Constipation in Older Babies

When to get help

See a GP, and do not wait. The NHS is unusually direct about this: if you think your child may be constipated, take them to a GP, and get help early — the longer a child is constipated, the more difficult it can be for them to get back to normal. That is different from most minor problems, where waiting is reasonable.

Seek urgent advice — NHS 111 in the UK (call rather than use the website for a child under 5), GP out-of-hours in Ireland, your paediatrician in the US or Canada, healthdirect on 1800 022 222 in Australia, Healthline on 0800 611 116 in New Zealand — if your baby has a swollen or distended tummy, is vomiting, will not feed, has blood in their nappy beyond a small streak from a hard poo, has a high temperature at the age thresholds of 38°C (100.4°F) under three months or 39°C (102.2°F) from three to six months, or seems generally unwell.

Call emergency services — 999, 112, 911, 000 or 111 depending on your country — for a sudden severe tummy ache, green or yellow-green vomit, blood in vomit or vomit that looks like ground coffee, or the universal baby red flags including a non-blanching rash and a baby who cannot be roused.

What counts as constipation once solids start

This page is about babies who have started solid food. Newborn poo is a different subject with different thresholds, and we cover that separately. Once weaning begins, the NHS signs are:

• fewer than 3 poos in the last week;
• poo that is large and hard;
• poo that looks like rabbit droppings or little pellets;
• straining or pain when pooing;
• some bleeding during or after, because the poo is large and hard;
• poor appetite or stomach pain that improves after a poo.

Note what is missing from that list: frequency on its own. A baby who poos every third day but passes something soft without distress is not constipated. NICE guideline CG99 covers diagnosis and management in children and young people for clinicians.

Why solids change things

Almost every family notices a change when weaning starts, and it is not a sign anything has gone wrong. Poo becomes firmer, darker and more variable because the input has changed. Milk intake often drops at the same time, which reduces the total fluid going in just as harder-to-digest food arrives. Iron-fortified foods and cereals can firm things up further.

The transition itself is normal. What is not normal is poo that becomes hard and painful, because pain creates the pattern that makes constipation stubborn.

The vicious circle

The NHS names the mechanism, and it is the most useful thing on this page. If your child is constipated they may find it painful to poo, which may mean they do not want to try to poo. The more they hold back, the more constipated they get.

That loop is why early treatment matters, and why the advice is to see a GP rather than to wait it out. Once a baby has learned that pooing hurts, you are no longer just treating a stool consistency problem.

What helps

• Fluids. Offer breastfed babies who are not yet on much solid food plenty of breastfeeds. Formula-fed babies can have extra drinks of water between feeds — the NHS specifies cooled boiled water for babies under 6 months.
• Variety of foods, including plenty of fruit and vegetables, which are a good source of fibre.
• Physical activity. Floor time, rolling, crawling — movement helps the gut move.
• Do not make formula weaker. Use it at its usual strength.

Some fruits contain sorbitol, which draws water into the bowel; the NHS names apples, apricots, grapes, raspberries and strawberries in its adult advice. Puréed or well-mashed versions of age-appropriate fruits are a reasonable thing to try for a weaning baby.

Laxatives come from a clinician

The NHS says laxatives are often recommended for children who are eating solid foods, alongside diet and lifestyle changes. Two things follow from that sentence, and both get missed.

First, laxatives for a baby are a medical decision, not a supermarket one. Get them prescribed or recommended by a GP or pharmacist who knows your baby's age and weight, and follow the instructions given rather than a label written for adults.

Second, treatment takes longer than people expect. The NHS says it may take several months for treatments to work, and to keep going until they do. It also warns that once constipation is dealt with, a GP may advise continuing laxatives for a while to keep poo soft enough to pass regularly. Stopping the moment things improve is the commonest reason constipation returns.

Toileting habits, for later

Most of the NHS's prevention advice is aimed at older children — a routine of sitting on the potty after meals, feet flat on the floor or a step, staying calm and unhurried, and praising the attempt whether or not anything happens. None of that applies to a six-month-old, but the underlying principle does start early: pooing should not become a stressful event. Keeping stools soft during weaning is the version of that you can act on now.

What not to worry about

Straining, grunting and going red in the face while producing something soft is normal in babies and is not constipation. Nor is a change in colour or smell after new foods. And a baby who is feeding well, gaining weight and comfortable between nappies is very unlikely to have a serious underlying problem, even if their pattern looks nothing like another baby's.