Constipation in infants

Constipation in infants is considered to be large, dry stools that are passed infrequently. They also may be like hard rocks or marbles. Breast-feeding babies, once they grow and digest milk more efficiently, can have a stool only once every 5 to 7 days. As long as the poop is soft and the baby does not have any fever, bloating of the tummy, vomiting, decreased eating or frequent crying episodes, this is normal. The key question is not only how often the baby poops, but when they do have a stool, does it have a hard dry texture?

It is normal for infants to have some grunting and redness in the face when passing stools. This is due to poor muscle tone. If the baby seems uncomfortable when passing stool, there is blood on the stool or in the diaper, or you see a tear at the rectal opening, have the doctor check your baby.

Do not change the baby's formula without talking to your pediatrician. It is important that babies have iron in their formula. We do not recommend low-iron formulas.

What are normal bowel movements for babies?

During the first 24 hours of life, your baby will have thick, sticky, brownish-black stools called meconium. After the first few days, the stool will lighten in color from black to brown to green to yellow. They also change to a more seedy, cottage-cheese look or sometimes more runny stools. Formula-fed babies have stools that usually are thicker and more brown in color. Babies usually have a bowel movement at least once a day during the first few weeks of life. After that, babies can stool several times a day to once every few days. As the baby grows older and you begin to add solids to the diet, the stool may change color and consistency depending on what the baby eats.

Some steps to take if you are concerned about constipation in your infant:

1. If your infant is younger than 1 month old and has not been seen by your physician for this problem, make an appointment to see the doctor.

2. If your baby is older than 1 month of age, and already has been seen by the doctor for constipation, you can try the following:

• You can add one to two teaspoons per day of dark Karo Syrup in formula or expressed breast milk. Try this first for 2 to 3 days.
• If the baby does not have results with the dark Karo Syrup or seems uncomfortable, you can try some gentle rectal stimulation with a fingertip lubricated with KY Jelly. Gently massage around the outside of the anus with your fingertip or try inserting the tip of a lubricated thermometer (as if you were taking a rectal temperature). If this doesn't work, an infant glycerin suppository often will provide quick relief. These usually need to be cut in half. Lubricate the tip of the suppository with KY Jelly and put half directly into the anus. If the baby does not have a bowel movement within 30 minutes, you can insert the other half. If the baby does not have a bowel movement after using these methods, contact your doctor.

3. If your baby is older than 4 months, you can try giving him or her apple or prune juice. Give 2 ounces of juice diluted in 2 ounces of water per day. You also can add baby foods that have higher fiber content twice a day such as peas, beans, apricots, prunes, peaches, pears, plums and spinach.

If the constipation does not go away, or you have any other concerns, call the triage nurse to discuss the problem and help you decide if you need an appointment with your doctor.