Foods that help with baby constipation

Is it really constipation?

Many babies grunt, strain and go red in the face when they poop. That’s normal: the AAP points out that it’s hard work to poop lying on your back. The NHS says your baby isn’t constipated as long as their poop is soft, even if they haven’t done one for a few days.

How often babies poop varies a lot:

• Breastfed babies over about 6 weeks may go several days, sometimes up to a week, without a poop (AAP, NHS).
• Formula-fed babies usually poop at least once most days, but may go 1 to 2 days between poops (AAP).
• Once on family foods, the AAP’s normal range is from 3 a day to 1 every 2 days.

Signs that your baby may really be constipated (AAP, NHS):

• fewer than 3 poops in a week, if they’re also hard, dry or painful to pass (a breastfed baby over about 6 weeks who goes several days between soft poops isn’t constipated)
• dry, hard, lumpy or pellet-like poop (“rabbit droppings”)
• poop that is larger than usual and hard to push out
• straining for more than 10 minutes without success, or crying with pain
• a little blood on or around hard poop
• being less hungry than usual, a firm tummy, or seeming grumpy and fussy

Why it often starts with solids

Constipation is common when babies start solid food, or when they switch from breast milk to formula. The NHS explains that their body is learning to digest new things. Other common causes are not getting enough fluid (for example when teething or ill), and, in older babies, not enough fiber. NICE lists weaning, formula changes and too little fluid as typical triggers in babies under 1.

Foods that can help

The AAP says there’s no special “constipation diet”, but fiber from fruits, vegetables, beans and whole grains helps keep poop soft. Once your baby eats solids, try offering fiber-rich foods twice a day. For babies on solids, the AAP names peas, beans, apricots, prunes, peaches, pears and plums, and the NHS singles out apples, pears and prunes. Good options:

• Prunes, pitted, stewed until soft and mashed: see prunes
• Pears, peeled, cored and cooked until soft: see pear
• Plums and peaches, peeled, with the stone removed, and cooked until soft (very ripe, soft peach can be served raw if it squashes easily): see plum and peach
• Apples, peeled, cored and cooked until soft, never raw: see apple
• Peas, cooked and mashed or squashed flat: see peas
• Beans and lentils, cooked soft and mashed: see black beans, chickpeas and lentils
• Whole grains like oatmeal and, as your baby grows, wholegrain bread and cereals

Other soft fruit and vegetables add fiber too. The AAP adds broccoli for children over 1, and its constipation page mentions kiwi as a higher-fiber fruit: see broccoli and kiwi.

Serve each food in a safe form for your baby’s age, as its food page shows. NICE advises against adding unprocessed bran: it can cause bloating and wind and reduce how well some nutrients are absorbed.

Milk and cheese

The AAP notes that milk and cheese are the only foods that, in large amounts, commonly cause constipation, with hard, pale poop. White, chalky or pale gray poop is different and needs checking the same day, even if your baby has a lot of milk: see baby poop after starting solids. For children over 1, the AAP suggests keeping dairy (milk, cheese, yogurt) to about 3 servings a day while constipated, and offering more fruit, vegetables and whole grains. Under 1, breast milk or formula is still the main drink: don’t cut back on it without talking to your pediatrician.

Drinks

• Under 6 months: offer breastfed babies plenty of feeds. Always make formula exactly as the label says: the NHS warns that adding too much powder can cause constipation and dehydration. (See the US and UK differences below on water.)
• From about 6 months: offer sips of water from a cup with meals, up to 4–8 oz (120–240 ml) a day in total. See water for babies.
• From 12 months: water and plain milk with meals and snacks, so your toddler drinks enough through the day.

Juice: no juice under 12 months unless your pediatrician advises it. Some AAP pages describe giving a small amount of pear, apple or prune juice to babies for constipation, but ask your pediatrician first, and never give juice in a bottle or at bedtime. See juice for babies.

