Constipation is uncommon in infancy, particularly in breastfed babies, but it can happen. Breastfed babies tend to have fewer episodes of constipation and diarrhea than formula-fed babies because breast milk is easier than formula to digest.
In older children, constipation is common and accounts for about 3% of visits to pediatric outpatient clinics and up to 25% of visits to pediatric gastroenterologists.
A baby might be constipated if they are passing hard pebble-like stools or have a distended belly. As every baby poops on their own schedule, the frequency of bowel movements is not always an accurate indicator of constipation.
In this article, we examine the possible causes of constipation in breastfed babies. We also look at the symptoms of constipation in babies and the treatments and home remedies.
The American Academy of Pediatrics recommend that babies exclusively have breast milk until 6 months after birth. During this time, they advise not giving any additional foods or fluids to the baby unless a doctor recommends it. After the first 6 months, parents or caregivers can then introduce solid foods to the baby’s diet.
A parent or caregiver may notice changes in the baby’s bowel habits and the color and consistency of their stools if they decide to switch to infant formula or when they begin introducing solid foods.
A 2018 study examined the bowel habits of 83,019 newborn babies in Japan. According to the authors, most instances of constipation coincided with the transition from breastfeeding to infant formula, regardless of whether the woman gave birth vaginally or by cesarean delivery.
A baby may develop harder stools and constipation after starting solid foods. Certain foods, such as rice cereal and dairy milk, may cause constipation in babies younger than 1 year.
Other possible causes of constipation in breastfed babies include:
- Not having enough liquids. Liquids help stool pass through the bowels smoothly.
- Illness. Infections can cause a decrease in a baby’s appetite or lead to vomiting and diarrhea, which may result in dehydration and constipation. Medical conditions that affect the gastrointestinal (GI) tract, such as Hirschsprung disease, can cause constipation and other digestive symptoms.
- Withholding stool. Babies may purposefully avoid passing hard or painful stools —a behavior that doctors refer to as withholding. Babies who have diaper rash may also withhold to avoid pain.
- Stress. Exposure to new environments, traveling, or weather changes may be stressful for a baby. Stress can affect their physical health and may result in a change in stool frequency and possibly constipation.
A woman who is breastfeeding may wonder how her diet affects her breast milk and whether her choice of foods can influence the baby’s digestive health.
According to the Centers for Disease Control and Prevention (CDC), women do not need to avoid specific foods while breastfeeding.
However, babies may appear to avoid feeding after a woman eats a particular food. In this case, the woman may wish to refrain from eating that food for a while and reintroduce it later.
Women may also want to limit or avoid caffeine while breastfeeding because small amounts of caffeine pass from the woman to the baby through breast milk.
Experts suggest that most women who breastfeed can safely ingest 300–500 milligrams of caffeine per day. Excessive amounts of coffee may lower the iron concentrations in breast milk, which may cause mild iron deficiency anemia in some babies.
Although most women do not need to restrict their diets while breastfeeding, they should aim to eat a nutritious and diverse diet.
Although changes in the frequency of a person’s bowel movements may indicate constipation in older children and adults, this is not necessarily the case for babies.
Newborn babies may have multiple bowel movements each day. According to the National Institute of Child Health and Human Development, from 3–6 weeks of age onward, breastfed babies may have only one bowel movement per week because breast milk leaves minimal solid waste to pass through the digestive tract.
Breastfed babies older than 6 weeks can go several days to a week between bowel movements.
Babies often show signs of straining, such as crying or getting red in the face, while having a bowel movement. However, straining does not necessarily mean that a baby has constipation. Babies may take a while to learn how to have bowel movements.
Symptoms of constipation in breastfed babies may include:
- being excessively fussy
- crying for prolonged periods
- refusing to feed
- having a hard, distended belly
- having rectal bleeding
- passing hard or bloody stools
- crying during a bowel movement
- experiencing weight loss or poor weight gain
Normal bowel habits vary from baby to baby. Parents and caregivers should monitor their baby’s bowel habits and take note of any changes. Doing this may help them decide when they need to take the baby to a doctor.
It is possible to treat constipation in breastfed babies at home using various remedies. However, constipation in exclusively breastfed babies is so uncommon that parents and caregivers may wish to speak to a pediatrician before trying home remedies.
Dietary changes for a baby who is taking formula or foods other than breast milk may help relieve constipation. Breastfeeding women can also try eliminating foods that have an association with infant constipation, such as dairy, from their diet. However, changes to the woman’s diet may not affect the baby’s digestion.
Babies who eat solids may have difficulty digesting high fiber foods or dairy products if parents or caregivers introduce them too early.
High fiber foods may also help relieve constipation in babies who can tolerate most solid foods. These foods include:
- whole grains, such as oatmeal or barley cereal
- skinless fruits
- pureed prunes
Liquids help move stools through the digestive tract. Increasing a baby’s fluid intake may also help relieve constipation.
Exercise can stimulate a baby’s bowels and help them pass stools. However, babies who cannot walk or crawl will require a parent or caregiver to help them exercise.
Parents and caregivers can help relieve constipation by gently moving the baby’s legs in a bicycling motion with the baby lying on their back.
Putting a baby on its stomach to squirm, reach, and play with toys can also stimulate a bowel movement.
Parents and caregivers can gently massage a baby’s stomach to help try to relieve constipation.
Massage techniques to consider include:
- using the fingertips to make circular motions on the stomach
- gently bending the baby’s knees and pushing the feet toward the belly
- gently sweeping an open palm from the top of the baby’s ribcage down their stomach
A warm bath may help relax a baby’s abdominal muscles, which might make stools pass through the digestive tract more easily.
Parents and caregivers should speak with a doctor or pediatrician if their baby:
- appears distressed or in pain
- has a hard, distended belly
- passes bloody stools
- has rectal bleeding
- refuses to eat
- has a fever
- loses weight or is unable to gain weight
- frequently struggles passing stools
A doctor can diagnose constipation in babies by reviewing their medical history and performing a physical exam. Rarely, a doctor may order additional laboratory tests, such as a stomach X-ray, to diagnose or rule out other conditions.
If home remedies and dietary changes do not relieve a baby’s constipation, a doctor might prescribe a mild laxative or suppository.
Parents and caregivers should never give these treatments to a baby without speaking to a trained healthcare professional first.
Constipation is not a common occurrence in breastfed babies. It usually happens as a result of changing to formula or starting solid foods.
Having infrequent bowel movements is not always an indication that a baby is constipated. Constipated babies are likely to pass hard, pebble-like stools.
Home remedies may help relieve constipation in breastfed babies. If a parent or caregiver is concerned about their baby’s bowel movements and accompanying symptoms, they should take them to see a doctor.