Constipation in babies

How can I tell if my baby is constipated?

First, consider what's normal for your baby. She may have a bowel movement after every feeding, or she may wait a day or more in between. Your baby's individual pattern depends on what she eats and drinks, how active she is, and how quickly she digests food.

If your baby drinks formula or eats solid food, she'll probably have a regular bowel movement at least once a day. If your baby is breastfed, there's no "normal" number or schedule – only what's typical for your baby. It's not unheard of for breastfed babies to have one bowel movement a week.

After a while, you'll be tuned in to your baby's unique habits. If you're concerned that your baby may be constipated, watch for these signs:

Less frequent bowel movements than usual, especially if your baby hasn't had one for three or more days and is obviously uncomfortable when she does
Hard, dry stools that are difficult for her to pass – no matter how frequently

Why is my baby getting constipated?

There are several possible causes:

Solid food. Don't be surprised if your baby becomes mildly constipated as he eats more solid food. That's often because rice cereal – a common first food – is low in fiber. Constipation can also happen when you wean your baby from breast milk because this sometimes leads to dehydration.

Formula. Babies who breastfeed exclusively are rarely constipated. Breast milk has the perfect balance of fat and protein, so it produces stools that are almost always soft – even if your baby hasn't had one for several days.

If your baby is on formula, it's possible that something in his formula is making him constipated. It's not uncommon for the protein component in different formulas to cause constipation. Ask your baby's doctor about switching brands.

(Despite what you may have heard, the amount of iron in formula doesn't cause constipation.)

Dehydration. If your baby becomes dehydrated, his system will respond by absorbing more fluid from whatever he eats or drinks – and also from the waste in his bowels. The result is hard, dry stools that are difficult to pass.

Illness or a medical condition. Although it's uncommon, constipation can be caused by an underlying medical condition such as hypothyroidism, botulism, and certain food allergies and metabolic disorders. Rarely, constipation is caused by Hirschsprung's disease, a condition caused by a birth defect that prevents a baby's gut from functioning properly.

If there doesn't seem to be a reason why your baby passes hard, painful stools, have his doctor rule out these conditions.

How can I treat my baby's constipation?

Here are some things to try:

*Help her get some exercise. If your baby's a crawler, encourage her to do a few laps. If she's not crawling yet, try pumping her legs instead. While she's lying on her back, gently move her legs in a forward, circular motion as if she were pedaling a bicycle.

*Massage your baby's belly. Measure three finger-widths below her navel on the lower left side and apply gentle but firm pressure there with your fingertips. Press until you feel a firmness or mass. Maintain gentle but constant pressure for about three minutes.

*If you feed your baby formula, ask her doctor about switching to a different brand. Sometimes adding dark corn syrup to the formula also does the trick: Start with 1/4 teaspoon per 4 ounces of formula. If that doesn't help, gradually increase the amount. Don't give her more than 1 teaspoon per 4 ounces.

*Add a little prune juice to formula or breast milk if your baby is at least 4 weeks old. Normally, it isn't necessary to give your baby juice, but a little is okay to help relieve constipation. (Try apple or pear juice if your baby doesn't like the taste of prunes.) Give her an ounce a day for each month of life, up to 4 ounces for a 4-month-old. After 8 months, your baby can have as much as 6 ounces of juice a day to treat constipation.

*If your baby is old enough to eat a variety of solid foods, cut down on constipating foods like rice, bananas, and cooked carrots. Try giving her a few tablespoons of pureed prunes, apricots, or pears to help loosen her bowel movements. For the best result, give your baby a belly massage first, then some high fiber food.

*Talk to your baby's doctor about other treatment options. Ask about using an over-the-counter stool softener to make it more comfortable for your baby to have a bowel movement, but never give her a laxative without her doctor's approval. The doctor may also suggest you try a glycerin suppository if your baby is severely constipated. The suppository stimulates your baby's rectum and helps her pass a stool. Using a suppository occasionally is fine, but don't do it on a regular basis because your baby could wind up relying on them to have a bowel movement.

*If your baby is passing such hard, dry stools that you see a little blood or even slight tears (fissures) in the delicate skin near the opening of her anus, you can apply some aloe vera lotion to the area to help it heal.  Keep the area as clean and dry as possible, and mention the fissures to your baby's doctor.

When should I call the doctor?

Call the doctor if your baby isn't eating, loses weight, or has blood in his stool. Or if basic treatments, such as adjusting his diet, aren't helping his condition. And if he's younger than 4 months old, call his doctor if he has very hard stools or hasn't had a bowel movement within 24 hours of when he usually goes. Don't give your baby a laxative or suppository without consulting his doctor first.