Other things that can help

• Lie your baby on their back and gently move their legs as if they’re riding a bicycle (NHS).
• Give a gentle tummy massage if they’re happy lying down (NHS).
• Hold their knees up toward their chest, like squatting, which makes it easier to push (AAP).
• Don’t give laxatives, suppositories or enemas unless your doctor recommends them. Treatments differ by age.

When to see a doctor

The NHS says that if you think your child may be constipated, you should take them to a GP and get help early. Talk to your pediatrician, GP or health visitor if:

• your baby is under 8 weeks old and hasn’t pooped for 2 or 3 days (NHS), or is under 2 months and seems constipated (AAP)
• there’s blood in or around the poop
• constipation lasts more than a week after changing their diet, or keeps coming back (AAP)
• your baby has had constipation since birth or the first few weeks, or was slow to pass their first poop (more than 48 hours after birth in a baby born at term) (NICE)
• your baby passes very thin, ribbon-like poop, or has new weakness in their legs (NICE)
• they’re not feeding well, not gaining weight, or seem unwell
• it seems to hurt every time, and your baby starts holding poop in

Call your doctor now if your baby has tummy or bottom pain that lasts more than an hour after trying these tips, vomits 2 or more times and their tummy looks more swollen than usual, is under 1 month old and breastfed, or looks or acts very sick (AAP). The NHS also says to get urgent help if a young child hasn’t pooped for around 3 days and has a swollen tummy, tummy pain, or bleeding from their bottom.

Constipation with a weak suck, poor feeding, a weak or different-sounding cry, drooping eyelids, less facial expression or floppiness can be a sign of infant botulism, which is a medical emergency (CDC, AAP). If your baby under 12 months has had honey and constipation is the only sign, call your pediatrician or GP the same day and mention the honey. See honey and botulism.

Call 911 or go to the emergency room if your baby vomits green or yellow-green fluid, is floppy, very sleepy or hard to wake, or has signs of botulism like a weak suck or cry, poor feeding, drooping eyelids or a face with less expression than usual. Also go now if your baby has bouts of severe tummy pain that come and go (often crying hard with their knees pulled up), especially with blood and mucus in the poop: this can be a bowel blockage called intussusception, which needs emergency treatment.Call 999 or go to A&E if your baby vomits green or yellow-green fluid, is floppy, very sleepy or hard to wake, or has signs of botulism like a weak suck or cry, poor feeding, drooping eyelids or a face with less expression than usual. Also go now if your baby has bouts of severe tummy pain that come and go (often crying hard with their knees pulled up), especially with blood and mucus in the poo: this can be a bowel blockage called intussusception, which needs emergency treatment.Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department if your baby vomits green or yellow-green fluid, is floppy, very sleepy or hard to wake, or has signs of botulism like a weak suck or cry, poor feeding, drooping eyelids or a face with less expression than usual. Also go now if your baby has bouts of severe tummy pain that come and go (often crying hard with their knees pulled up), especially with blood and mucus in the poop: this can be a bowel blockage called intussusception, which needs emergency treatment.

Where US and UK advice differs

• Water under 6 months. The AAP says healthy babies under 6 months don’t need water. The NHS says formula-fed babies can have extra drinks of cooled boiled water between feeds to help prevent constipation.
• Juice. The AAP’s general rule is no juice under 12 months, though some AAP pages describe small amounts of fruit juice for constipation in babies. The NHS doesn’t suggest juice for constipation: its advice is extra water, gentle leg and tummy exercises, and fiber from apples, pears and prunes once on solids.
• Seeing a doctor and laxatives. The NHS says to take a child you think is constipated to a GP and get help early, and that laxatives are often recommended for children eating solids. NICE says diet changes alone shouldn’t be the first treatment. The AAP’s home-care advice starts with diet changes and suggests an over-the-counter stool softener only for children over 1. Its gastroenterology page says polyethylene glycol (PEG 3350) is the recommended laxative for infants and children when a doctor advises it. Either way, don’t give a baby a laxative unless their doctor recommends it.

For what’s normal in the diaper after starting solids, see baby poop after starting solids.