Is this your child's symptom?
- Can't pass a stool or pain when passing a stool
- Crying when passing a stool (bowel movement or BM) or
- Can't pass a stool after straining or pushing longer than 10 minutes or
- 3 or more days without passing a stool (exception: breastfed and over 1 month old)
- Caution: any belly pain from constipation comes and goes. Most often, it is mild. Use the Abdominal Pain (Stomach Pain) care guide if there is constant belly pain.
Causes of Constipation
- True constipation is uncommon in infants.
- Sometimes, it is caused by a formula-only diet.
- Infantile botulism is a rare cause of constipation during the first year. More common symptoms are the new onset of a weak suck, weak cry and droopy eyelids.
- Lots of grunting during the first 3 months is often mistaken for constipation. See below.
Grunting to Poop During Early Months – Normal
- Grunting, straining and pushing to pass a stool is normal during the first 3 months
- They also become red in the face.
- They draw up their legs to tighten their tummy muscles.
- They are fussy but not in any pain. They usually don't cry.
- Straining even occurs with soft stools.
- After 5 minutes or so, they usually pass a poop. If not, they most often pass one after the next feeding. Unlike constipation, they pass several soft stools per day. They don't skip days.
- Doctors call this the grunting baby syndrome.
- It is normal, not constipation.
Cause of Grunting to Poop
- Some newborns have to learn how to relax their anus when their rectum is full.
- Reason: they spent 9 months in the womb with the anus tightly closed.
- They also have to build up their tummy muscles.
- This normal process takes longer in some babies than others.
- About 20% of newborns have the grunting baby syndrome.
When to Call for Constipation (0-12 Months)
Go to ER Now
Call Doctor or Seek Care Now
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Contact Doctor Within 24 Hours
Contact Doctor During Office Hours
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Self Care at Home
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Go to ER Now
- Vomiting bile (green color). Exception: stomach juice which is yellow.
Call Doctor or Seek Care Now
- Straining goes on more than 1 hour after using care advice
- Age less than 1 month old and breastfed
- Age less than 12 months with recent onset of weak suck or weak muscles
- Your child looks or acts very sick
- You think your child needs to be seen, and the problem is urgent
- Vomits 2 or more times and stomach looks more swollen than normal
Contact Doctor Within 24 Hours
- Age less than 2 months. Exception: normal straining and grunting.
- Bleeding from anus
- Suppository was given but did not work
- You think your child needs to be seen, but the problem is not urgent
- Child may be "blocked up"
Contact Doctor During Office Hours
- Suppository was needed to get the stool out
- Painful stools occur 3 or more times after changes to diet
- Constipation is a frequent problem
- Infrequent stools do not get better after changes to diet. Exception: normal if breastfed infant more than 1 month old and stools are not painful.
- Stool softeners are being used and have not been discussed with your doctor
- You have other questions or concerns
Self Care at Home
- Mild constipation in infant
Care Advice
What You Should Know about Constipation:
- True constipation is not common in infants.
- When it occurs, most often, it's from a change in diet.
- Passing a stool should be free of pain.
- Any child with pain during stool passage or infrequent stools needs treatment. At the very least, they need changes in their diet.
- Here is some care advice that should help.
Diet for Constipation in Infants:
- Age more than 1 month old: only on breast milk or formula, add fruit juice.
- Amount. Give 1 ounce (30 mL) per month of age per day. Limit amount to 4 ounces (120 mL).
- Pear and apple juice are good choices. After 3 months, can use prune (plum) juice. Reason for fruit juice: approved for babies in treating a symptom.
- If on solid (baby) foods, add those high in fiber. Do this twice a day. Examples are peas, beans, apricots, prunes, peaches, pears, or plums.
- If on finger foods, add cereals and small pieces of fresh fruit.
Exercises to Help Stool Release:
- Help your baby by holding the knees against the chest. This is like squatting for your baby. This is the natural position for pushing out a stool. It's hard to have a stool lying down.
- Relax the legs then press up again. Move them like riding a bike.
- Gently pump on the lower abdomen with your fingers. This may work even better.
- If no stool release within 5 minutes, stop. It will usually work next time your baby is straining.
Warm Water to Relax the Anus:
- Warmth can help relax the anus and release a stool.
- Apply a warm wet washcloth to your baby's bottom. Or help them sit in a basin of warm water. Caution: always stay with them.
- You can also put a warm wet cotton ball on the anus. Vibrate it side to side for about 10 seconds to help relax the anus.
- Caution: don't put anything inside the anus to trigger pooping. Reason: It could become habit forming.
What to Expect:
- Most often, changes in diet helps constipation.
Call Your Doctor If:
- Constipation lasts more than 1 week after making changes to diet
- You think your child needs to be seen
- Your child becomes worse
