Constipation in babies: signs, causes and what helps by age

Constipation in babies is about the poo itself: hard, dry or pellet-like poos that are difficult or painful to pass. A long gap on its own isn't constipation. Some breastfed babies go a week or more between soft poos, while formula-fed babies usually go more often. Straining and going red before a soft poo is normal in young babies.

Most constipation settles with small changes at home. A few signs alongside it need urgent care. This guide covers what's normal, what helps at each age, what not to give, and when to get help.

How often should a baby poo?

The normal range is wide and depends on age and feeding:

Pregnancy, Birth and Baby says some breastfed newborns poo after every feed, up to 7 times a day, while others poo only once every 7 to 10 days. The Royal Children's Hospital Melbourne (RCH) says breastfed babies may poo after each feed or only once a week, and bottle-fed babies usually poo at least every 1 to 3 days.

In the early weeks, frequent poos are a sign a breastfed baby is getting enough milk. The NHS breastfeeding guidance says to speak to your midwife or child-health nurse if a breastfed baby hasn't pooed for 24 to 48 hours in this period. See baby poop for colours and textures.

What are the signs of constipation in a baby?

The main sign is hard poo. Pregnancy, Birth and Baby and the NHS list:

• Hard, dry, lumpy or pellet-like poos, sometimes larger than usual.
• Straining, or seeming in pain when pooing.
• Fewer than 3 poos in a week, for a baby who usually goes more often.
• Being unsettled, grumpy or lacking energy.
• Feeding less well than usual.
• A firm tummy, or unusually smelly wind and poo.
• A small tear around the bottom, which may bleed a little.

Straining isn't always constipation

Pregnancy, Birth and Baby says healthy babies under 9 months can strain and cry before passing a soft poo. This is called dyschezia, and it settles as babies learn to relax the right muscles. The NHS agrees that a baby isn't constipated as long as their poos are soft, even after a few days without one.

What causes constipation in babies?

Pregnancy, Birth and Baby lists these common causes:

• A change in diet, such as starting formula or starting solids.
• Formula made up incorrectly. Always measure the water first, then add the powder. The NHS bottle-feeding guidance says too much powder can cause constipation and dehydration.
• Not enough fluid from breast milk, formula or, for older babies, water.
• Not enough fibre once solids have started.

Very rarely, a medical condition causes constipation, and your doctor can check for these. For toddlers, the RCH notes that drinking large amounts of cow's milk can contribute. See cows' milk transition.

What helps a constipated baby under 6 months?

Try these first, and give them a few days to work:

1. Check the formula. Follow the tin's instructions exactly, water first, with level scoops. See preparing formula.
2. Offer extra feeds. The NHS suggests extra breastfeeds for breastfed babies who aren't eating solids yet.
3. Try gentle tummy massage. Rub your baby's tummy gently while they're relaxed and happy lying down.
4. Cycle their legs. Lie your baby on their back and gently move their legs as if they're riding a bike.
5. Give a warm bath. Pregnancy, Birth and Baby says this can calm your baby and ease discomfort.

What about water under 6 months?

Advice differs between countries. The NHS says formula-fed babies can have extra water between some feeds, and it must be cooled boiled water under 6 months. Breastfed babies are offered extra breastfeeds instead.

Australian sources are more cautious. Pregnancy, Birth and Baby says to speak with your child-health nurse or doctor if your baby is younger than 6 months. The RCH dehydration fact sheet notes babies up to 6 months get their fluid from breast milk or formula and don't need water. Ask before adding water, and see water for babies.

What helps once my baby is eating solids?

Once your baby has started solids, food and drinks become the main tools. Pregnancy, Birth and Baby suggests:

• From 6 months: offer prune or pear juice, or extra water, and more fruit and vegetables.
• From 9 months: add stewed prunes or apricots, up to 3 tablespoons, 3 times a week. The RCH gives the same amount. Cereal with bran may help mild constipation.
• For older babies: offer diluted prune juice, half juice and half water. Start with 10 mL and increase until poos are soft.

The NHS says apples, pears and prunes are particularly good for constipation. Our starting solids guide has more on first foods.

What shouldn't I give without advice?

• Laxatives. The RCH says children shouldn't take laxatives without medical advice. If your doctor or pharmacist recommends one, give it exactly as they say.
• Suppositories. Pregnancy, Birth and Baby says a doctor may recommend one for babies older than 1 month if oral laxatives haven't helped. Only use one on a doctor's advice.
• Enemas. The RCH says never give your child an enema unless their doctor has told you to.
• Extra formula powder or changed recipes. Never make bottles stronger or weaker than the tin says.
• Probiotics. Pregnancy, Birth and Baby says limited research shows they don't help constipation.

The RCH says some formula-fed babies with constipation might need a different formula. Talk to your GP or child-health nurse before switching.

When should I get help for constipation?

These tiers match our when to call the doctor guide.

Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) now if your baby:

• Has green or yellow vomit. The Sydney Children's Hospitals Network says this can mean a blocked or twisted bowel, even in a baby who looks well.
• Is vomiting and has a swollen, hard tummy. NICE says a swollen, tender tummy can suggest a blockage or other surgical problem.
• Is floppy, very sleepy or hard to wake.
• Has had no wet nappy for 12 hours.
• Is under 3 months and has a temperature of 38°C or more. Pregnancy, Birth and Baby advises going to the nearest emergency department or calling your local emergency number (000 in Australia, 999 in the UK, 911 in the US).

Get medical help today if your baby:

• Is under 8 weeks and hasn't pooed for 2 or 3 days. The NHS bottle-feeding guidance says to talk to your midwife, health visitor or GP.
• Is under 8 weeks and seems unwell, or isn't feeding well.
• Hasn't passed their first poo (meconium) within 48 hours of birth.
• Has blood in their poo, or ribbon-like, pencil-thin or mucus-filled poos.
• Has a swollen tummy, or seems to be in pain that won't settle.
• Is vomiting, or has a fever.
• Is under 6 months and has fewer wet nappies or other signs of dehydration.
• Has white, red or black poo. The RCH advises a doctor's visit for these colours.

The NHS urgent-help guide also lists no poo for around 3 days with a swollen tummy, tummy pain, straining or bleeding as a sign of serious illness.

Talk to your GP or child-health nurse if:

• You think your baby under 12 months is constipated. The RCH recommends checking with your GP or maternal and child health nurse.
• Things haven't improved after a few days of home steps.
• Constipation keeps coming back, or isn't improving after treatment.

What is worth noting about your baby's poos?

For a few days, note when your baby poos, what it looks like (soft, hard or pellets), whether they seem in pain, and their feeds and wet nappies. For formula-fed babies, note how you're making up bottles. This helps your GP or child-health nurse see whether it's true constipation or a normal pattern.