When to Worry About Constipation with a Baby

It’s hard to imagine anything more miserable than a constipated newborn. When your entire life revolves around eating, sleeping, and pooping anything that interferes with those 3 things is worth crying about. Concerns about pooping are one of the top reasons new parents find themselves in the pediatrician’s office.

Colic, or excessive crying in an otherwise healthy newborn, can sometimes be prompted by constipation.

But how do you know if constipation is the cause of your babe’s crying? And what can you do to help?

Alex Biller, DO, a pediatric GI specialist, helps many children with constipation. But with babies, the causes, symptoms, and treatments are often different. And there’s a huge range in what’s normal.

How Often Should Babies Poop?

Tracking poop frequency is one of those things that can tell you a lot about how your baby is feeling. But, like snowflakes, all newborns poop a little bit differently.

Biller shares, “Babies can poop multiple times a day or they can poop once week. There's really no rhyme or reason to it. As long as their poop is soft, they're comfortable, they're eating and growing, it's likely okay and normal and nothing to be concerned about.”

As long as they’re comfortable, eating, and growing, it’s fine. It takes tummies a while to get on a ‘regular’ schedule.

When It’s Definitely Constipation

Constipation in newborns often looks like constipation in everyone else.

• Hard, pellet-like poops
• Straining to poop
• Crying while pooping

And of course, not pooping for an extended period. This can vary by baby, but more than 7 days is unusual. Especially when combined when any of these other symptoms.

Newborn Constipation: The Usual Suspects

Considering your baby is on an all-liquid diet, it’s a little confusing that they developed constipation. But don’t worry, you’re in good company. Around 30% of newborns struggle with this, and that number is probably underreported.

Movement Limitations

Your baby is most likely not moving much. And moving is one way our bodies tell our digestive systems to start moving.

Diet Impacts

Yes. Your baby isn’t eating solid foods. But that doesn’t mean all nutrition is the same. When babies move from breastmilk to formula, they can have a brief struggle with constipation. But breastfed infants can also react to dietary changes. Breastmilk is unique, and whatever goes into the breastfeeding parent’s diet can be something baby reacts to.

Infant Dyschezia

Dyschezia sounds like a very serious medical condition. But it’s not. It’s basically something we all have to go through.

Biller explains, “Dyschezia is often what happens when babies are learning how to use their muscles to poop. When you poop, you have to squeeze some muscles and relax others. That’s a lot for a baby to coordinate. What often happens is they squeeze everything, which causes them to grunt, tense up, turn red, and even cry out. It’s a very normal part of development in babies.”   

Eventually, time is the solution for this.

More Serious Causes of Newborn Constipation

Occasionally, there’s a more serious reason why your baby is struggling to poop. These causes aren’t very common, but if it’s one of them, the constipation will be recurrent and won’t respond to normal treatment.

Cow’s Milk Protein Allergy

This condition probably affects around 1% of newborns, and it can cause serious changes in stool. Usually, it’s diarrhea and mucus. But occasionally, it’ll show up as constipation. Usually this comes along with other symptoms like:

• Eczema

• Bloody poop
• Severe diaper rash

CMPA can be very serious . But it’s not the most common reason for constipation. If your baby is struggling with pooping and you suspect this, talk to your child’s pediatrician about whether changing formula or removing dairy from the breastfeeding parent’s diet.

Keep in mind that changing formula frequently isn’t just expensive, it can also cause even more GI upset. It’s a great tool for many problems, but figuring out the problem is even better.

Hirschsprung Disease

Nerves in your colon are what tell your body to have muscle contractions that push poop out of your body. Incredibly rarely, someone is born without these nerves. The most severe cases of Hirschsprung are usually diagnosed almost immediately.

“The majority of cases are going to present in the first several days of life, usually in a pretty severe presentation. If they have not pooed in the first 48 hours of life, they need an evaluation and preferably before they leave the nursery,” says Biller.

But in milder cases, it can be easier to miss.

These children have:

• Severe constipation
• Vomiting
• Failure to gain weight
• Abdominal bloating

This condition requires surgery. It’s also one of the rarest causes of constipation and only affects 1 in 5,000 babies.

Spinal Differences

Spina bifida occulta and tethered cord can be considerations. Usually though, spinal differences won’t usually show up as just constipation. But your pediatrician can help check. Looking at your baby’s spine is part of your well-child visits.

Lead Poisoning

If you live in an older home or suspect your baby has been exposed to lead, then doing a blood lead test is a good idea. Most symptoms of lead poisoning are hard to spot in babies, which means that constipation is sometimes the first indicator that something is wrong.

In Virginia, with historic homes and the lead paint that goes with them, regular lead checks are already on your pediatrician’s radar. So, if you know your child has any additional exposure (like hanging out in a century-old home) then you should talk about it and your baby’s risk level.

How to Help Your Baby with Constipation

Eventually, everyone poops. But you also don’t want to see your child in pain. Thankfully, there are a few things you can do to help.

Tummy Time

Tummy time is crucial for spinal development. But it’s also very helpful for getting tummies moving. And by encouraging your baby to move their limbs and stretch.

PT Movements

You can help baby by doing some bicycle kicks, froggy squats, or other newborn-pt movements. These are easy to make fun at the same time as giving their gut motility a little help.

I Love You Massage

You can also do what’s called an “I Love You” Massage. Pressing gently, use your hand to make an I down the left side of your baby’s belly, from rib to hip. Then trace an upside down L, starting on the right side of your baby’s tummy and going across before again going down the left hand side. Finally, make a U, going up the right side, across, and down the left.

This follows the digestive tract and can help with motility. Just use light and consistent pressure.

Change Up Your Diet for Breastfed Babies

Breastmilk is unique, and influenced by your diet. If your diet is constipating, it’s possible your baby will also be feeling  it. But you can use this to your benefit.

Foods that are high in sorbitol ( a natural sugar-alcohol) are known to help with constipation. This includes:

• Apples
• Prunes
• Apricots
• Figs
• Raisins

Eating more of these in your own diet can help your baby with constipation as well.