Concerns for babies being constipated is one of the most common reasons we see infants in clinic. It can be major source of anxiety for parents. Constipation means different things for infants (< 1 year of age), toddlers and preschoolers. Let’s dive into what it means for babies today and we’ll talk about the older kids in another post.
What is normal?
When we talk about poop, we look at consistency and frequency. A persistent change in either or both may represent underlying true constipation.
- 99% of the newborns should have a bowel movement within 24 hours of birth, a 100% by 48 hours
- Breast fed babies: may poop with every feed for the first 2-4 weeks and gradually have a bowel movement once a day. The number of stools per day significantly decreased after 3 months of age
- Formula fed babies: Have less frequent stools as compared to breast fed infants. Usually 1-2 times per day for the first 2-4 weeks and once a day to every other day after a month.
Most babies will get squirmy, grunt/groan and turn red when trying to pass stool. That does not mean that they’re constipated or in pain. Having a successful bowel movement requires increasing pressure in the abdomen and relaxing our rectal muscles. Babies do not know how to relax the muscles around the anus till 3-4 months of age. Plus, they’re trying to poop lying down, which means they cannot squeeze their belly muscles or push!
When to get concerned about true constipation?
Red flag signs to look for:
No stool or pebble like stool for 3 days- by itself or associated with
- Excessive spitting up/throwing up
- Taking in Decreased amount per feed
- Infant being very fussy
- Blood in stool
- Belly looking bloated
What can we do?
- Under a month of age, regular feeding and ‘bicycling movements “to increase the pressure in the abdomen
Changing the formula (without being seen by a Pediatrician) should not be the first thing to do since it does not help in most cases.
- After the first month of life, you can try giving him or her a little apple or pear juice. The sugars in these fruit juices aren’t digested very well, so they draw fluid into the intestines and help loosen stool. As a rule of thumb, you can give 1 ounce a day for every month of life up to about 4 months (a 3-month-old baby would get 3 ounces).
- After 6 months, if your baby is eating solid foods, increase the high fiber fruits (All P’s: pears, plums, peaches, prunes,) and decrease foods that tend to cause constipation (banana, rice, cereals etc)
If you’ve tried all the above and your baby is still having trouble pooping, Call your Pediatrician. If this is not your first Rodeo and you’re comfortable giving your baby an OTC infant suppository, it is okay to do so.
However, if he or she needs it more than 2 times, a visit to the Pediatrician is advised!
By: Dr. Vasudha Mahajan – Pediatrician at Preferred Medical Group