What is constipation in babies?
Constipation in babies refers to a decrease in the frequency of bowel movements or the passage of hard, dry stools that are sometimes painful to pass. It is not defined solely by a number: the appearance of the stools and the baby’s discomfort are the primary factors guiding the diagnosis, rather than the frequency of bowel movements.
Physiological patterns vary considerably depending on age and feeding method: a breastfed infant may go as long as 5 to 7 days between bowel movements without being constipated, as long as the stools remain soft and are passed without straining. Bottle-fed babies generally have more frequent and firmer stools. Once solid foods are introduced, the pattern becomes more similar to that of adults, often one bowel movement per day or every other day. For infants and babies in general, additional resources are available.
What are the signs to look for?
Several signs may indicate true constipation:
- Hard, dry stools, broken into small pellets or resembling marbles
- Difficulty passing stools, accompanied by visible straining and facial flushing
- Crying or discomfort during a bowel movement
- A hard, bloated abdomen, sometimes tender to the touch
- Significantly longer intervals between bowel movements than the baby’s usual pattern
- Loss of appetite or associated sleep disturbances
- Minimal bleeding (anal fissure) related to straining
- Baby is less playful and more irritable
A longer interval between bowel movementson its own, without discomfort or changes in stool consistency, does not constitute constipation, particularly in breastfed babies. It is the combination of symptoms that guides the diagnosis. For infant colic in general, specific resources are available.
What are the possible causes?
Several factors can explain constipation in infants:
- Dietary transitions: switching from breast milk to infant formula, changing brands, or starting solid foods
- Insufficient hydration, particularly in babies who have started solid foods
- Limited fiber intake from the start of solid food introduction
- Improperly preparedinfant formula (too concentrated)
- Changes in bowel movements as the digestive system matures
- Emotions, stress, and changes (moving, childcare arrangements, separations)
- Toilet training in older children, with intentional holding back
- Medications: certain treatments (iron supplements, prescription codeine-based cough suppressants, certain antacids)
- Raremedical causes: cow’s milk protein allergy, hypothyroidism, digestive malformations (Hirschsprung’s disease)
Identifying the triggering factor guides treatment. Most cases of constipation resolve with simple adjustments to diet and fluid intake. Specific resources are available forinfant feeding and the introduction of solid foods in general.
How can you help soothe your baby on a daily basis?
Several simple steps can relieve a constipated baby:
- Abdominal massage using gentle, clockwise circular motions around the navel for 5 to 10 minutes several times a day
- Leg pedaling: gently bring the knees toward the tummy, alternating legs, for a few minutes
- Tiger position: Lay the baby face down on the parent’s forearm
- A soothinglukewarm bath at 37°C to relax the abdominal muscles
- Gentle warmth on the tummy (a lukewarm hot water bottle securely wrapped in a cloth)
- Close-contact carrying in a physiological position
- Squatting position for older children (helps with bowel movements)
Listening to the baby’srhythm and exercising patience remain essential: forcing a bowel movement often worsens the discomfort. Glycerin suppositories or rectal enemas should be avoided as a first-line treatment without pediatric advice, due to the risk of dependency and irritation. Specific resources are available for baby massage in general.
What diet should be followed?
Dietary adjustments are the primary approach to managing this condition:
- Hydration: Maintain adequate fluid intake—low-mineral-content still water starting at 6 months—in small amounts during meals
- Magnesium-rich waters (Hépar, Contrex) may be given occasionally starting at 6 months, as advised by a pediatrician
- High-fiber vegetables: zucchini, broccoli, spinach, green beans, and peas—introduce them gradually
- Laxative fruits: unsweetened prune compote, very ripe pears, peaches, apricots, kiwis (starting at 8–10 months)
- Whole grains: oatmeal, whole-grain semolina starting at 8–10 months
- Well-cooked and pureedlegumes starting at 8–10 months (lentils, split peas)
- Raw vegetable oil with every meal (alternating between canola, walnut, and flaxseed oils)
- Limit foods that can cause constipation if eaten in excess: white rice, very ripe bananas, cooked carrots, potatoes
Constipation is rare in breastfed babies. If it occurs, check the baby’s latch and feeding frequency before making any changes. For bottle-fed babies, check the dosage (strictly one level measuring spoon per 30 ml of water). Any change in infant formula should be made only on the advice of a pediatrician. Specific resources are available regarding the baby’s nutritional needs, infant formula, andbreastfeeding in general.
Are Probiotics and Supplements Helpful?
Several probiotics have been studied for functional constipation in infants:
- Lactobacillus reuteri DSM 17938: documented benefits in several studies regarding improved bowel movements in infants
- Bifidobacterium animalis subsp. lactis: shown to improve stool frequency in several studies involving children
- Specific pediatric formulations in drops or powder form, available upon recommendation from a pharmacist or pediatrician
Probiotics are typically administered as a 2- to 4-week course of treatment, ideally not taken concurrently with antibiotics. They do not replace basic dietary and hydration measures. Magnesium obtained through diet (appropriate mineral waters) remains beneficial for older children. Specific resources are available regarding probiotics and improving digestion in general. Avoid self-medicating infants with: adult laxatives, irritating suppositories used routinely, homemade enemas, concentrated herbal laxatives (senna, buckthorn, cascara), or Microlax without pediatric advice.
When should you see a doctor?
Several situations warrant a pediatric consultation:
- Persistent constipation lasting more than 5 to 7 days despite properly implemented measures
- A baby who is visibly distressed, in pain, or refusing to eat
- Associated vomiting, marked abdominal distension, persistent bloating
- Presence of fresh blood or blackish stools
- Weight plateau or interruption in the growth curve
- Visible anal fissure, perianal sores
- Associated fever
- Pallor, unusual drowsiness, marked irritability
- First episode of constipation in a newborn before the first passage of meconium (to be confirmed within the first 24 to 48 hours of life)
- Chronic constipation with voluntary retention in older children
- Family history of digestive disorders
The pediatrician confirms the diagnosis, rules out medical causes (cow’s milk protein allergy, hypothyroidism, digestive malformations), and guides management. Depending on the situation, the pediatrician may prescribe a pediatric macrogol (a mild, well-tolerated osmotic laxative for functional constipation), consider additional testing, or refer the child to a pediatric gastroenterologist. Specific resources are available for childhood constipation and constipation in general. Your pharmacist remains a valuable resource for providing initial advice on daily management, in addition to regular pediatric follow-up.
