This blog is all about poo!
Baby constipation a subject I get asked about a lot. Understandably it can cause some anxiety in parents. I’ll talk you through what’s normal in terms of the frequency, colour and consistency of your baby’s bowel movements and talk about baby constipation remedies.
This blog will attempt to get to the bottom (excuse the pun), of what causes constipation, how to get things moving and how we can try and prevent it.
What is normal baby poo?
Like babies, bowel habits are very individual and there’s a wide range of what’s considered normal. It’s all about understanding what’s ‘typical’ for your baby.
Babies should be passing a stool (pooing) on a consistent basis but some will be more regular than others.
Your little one’s bowel movements can also change as they grow, a one month old is likely to poo more than an eleven month old. Typically babies poo less as they get older. Bowel habits are also affected by age, how babies are fed, what their weaning diet looks like, what their weaning stage is, illness and lots, lots more.
Stools (poos) can also vary in colour and texture from day to day.
There is a handy chart you can use called the ‘Bristol Stool Chart’
which shows you images of different shapes and types of poo – and likens them to foods! However, it can be quite hard to make a judgement when the poo is contained in a nappy, especially if it’s been sat on!
Poo before weaning
Before solid foods are introduced to your baby, the type of milk they have impacts on the frequency, colour and consistency of poo:
Breast fed babies
Breastfed babies, especially newborns, can poo after (or even during!) each feed. As they get older, this tends to reduce. However some breastfed babies can go several days without having a poo and this is also normal, although more common in babies aged 6 weeks or older (11).
The texture and colour of poo can also vary. Typically a breastfed baby’s poos are runnier than formula fed babies poos (12). There are many shades of normal for breastmilk poos. For exclusively breastfed babies, the colour is often yellow, or sometimes a yellow-green. A poo with a green tinge is not normally a concern especially if the baby is otherwise well (11).
Constipation in breastfed babies is not common as breastmilk is easier to digest (17). However, if you decide to introduce formula, alongside or to replace breastfeeding, this is when constipation can occur for some babies (17).
Formula fed babies
Formula fed babies may poo up to 5 times a day or even just once a day and both are considered normal! Baby constipation tends to be more common in formula fed babies, as formula milk can be more difficult to digest (13).
Poo tends to be thicker and not as runny as breastfed babies poo and generally more brown in colour, although a yellow-green colour is normal too (12). Formula fed babies can be more prone to constipation as formula milk contains more waste products your baby’s digestive system needs to get rid of (17).
Take note of how you are making up your baby’s bottles, it’s very important to follow the onpack instructions levelling the scoops because making bottles with too much powder can cause dehydration and constipation.
Poo during weaning
Sometime’s babies suffer from constipation during this stage, as your baby’s digestive system is learning to manage new foods.
When introducing solid food, the consistency and frequency of poo can change quite dramatically and this is often when the mums on my Baby Nutrition & Weaning Course get in touch. Generally poo colour changes from yellow towards a browner colour.
If you are baby led weaning you may be able to spot some undigested food in your baby’s nappy – think peas and sweetcorn. Your baby is still learning to move food around her mouth and chew and if food comes out whole it’s likely she’s swallowed it without chewing. It’s energy consuming work moving food through the digestive system with no nutritional reward if it comes out whole.
This is often a telltale sign that your baby is not developmentally ready to manage those types of foods just yet and could benefit from having them chopped before eating. (11).
What is constipation?
Signs of constipation in your baby include:
They have type 1 or 2 poo on the Bristol Stool Chart
Pooing fewer than three times a week
Large hard poos that are difficult to pass
Small, dry, hard poos, which look like “rabbit droppings” or little pellets (3)
A poor appetite that gets better after a poo
Painful bowel movements (causing your baby to arch their back or cry) (4)
Passing blood when pooing
If your baby is constipated, they may find it uncomfortable or painful to poo. This can create a vicious circle: the more it hurts, the more they hold on, the more constipated they become, the more it hurts, and so on.
When isn’t your baby constipated?
Baby’s can often strain during a bowel movement. Constipation is unlikely if your baby passes a soft bowel movement after a few minutes of straining (5).
Why do some babies get constipation
There are lots of reasons your baby might become constipated. Some of the reasons why babies suffer from constipation include;
The early days of weaning, it can be common for babies to become constipated for a few days whilst their digestive system adapts to having food. This normally settles once their digestive system adjusts to regularly having solid food.
