Constipation in babies and toddlers

Most children will suffer from constipation at some point between the ages of about 7 months and 8 years. The reasons are many so it’s important to try to identify the specific cause of your child’s constipation before treatment is sought. The goal is to seek a long-term solution and not just treat the symptom (constipation), as this will probably mean you’ll miss the underlying cause – and for some it could be a serious disease or condition.  

What is constipation?

Normal stooling patterns for infants and toddlers change as they get older. Newborn babies have about four bowel movements a day; this falls to around one to two a day by the time they’re 2. From 4 years onwards you can expect one bowel movement a day. However, because not all children fall within the average, doctors define constipation as a difficulty or delay in having a bowel movement for two or more weeks. 

Recognising constipation is tricky for parents of small babies. A baby having a normal bowel movement may grunt, cry and kick his legs before passing even a soft stool. This is because babies don’t have the benefit of gravity, and they’re learning which muscles to use to make a bowel movement.

So it’s important to keep an eye on the consistency of your baby’s stools, as well as the frequency, before concluding that your baby has constipation. 

What causes constipation?

Incorrect diet is the biggest cause of constipation in young children, but there are other non-diet-related causes including the use of certain medications and calcium or iron supplements, especially in adults. If your child is not taking a supplement that contains calcium, make sure he’s not drinking a lot of cow’s milk, which is very high in calcium.

A child older than a year does not need more than 500ml of cow’s milk per day. As for iron intake, eating excessive amounts of iron-fortified baby cereals (most of the products on the supermarket shelves are iron-fortified) can also contribute to constipation.   

BABIES UNDER 1 YEAR

In babies under the age of 1, constipation is uncommon. Occasional constipation can be helped by exercising your baby’s legs (“bicycle riding”) with every nappy change. If you are worried, speak to your doctor. 

In babies that are exclusively breastfed, infrequent bowel movements are normal (one stool every three to seven days). When a baby does have a bowel movement, there is no need to worry if the stool is soft. Only when the stool is hard, or difficult to pass, will it be considered constipation. 

What to do

If your baby is on infant formula, make sure the milk is made up according to the instructions. Adding too little water makes the formula too concentrated, which can lead to constipation. 

Under the age of 6 months, give your baby a little bit of extra water between formula feeds. After 6 months, offer a variety of diluted fruit juices such as prune, apple and pear juice. Be sure not to give more than one serving of 125ml per day. Once your baby is on solids, stewed prunes can also be given. 

TODDLERS OVER 1 YEAR

It is fairly common for toddlers to have constipation now and again, and it’s rarely anything to be concerned about. Often, increasing fibre and fluid intake will solve the problem. However, if constipation persists after dietary and behaviour modification, a paediatrician needs to be consulted. 

What to do

Normal bowel function is promoted by eating well-balanced, regularly scheduled meals that involve eating lots of fresh fruit and drinking enough fluids. Regular physical activity and a toilet routine also helps.  

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