What to Know

• Know the symptoms of constipation and when it is most likely to occur
• Learn common dietary treatments for constipation

Constipation in children is defined as having fewer than two bowel movements per week and/or difficulty passing stools that are small, hard and dry. But every child is different. Pay attention to whatever seems regular for your baby, because any deviation from your baby’s “normal” can be unpleasant.  

So what causes this discomfort and how can you help your little one avoid it? Inadequate hydration is the likely constipation culprit, along with eating a diet low in fiber.

It is important for babies and toddlers to drink enough fluids to keep their bodies properly hydrated and bowels moving regularly. And when increasing the amount of fiber in your child’s diet, it is important to keep increasing the amount of water to help process the added fiber.

Healthy babies under 6 months are unlikely to experience constipation because they receive adequate hydration and nutrients from breastmilk or formula or a combination. If your baby is experiencing constipation, here are some reasons it may be occurring:

• Incorrect preparation of formula. Always make sure to add water first, then the formula powder so that baby is getting enough fluids and to ensure the formula is not concentrated.
• Intolerance or allergy. Certain proteins in formula may cause constipation if your baby is not tolerating them well. And while rare, a breastfed baby may experience constipation if allergic to some of the foods mom is eating.
• Solid foods before 4 months. Adding cereal or other solid foods before baby is 6 month old may also create constipation and other issues.

Contrary to popular belief, recent studies have found that formulas with iron do not necessarily cause more constipation than formulas without iron.

Once your baby begins eating solid foods (likely around 6 months), constipation may occur. The transition from breastmilk or formula to solid foods is one of the most common times for children to become constipated because the digestive system needs time to adapt. Some straining during bowel movements is normal (babies still have weak abdominal muscles). But if your baby exhibits any of these symptoms, he may be constipated:

• dry, hard stools with pain upon passing
• blood streaks along the outside of the stool
• abdominal pain with hard and infrequent stools
• pellet sized stools passed with straining or grunting
• standing on tiptoes and rocking back and forth
• clenching buttocks muscles
• making dancelike movements
• stool in underwear, and urinary incontinence or “wetting the bed”

Once in toddlerhood, constipation can occur if your child holds in his stools. Many children do this as they learn to control their bowels, during potty training or when they transition to preschool or daycare.

Although constipation is more common in toddlers than babies, most cases aren’t serious and generally last a short amount of time. Even though most cases aren’t dangerous, it is important not to ignore symptoms or leave constipation untreated because it can lead to more serious health problems (such as fecal impaction, anal fissures, and rectal prolapse).

What to Do

Keep your child hydrated

Keeping your child well hydrated will help prevent and alleviate constipation. Choose water as the main source of hydration and limit drinks such as fruit juices (and no juice under the age of 1). And remember that in addition to fluids, fresh fruits and vegetables can also contribute to proper hydration.

Constipation in infants

When preparing formula, add water first and then the powder to ensure baby is getting enough fluids. If constipation is consistent even with correct preparation of formula, speak with the pediatrician about additional signs that your little one may not be tolerating the formula well.

Even though research indicates that iron in formula may not cause constipation, all babies are different. If you feel this is the cause, call the pediatrician before switching to a low -iron formula, as iron is important for growth and development.

If you are breastfeeding and are concerned about your baby having an intolerance or allergy to foods you are eating, contact the pediatrician for more information.

If needed, a small amount of 100% prune, apple, or pear juice may be added to formula or breastmilk as long as baby is older than 4 weeks. The general recommendation is to give 1 oz per day for every month of life up to 4 months. For example, a 3 month old would be allowed to have 3 oz per day. Be sure to discuss with your doctor before providing your baby with juice. Note that juice is not recommended for infants younger than 1 year old at any other time.

If these dietary changes do not work, or if you are at all concerned, call the pediatrician.

Include lots of fiber in your child’s diet, from vegetables, fruits, beans and whole grains in your child’s diet

The recommended amount of fiber for toddlers (children 1-3 years old) is about 19 grams of fiber per day.

Examples of foods with fiber include apples and pears (keep the skin on for added fiber), berries, prunes, sweet potatoes, peas, broccoli, beans, oatmeal and whole grain bread or pasta. You can’t go wrong with vegetables and fruits so offer a variety to your child daily.

For reference, half a cup of cooked beans has about 6-9 grams of fiber, 1 small apple with skin has about 3 grams of fiber and half a cup of broccoli or greens has about 3 grams of fiber.

Check the nutrition facts panel on whole grains to determine the amount of fiber they provide.

Avoid too many low fiber foods

Examples of foods that are either low in or don’t have any fiber include cheese, chips, ice cream, meat and many processed foods. Try swapping out low fiber foods for those high in fiber.

Try probiotics

Probiotics, or healthy gut bacteria, may also be helpful in relieving constipation. Try adding yogurt or other foods with added probiotics

Breastmilk contains both probiotics and prebiotics, which have been shown to be beneficial for gut health in people of all ages. Research on formulas with prebiotics shown that they may lead to better stool consistency and frequency in infants. So if your baby struggles with constipation and all other dietary changes have not helped, choosing a formula with prebiotics may be beneficial.

Massage your baby

The “I love you” massage for babies and toddlers can be helpful in reducing constipation, abdominal pain, bloating, and gas. Read Baby massage: Benefits and techniques for all the details.

Encourage your child to move his bowels

When potty training, ask your child frequently if he needs to use the bathroom and visit the bathroom regularly even if your child does not ask to go. Help your child feel comfortable using the bathroom in places other than your own home.

If constipation persists, contact your healthcare provider

If your child is experiencing persistent constipation for 2 weeks or constipation accompanied by fever, vomiting, blood in stool, swollen abdomen or weight loss you should contact your child’s pediatrician.

Do not use treatments such as mineral oil, stimulant laxatives, or enemas without consulting your child’s pediatrician.