Baby constipation: what helps and when to see a GP

Every baby's poo is different, and so is every baby's normal. Some poo after every feed; others go days. The number on its own tells you very little.

Constipation is about what the poo is like and how your child feels, not how often they go. This guide explains the signs, what to try at each age, and the red flags that need a doctor. It is general information, not a diagnosis.

What counts as constipation#

Constipation is when poo is hard, dry or pellet-like, or when passing it is painful or difficult. Your child may also:

• strain or cry when doing a poo
• refuse to sit on the toilet or hold on
• have tummy pain that comes and goes
• have a bloated tummy
• lose their appetite or seem irritable
• have small tears around the anus (anal fissures) with a little blood on the tissue
• soil their pants, sometimes without noticing

Normal frequency varies enormously. Breastfed babies may poo several times a day or only once a week. Formula-fed babies and older children usually poo at least every one to three days, and the overall range for children is three times a day to twice a week. If the poo is soft and your child is comfortable and growing, the frequency is probably fine.

What causes it#

Most childhood constipation does not have a serious underlying cause. Common triggers include:

• starting solids
• not enough fluid
• formula made with too little water
• a diet low in fibre or high in processed food
• too much cow's milk
• illness or a period of poor eating and drinking
• a painful poo that leads to holding on
• toilet training, starting childcare or a new toilet
• being too busy playing to go

Less commonly, constipation can be caused by a medical condition, including problems with the bowel, thyroid or spinal cord. These are rare, but they are why persistent constipation needs a proper assessment.

Babies under 12 months#

If your baby is under 12 months and you think they are constipated, see your GP or child and family health nurse. For babies under six months, do not give water, juice, laxatives, suppositories or enemas without advice.

For a breastfed baby, true constipation is rare. If your baby is pooing less often but the poo is soft, they are comfortable and they are growing well, it is usually normal. If they are also feeding poorly, have a dry mouth, fewer wet nappies or are not gaining weight, get advice the same day.

For a formula-fed baby, check that you are making the formula exactly as the tin says. Too little water makes it concentrated. Do not add extra water to dilute it, and do not switch to a different formula without advice.

Straining in a young baby is not automatically constipation. Babies often grunt and turn red before passing a soft poo. If the poo is soft and they are otherwise well, it is not constipation.

Babies on solids#

Starting solids often changes poo. It may become firmer, less frequent or a different colour. This usually settles within a few weeks.

What can help:

• offer water in a cup with meals, once your baby is eating solids
• include fruit and vegetables such as pear, prune, apricot, plum and peach
• offer a variety of textures and foods rather than large amounts of one thing
• keep offering breastmilk or formula as the main drink
• avoid adding cereal to bottles unless advised

For babies already on solids, the Royal Children's Hospital suggests up to three tablespoons of strained stewed prunes or apricots three times a week, or diluted prune juice. Ask your child health nurse before using this if your baby is very young or has other health issues.

Do not give your baby a lot of fruit juice. It is sugary, can cause diarrhoea and does not teach good drinking habits. Water and milk are the drinks to focus on.

Toddlers and older children#

For toddlers, the foundations are fluid, fibre, movement and routine.

Fluid#

Offer water regularly through the day. If your child is over 18 months, the Royal Children's Hospital recommends limiting cow's milk to no more than 500 ml a day, because too much milk can reduce appetite and contribute to constipation. Avoid sweet drinks.

Fibre#

Offer fruit and vegetables at most meals, wholegrain breads and cereals, legumes and prunes. Increase fibre gradually and alongside fluid, because fibre without fluid can make constipation worse.

Movement#

Active play helps the gut. Aim for at least three hours of active play a day for children aged one to five, spread across the day.

Toilet routine#

If your child is toilet trained, encourage them to sit on the toilet for three to five minutes after breakfast, lunch and dinner. They may not go, and that is okay. Praise them for sitting.

Make sure their feet are supported and their knees are higher than their hips. A foot stool and a child toilet seat insert make a big difference. A relaxed, upright posture helps the muscles relax.

Laxatives and other medicines#

Some children need laxatives to break the cycle of pain and holding on. They are not a last resort or a sign of failure. But they should be recommended by your GP or paediatrician, not chosen at the pharmacy without advice.

Common options include osmotic laxatives such as macrogol or lactulose, which soften the poo by drawing water into the bowel. Some children need them for several months while the bowel and the habit recover. Stopping too early is a common reason constipation comes back.

Do not give your child suppositories or an enema unless a doctor has told you to. They are distressing, can cause injury and do not treat the underlying problem.

What not to do#

• Do not give a baby under six months water, juice or laxatives without advice.
• Do not use soap, a thermometer or a finger to stimulate a baby's bottom.
• Do not force your child to sit on the toilet for long periods.
• Do not punish or shame your child for soiling. It is a medical symptom, not misbehaviour.
• Do not remove foods from your child's diet without advice, especially if they are growing or have allergies.
• Do not ignore ongoing constipation because it seems minor. Chronic constipation is easier to treat early.

Common mistakes#

• Assuming less frequent poo means constipation when the poo is soft.
• Cutting out dairy completely when the issue is too much milk or low fibre.
• Increasing fibre without increasing fluid.
• Stopping laxatives as soon as the poo looks soft.
• Waiting for a child to "grow out of it" when they are in pain or soiling.
• Using a potty or toilet that is uncomfortable or scary.

When to get help#

See your GP or child and family health nurse if your child:

• is under 12 months and you think they are constipated
• has blood in their poo
• has a fever, vomiting or weight loss
• has severe or persistent tummy pain
• has a swollen, hard tummy
• is soiling their pants
• is not improving with diet, fluid and routine changes
• is holding on, in pain or afraid to poo

Call 000 or go to the nearest emergency department if your child:

• has severe abdominal pain that is constant or getting worse
• has a rigid, swollen tummy
• has green or bloody vomit
• is pale, sweaty, floppy or unusually sleepy
• has a baby who is not feeding, has fewer wet nappies or is difficult to wake

For urgent advice when it is not an emergency, call healthdirect on 1800 022 222.

The bottom line#

Constipation is common, especially around starting solids and toilet training. Look at the poo and your child's comfort, not just the calendar. For babies under six months, get advice before trying home remedies. For older children, focus on fluid, fibre, movement and a relaxed toilet routine. If it persists, get help early. A good plan can prevent months of pain and worry.