Not eating enough high fibre foods like fruit, vegetables, beans, pulses and wholegrains.
Eating too many processed or refined foods in the diet, for example, white bread, cakes, biscuits, crisps, pastry snacks, ‘fast foods’.
Drinking large amounts of milk each day, meaning food intake is low
Not drinking enough fluids
Allergies or intolerances – less commonly, persistent constipation can be one of the symptoms of Cows Milk Protein Allergy (CMPA). This can affect both breast and bottle fed babies. It is estimated that 2-3% of babies under 1 have CMPA (16).
Generally, CMPA develops when cow’s milk is first introduced, either as formula or when weaning (16). CMPA is rare when exclusively breastfeeding although not unheard of as cow’s milk protein is passed from the mother’s diet through breastmilk. You can read more about CMPA here
There are often other symptoms of CMPA alongside constipation, if your baby suffers from persistent constipation, speak to your GP for advice.
In a very small number of children, health conditions can cause constipation (such as thyroid deficiency and certain metabolic disorders). These are incredibly rare, but please seek medical advice if you think your baby might have any conditions which could be causing constipation. (7)
Often the treatment for constipation involves medication but there are a few home remedies you can try too. These differ depending on the age and weaning stage of your baby.
Babies under 6 months:
Increasing fluids may help so try offering more feeds during the day to relieve constipation.
There’s a small chance that something you eat could be causing your baby to be constipated such as cow’s milk. Discuss with your GP the idea of a short 2 week elimination of all dairy foods from your diet to see if your baby’s constipation gets better.
It’s really important not to do this for any longer than 2 weeks unless you have the guidance of a Registered Dietitian as your breast milk quality and supply can be affected. In addition, your own nutritional status needs to be assessed as you will need to ensure you receive enough energy, protein, calcium, iodine and other nutrients from alternative sources to make sure that your own health doesn’t suffer.
Formula fed babies –
If you think constipation could be due to your baby not getting enough fluid you can try offering extra drinks of cooled boiled water between feeds.
What about special baby formula’s for constipation?
There are several ‘comfort’ infant formula’s marketed for helping with constipation. There is no evidence that these formulas can help relieve constipation (13). However, trying one is unlikely to harm your baby so some mum’s want to give them a go.
Changing to an alternative formula brand is unlikely to make much difference (13). If one change does not make a difference, continuing to try different formulas is unlikely to help (8). Sometimes changing formulas can cause constipation or make constipation worse.
Lactose free formula is not for constipated babies. They are only to be used under medical supervision for babies with lactose intolerance. (13). Lactose intolerant babies have diarrhoea rather than constipation.
Soya infant formulas are also not indicated in the treatment of constipation. They are only suitable from 6 months of age but again only under medical supervision to help manage cow’s milk protein allergy (CMPA). They also contain a type of sugar which is damaging to teeth.
What else can help relieve constipation?
To get things moving you could also try;
A warm bath to relax muscles
Tummy massage – a gentle tummy massage can help get things moving.
Bicycle leg exercises – lay your baby on their back and gently move their legs as if riding a bicycle
Babies over 6 months
There are lots of home remedies you can try to help relieve constipation. These include;
There are many types of fibre but two which are referred to in managing constipation, these are often called soluble and insoluble. Fibre helps to keep our digestive system healthy and helps to prevent constipation, however, each type does something different:
Insoluble fibre pushes food through the digestive system quickly. Think of it as a broom, pushing the poo through. Although this type of fibre will likely make your child poo, it doesn’t prevent constipation from coming back as it’s not teaching your child’s digestive system how to move the food along properly.
Insoluble fibre is found in wholegrain pasta and bread, wholegrain cereals, bran, brown rice, bulgar wheat, potato skins (15).
Soluble fibre bulks up the poo and draws water in making it softer and easier to pass. Bulky poo has to press against the bowel walls and this teaches the digestive system how to work properly, hopefully getting rid of constipation once and for all.
Foods containing soluble fibre are oats, seeds like linseeds, flax, chia, pumpkin and sunflower seeds (1), pulses such as kidney beans, baked beans, chickpeas, lentils, vegetables, particularly sweet potato, avocado, broccoli, turnips, pumpkin, Brussels sprouts, carrots, french beans and courgette. (15)
Fruits and fibre
Good sources of fibre include berries such as strawberries and raspberries, bananas, kiwi fruit and fruit where the skin is eaten such as pears (19).
