Constipation in Infants and Children

What Classifies as Constipation in Infants?

Constipation refers to difficulty in passing stool, often resulting in hard stools that cause discomfort or pain. Signs of constipation may include:

• Straining or crying while trying to pass stool
• Hard, dry stools
• Foul-smelling stool
• Loss of appetite
• Tense or bloated abdomen
• Occasional leakage of liquid stool

Since an infant’s digestive system is highly sensitive, even small changes in diet can lead to constipation.

Common Causes of Constipation

Introduction of solid foods

When babies start eating solids, their digestive system adapts, sometimes leading to constipation.

Dehydration

Not consuming enough fluids can make stools harder and more difficult to pass.

Illness

Infections or fever can lead to dehydration and constipation.

Food sensitivities or allergies

Some infants may react to certain foods, affecting stool consistency.

Congenital conditions (rare)

Some medical conditions can cause difficulties in passing stool.

Psychological or behavioral factors

During weaning, some infants develop stool-withholding behaviors due to fear of pain.

When stool builds up in the intestines, it can cause small tears around the anus, leading to discomfort, leakage, and an increased reluctance to pass stool—worsening the cycle.

How Often Should an Infant Poop?

• Breastfed infants – Stool frequency varies widely, from multiple times a day to once every seven days. The stool is typically soft and yellow, resembling mustard seeds.
• Formula-fed infants – Generally pass stool around twice a day until the age of one. Before solids are introduced, stool consistency is more uniform, resembling peanut butter in texture and brown in color.

Dietary and health changes – The addition of vitamins, dietary shifts, and illnesses can all affect stool consistency and frequency.

Tips to Relieve Constipation in Infants

• Increase fluid intake – Offer small amounts of warm or room-temperature water to help soften stool.
• Dried figs (4+ months) – Soak dried figs in warm water for an hour, then offer the water to the baby. Alternatively, boil figs, cool, strain, and serve. Older infants may benefit from mashed figs or diluted fig juice.
• Tomatoes (4+ months) – A small amount of peeled and deseeded tomatoes may help ease constipation.
• Warm baths – Help relax the abdominal muscles, easing bowel movements.
• Gentle abdominal massage – Using circular motions in a clockwise direction can help relieve discomfort.
• Bicycle leg movements – Moving the infant’s legs in a pedaling motion may help stimulate digestion.
• Correct bottle preparation – If using formula, ensure it is mixed according to the manufacturer’s instructions, as incorrect ratios can contribute to constipation.
• Avoid constipating foods – Limit intake of rice, bananas, white flour products, processed foods, and fatty foods.
• Increase fiber intake – Once solid foods are introduced, incorporating fiber-rich foods such as fruits, vegetables, whole grains, and legumes can help maintain regularity.
• Avoid external stimulation – Do not use items to stimulate the anus unless directed by a doctor.

Constipation is usually temporary and manageable with dietary and lifestyle adjustments. However, if constipation persists or is accompanied by vomiting, weight loss, or extreme discomfort, consult a healthcare provider.

Constipation in Toddlers and Children

The most common risk factors for constipation are: family history of constipation, cow’s milk allergy and possibly a diet low in fiber. 

Usually, constipation starts with one severe attack, then the child refuses to pass a bowel movement, the stool become dry and hard in the bowel, which causes further difficulty passing the stool. Also, delayed weaning of diapers (toilet training), may lead to constipation.

Dietary Changes

To treat constipation, the child’s diet needs to be changed. For children over 1 year, it is necessary to limit the amount of milk products (especially cow’s milk or chocolate milk) and eat more fruit and vegetables (3 times per day), preferably not cooked fruit. You can give dates, plums, figs, broccoli and cabbage. Using whole wheat flour and products without white flour can also be helpful. After a meal, your child should drink water or juice, even when the stool is normal. It is important to avoid giving too many eggs to children to eat.

Toilet Training

At the time of toilet training, you should encourage the child to try go to the
toilet 10 minutes after a meal. With children, a reminder and a regular time to try go to the toilet will help them. Don’t force toilet training on a child who is resisting it.

Medication 

If all this does not help with the constipation, it can be helpful to use a stool softening medicine, such as paraffin oil, Peglax, Avilac or other brands. If the medicine does not help, go see your doctor for advice.

Pain Relief

Until you have complete resolution of the constipation, you can help
relieve the pain in the anus by taking a lukewarm bath. In addition,
you can use a glycerine suppository. If the pain continues, it may be
helpful to have an enema at your clinic.