fed babies might experience constipation more frequently than their breastfed counterparts. This can be due to the different composition of formula, which can be harder for some babies to digest. If constipation occurs, parents may need to consult with a paediatrician, who might suggest trying a different type of formula, adjusting feeding techniques or administering a softener.
Similar to above with Iron rich foods at the commencement of solids – many formula brands also suggest switching to ‘stage 2’ versions to increase the iron content. It is perfectly safe to remain on newborn/starter versions of common formula brands, especially if flow-on versions are causing constipation.
Can switching from breastmilk to formula cause constipation?
Yes, the introduction of formula can impact your baby’s bowel movements, but babies need to be fed – so if there’s inadequate breast milk (for whatever reason) never let a baby go hungry. Formula can be harder for some babies to digest compared to breastmilk. If possible, transition slowly and monitor your baby’s response. Always talk to your healthcare professional if you need advice.
When to talk to your paediatrician or baby’s doctor about constipation
As mentioned up top, this blog isn’t medical advice and if in doubt – always consult your healthcare professional. It might be time to talk to your baby’s GP or paediatrician if:
- The simple remedies listed above aren’t improving things
- Your baby seems unusually uncomfortable
- Your baby continues to have hard or dry stools
Also, look out for symptoms like a hard bloated belly, refusing to eat, or blood in the stool.
Relieving constipation in your baby might be as simple as switching some foods, but for other babies they may need to be prescribed something or even have scans (ie abdominal ultrasound or x-ray). Every baby is unique, so what works for one may not work for another. I don’t recommend offering any stool softeners, other medicines or supplements without the guidance of your baby’s doctor or paediatrician.
Remember, when it comes to healthy bowel habits, the goal is to maintain a colourful & fresh diet, rich in fibre and hydration… this goes for babies and adults!
