Constipation in babies when starting solids: how to prevent it and manage it

There are a few times in one’s life where poo is a hot topic of conversation. However, amongst new parents, no detail of the frequency, colour and consistency of their baby’s bowel movements is spared.

Paying attention to your baby’s nappies is an important part of parenting as their poo, as well as other behaviours, can help you determine if your baby is unwell.

Although constipation, which is defined as the passing of hard and dry bowel movements (stool), can be a concern in infants, it is uncommon in infants less than 6 months of age and mainly arises as the infant ages and transitions to a solid diet.

Symptoms of constipation in babies are slightly different to those of an adult. Many parents believe their baby is constipated because their bowel movements are irregular, they strain, make noises and/or go red in the face when they are doing a poo. These characteristics are completely normal as long as the baby’s poo is soft.

Here are some signs and symptoms of constipation to look out for:

• Stools are hard
• Stools are dry
• Stools look like pebbles
• Blood is present
• Excessive crying or distress when attempting to pass a bowel movement
• Your baby refuses to feed (because their tummy is sore).

There are a few factors that can contribute to the texture and frequency of an infant’s stools. Breast-fed babies are less likely to experience constipation compared to those who are bottle-fed. This is because of the different types of fats, proteins and minerals in infant formula that are digested differently to breastmilk and ultimately leads to stool firmness.

Additionally, as your baby transitions to a solid diet, there is a greater chance your baby will develop constipation due to inadequate fibre or fluid.

Before the use of medications, there are some home remedies you can try.

Babies under 6 months (breastfeeding):

• Increase fluids by offering more feeds throughout the day
• There is the potential that something that you are eating or drinking could be causing your baby to be constipated. In this case, a short elimination diet may be advised under the supervision of a dietitian.

Babies under 6 months (formula fed):

• Double check that you are making the formula exactly following the instructions on the tin. Too much formula or too little water can lead to constipation.
• Increasing fluids by offering extra drinks of cooled boiled water
• Try changing formula to a different brand.  Different brands of infant formulas have different ingredients that may help to soften your baby’s stools.  In particular, a formula fortified with prebiotics such as galacto-oligosaccharides (GOS) may be helpful.  Breastmilk is rich in Human Milk Oligsaccharides (HMO) which is believed to be the reason why breastmilk-fed babies experience constipation significantly less frequently than formula-fed babies.  Increasing evidence suggests that baby formulas containing oligosaccharides such as GOS may be helpful to reduce constipation in babies.  It may be helpful to speak to a paediatric dietitian to get advice on the best type of formula for your baby’s requirements.
• Consider trying a course of infant probiotics.

Babies over 6 months:

• Increasing fibre with foods such as wholegrains, oats, seeds, beans, lentils, vegetables and fruits – especially prunes, kiwifruit, plums and pears.
• Ensure that your toddler has a sippy cup and is encouraged to drink water with meals, as well as between meals.
• A warm bath can relax the muscles around the bowel and encourage a motion
• Introduce a small amount of 100% natural prune, pear or apple juice
• Probiotics may be an effective strategy in relieving constipation.

If you are still concerned about your baby’s diet and bowel movements, a dietitian will be able to perform a detailed nutrition assessment for you and your baby to provide personal advice and guidance to ensure your baby has optimal digestive health.