Babies and Constipation

Dr. Greene’s Answer:

As long as your son is in diapers, every single poop will be right there for you to see when the diaper is changed. During these years, the stools undergo several changes. The first poops are the thick, sticky, tarry meconium stools that consist partly of old skin cells that are shed and then swallowed while the baby is still inside you.

During the first week, these give way, in breast-fed babies, to soft, yellow, breast-milk stools. These usually look like yellow mustard with little seeds.

How Often Should Babies Have a Dirty Diaper?

By the time a baby is one week old, he has an average of 8 to 10 of these pleasant (as stools go) stools each day.

You can imagine that if these were 8 to 10 stinky stools, or if even the pleasant (as stools go) stools kept up at this pace, changing diapers would get real old real fast.

For most breast-fed babies, the number drops to about 4 per day by 4 weeks old (although many kids have a different pattern).

Formula-fed babies usually stool less often at this age, and the stools do not change much with time until solid foods are introduced (because, unlike breast milk, formula doesn’t change over time). Formula-fed stools are often tan or yellow at this stage and a little firmer than breast-milk stools.

For any baby, tan, yellow, green, or brown stools can all be normal.

By 8 weeks old, the number of dirty diapers drops again, however, there remains a wide range of normal. Most formula-fed babies will not go less often than daily, but many breast-fed kids will poop even less often than this. I know many babies who only go every three or four days.

If a happy formula-fed baby goes 4 days, or a breast-fed baby goes 7 days without a stool, I recommend that he or she be checked once by a pediatrician. If the child seems to be in pain, has vomiting, or has blood in the stool, he should be seen by the pediatrician immediately. Otherwise, it can be completely normal to go only once every eight days — as long as the stool is soft when it comes out and your baby is eating well in between. Breast milk is an amazing food that leaves very little in the way of waste.

Is Straining Normal for a Baby?

Babies will strain from time to time to move the stool along through the intestines. If you want to do something when babies grunt, push, or strain, try picking them up to get gravity to help them in their efforts, or try holding the knees against the chest to help them “squat” — the natural poop position. Sometimes moving their legs in a bicycle motion may also help move the gas and stool down through the intestines. Straining is usually normal. Crying while straining may be a sign of constipation, but could also be related to painful gas as well.  

Babies and Constipation: When to Contact Your Doctor

When a child is constipated, the stool in the intestines has backed up more than it should. What “more than it should” means varies depending on the age of the child and the diet. The longer stool sits in the colon, the more water is absorbed back into the body. When a child is constipated the stool tends to be hard, larger in volume than typical, and painful to pass.

Stool that is hard (firmer than peanut butter) or foul-smelling (you’ll know) in a child who has not yet had solid foods may represent something as simple as needing more to drink (especially during hot weather), but it may also be the sign of a disease. Contact your pediatrician to discuss the situation. Also, contact your pediatrician if your baby is less than a month old and hasn’t gone for 4 days.

If the baby is otherwise healthy and is older than 4 months, one teaspoon of pure maple syrup in 4 ounces of water will often get things back on track. When kids begin to take baby food, the stools change once again. They may be either softer or firmer, but they will likely smell worse (kids also smile and laugh more at this age, more than making up for the unpleasantness). Most children’s intestines are very responsive to the foods they eat, and their stools can often even resemble what they ate.

Babies and Constipation: Foods that Do, Foods that Don’t

Foods that tend to produce firmer stool:

• Bananas
• Rice cereal
• Applesauce
• Carrots and squash are constipating for some babies.

Foods that tend to produce softer stool:

• Pears
• Peaches
• Plums
• Apricots
• Peas
• Prunes

By balancing the diet, you can often keep the stools comfortably mid-range. If the stools are still too firm, juice is the gentlest medicine to soften them up. Two ounces of apple juice twice a day is a good bet. If this doesn’t work, prune juice is even better. Also, when your son is straining you might want to put him in a tub of warm water. This will relax his muscles and make the stool easier to pass.

Spit Up and Constipation

When kids in the first month or two spit up, it is much more likely to be a mechanical issue than a formula intolerance. The valve at the top of the stomach may be too loose (so it can’t hold things in), the valve at the bottom of the stomach may be too tight (so the stomach gets too full), or big air bubbles may take up too much room.

Smaller, more frequent feedings are more likely to help than switching formulas. If “projectile splat” of spit-up shoots across the room, it’s important to consider the condition called “pyloric stenosis”. Here, the too-tight valve at the bottom of the stomach needs to be treated.

If your baby is experiencing constipation, the most likely cause is liquid not getting in (and staying in) — again more likely than a formula intolerance. Different formulas do produce different consistencies of stools, and switching formulas may help. Sometimes spitting up and constipation may signify a milk protein intolerance or allergy. A special formula may be prescribed by a pediatrician in these cases.

Babies and Constipation: When Diet Doesn’t Do the Trick

Glycerin suppositories can be very helpful if diet and juice don’t work, but constipation that is stubborn enough to make these optimal should be discussed with your pediatrician. The same holds true for baby laxatives (hint: if your pediatrician does recommend a laxative, unprocessed bran, 1/2 teaspoon mixed with food twice a day is much cheaper than Maltsupex, and about as effective).

For most breast-fed babies, a 3-day break from dirty diapers is a reason to celebrate, not a cause for alarm. It’s nature’s reminder that breast milk is the perfect food for babies — or more broadly, that giving of yourself is a perfect gift for your child. This normal poop-pause is also a little foretaste of what life will be like when there are no more dirty diapers!

Resources and References

Loening-Baucke V. Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatr 2005; 146:359.

Tabbers MM, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58:258.