Is your baby drinking enough?
Poo needs fluid to be soft enough to move through the bowel. Often enticing your little one to drink can be the problem. Water and milk are the best fluids to offer your baby but if they aren’t keen to drink, get creative! You could try ice lollies made up with diluted fruit juice and frozen or homemade fruit jellies which are great fun and often readily received by little ones.
Between 0-6 months: Babies require 150ml/kg of fluid per day. So if your baby is 7kg she will need 1050ml fluid per day.
7-12 months: They require 640-800ml of water from drinks each day
1-2 years: They require 880-960 ml water from drinks each day (10)
Don’t think they have to drink this amount, sauces, soups, yoghurts and custard, vegetables and fruits all contain fluid and so contribute towards their fluid intake.
Try prunes, plums or pear
These fruits are high in sorbitol which is a natural laxative. Sorbitol is a non-fermentable carbohydrate and draws water into the bowel, softening poo making it easier to pass. Small amounts of these fruits or diluted juice from these fruits could help.
Try fruit juice
Apple juice also contains sorbitol but it also contains the right amounts of fructose and glucose, which draws water into the bowel and can soften poo making it easier to pass. You could also try pear or prune juice. Your little one will only need a small amount of juice though and it’s recommended to dilute further with water too.
However too many apples without the skins such as apple puree may not help constipation, apple puree is sometimes recommended after an episode of diarrhoea to help bind stools together (18) this is because apples contain a gel called pectin.
Try a baby probiotic
Probiotic supplements are live ‘friendly’ bacteria that live naturally in our digestive system. They make up part of our immune system. Sometimes the balance of these bacteria can get out of sync. There is some research that has shown that certain strains of probiotic can be effective in terms of relieving constipation. You can read all about them here and how to choose one that’s right for your child. You can read my blog on probiotics
for kids here.
Foods to avoid:
Consistent, large amounts of low fibre carbohydrates such as white bread, white rice and pasta may increase the risk of constipation. A diet high in processed foods, such as processed meats (e.g. hot dogs), ‘fast food’ (e.g. pizza), pastry snacks (e.g. sausage rolls), may also increase risk (15). Instead, try higher fibre varieties such as wholemeal bread and make sure your little one is having enough fibre rich foods alongside these such as fruit, vegetables, beans and pulses.
Foods that bind
Too many bananas (particularly unripe bananas) and apples (especially without skin) may have a binding effect on stools for some babies.
Regular intake of rice or rice-based cereals may also have a binding effect (15). You could try oat-based cereals instead.
Many fibre supplements are not suitable for babies under 1 year, they are usually a dissolvable powder, mixed into food or drinks. Fibre supplements may be considered if it is not possible to get enough fibre from the diet. However, these should not be introduced without advice from your GP or Registered Dietitian.
Busting myths about constipation
Dairy foods are often blamed for causing constipation. In Cow’s Milk Protein Allergy (CMPA), this may be the case however, this only affects about 2-3% of babies (16).
Lactose intolerance does not cause constipation. Difficulty in digesting lactose, the natural sugar in milk can affect babies, but symptoms more frequently include diarrhoea, alongside stomach pains, wind and bloating (16).
Babies can’t have fibre. This is a myth, babies can and should have fibre and a mixture of wholegrain bread, wholemeal pasta and brown rice alongside the white versions of these foods are absolutely fine. This myth stems from the fact that having too much fibre can inhibit appetite and may also affect the absorption of iron and zinc. It’s best therefore to have a mixture of both white and wholegrain versions of food.
Eggs are not binding. Eggs are lower in fibre, so introducing extra eggs are unlikely to help relieve constipation however, they do not cause constipation either.
If you’ve tried all of the above and are still getting nowhere it might be worth asking for a referral to a paediatric dietitian. There are certain fermentable carbohydrates that can cause constipation but they can only be identified through an individualised elimination diet. Your GP can make a referral but ask to see someone who is experienced in both paediatrics and gastroenterology.
So there you have it! I hope you found this blog helpful, comment below with what you have tried and whether its been successful, I’d love to know.
The information behind this blog was researched by my intern Charli Farrar and content edited by Gaby Goodchild.
For the full reference list please contact me.
Sarah Almond Bushell MPhil, BSc (Hons) RD MBDA – Registered Dietitian & Children’s Nutritionist