Baby Not Pooping

by Spencer
(D.C.)

My baby is not pooping. He seems to be constipated and he is only 28 days old. He is still feeding and urinating as usual, but no bowel movement. Is it common for 1 month old babies to be constipated?

What can I do to help him?

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Baby Help Line:

Baby Constipation - Causes, Signs & Remedies

• Breastfed or bottle fed
• Signs of constipation
• How to mitigate constipation
• How often does a baby poop
• Call the Doctor if...

Breastfed or bottle fed

You don't tell if you are breastfeeding or not. If you are breastfeeding and if your baby has had normal breast milk poop earlier, chances are that he is only going through a growth period and therefore actually absorbs pretty much everything he eats. Also, at around 4 weeks of age, a baby's digestive system begins to mature and the number of bowel movement usually decreases, especially if the baby is breastfed. If he seems completely happy and eats and urinates just as usual, there is probably nothing you have to do. The poop will come.

If your baby is formula-fed, the risk of constipation is higher. Formula-fed babies are more prone to become constipated, because the formula is much harder to digest than breast milk. Also, the formula can't be as fully digested as breast milk, so formula fed babies, regarding of age, should have quite regular bowel movements. A formula fed babies should not go several days between pooping; for them, it can be a sign of constipation.

It is also important to know when your baby started having constipation problems and if he passed meconium in the first 36 hours of his life.

If his meconium passage was delayed and he has been having constipation since birth, one of the possible reasons for his constipation might be Hirschsprung's disease. This is a condition caused by the absence of neural ganglia in the terminal bowel regions. The absence of the ganglia leads to decreased bowel movement and hence constipation. The condition is usually screened for by performing a rectal exam in a constipated child during a routine paediatric visit.

Signs of constipation

Here are some signs of constipation to look for:

• In a newborn, firm stools less than once a day with straining and difficulty passing them


• In older babies, firm stools less often than 7 days for breast-fed babies and 4 days for bottle-fed babies


• Dry, hard stools and pain on passing them


• Hard, pebble-like stools passed by a baby who strains during a bowel movement


• Signs of blood along the outside of the poop


• Belly pain along with hard, infrequent stools

How to mitigate constipation

While it is normal for babies will strain from time to time to move the stool along through the intestines, crying hard is not. If you want to do something to help your baby while straining, try holding his knees against his chest to help him "squat". This is also very effective for tummy pain to release gas.

If your baby is bottle-fed you can experiment with different types of formula to find the one that has the least tendency to result in constipation. For some babies soy based formulas work better. For others, a hydrolysate formula, such as Nutramigen (link to Amazon) can make a real difference.

You can also feed your boy smaller amounts of formula more frequently, to help the intestines cope with the formula. Twice as often is a rule of thumb.

Make sure that you don't add too much formula powder when preparing the formula. Take care not to overfill or tightly pack the scoop.
You can also try offering your baby some extra water – about 1 oz once or twice a day.

If you breastfeed at all, you can try to increase the share of breast milk you baby gets. Breast milk is a great laxative.

There are also baby laxatives or glycerin suppositories available, but don't use them more than as a last resort. It is much better to try to change what your baby eats than to use short-term solutions, like these are.

Another short-term option, that can be used once in a while, is to insert a q-tip very gently into your baby's anus. Sometimes that is enough to trigger the bowel movement. Just don't make it a habit; the baby needs to learn how to poop without your help.

How often does a baby poop

How often the average baby will poop depends on his or her age as well as on if breastfed or formula fed.

A newborn baby, from day 5 or 6 may poop after every feeding. At 1 month old, the average is still some 4 times per day. By the time your baby is 2 months old, the average has dropped to 1 time per day.

At 3 months, a fully breastfed baby may go for up to 10 or 14 days without pooping. They grow rapidly and digest practically everything they consume. This can continue until the baby is introduced to solid baby food. This is not true for formula-fed babies, who really should continue pooping more or less every day.

Remember that the variation can be quite large and your baby is not likely to be constipated unless you notice some of the symptoms described above.

Two of my kids had periods at around 3 months old, when they pooped every 10-14 days. Very convenient... However, they were both completely breastfed and showed no signs of constipation or illness.

Call the Doctor if...

If your baby is a few days old and has not pooped regular breast milk or formula poop, definitely call a doctor, to rule out any blockage and make sure your baby eats enough.

For a newborn baby that has pooped and then stopped, I would contact a pediatrician if it has been a couple of days since your baby pooped, regardsless of it the baby is breastfed or formulafed. This is to get advice on possible treatment for constipation and to make sure that your baby is completely healthy.

For older babies, if they are in pain (regardless of it the poop is hard or not), a doctor should assess the situation.
Blood in poop, beyond some streaks should also be assessed. (You'll find more guidelines on blood in your baby's poop here.

Finally, if your baby continues to be constipated despite your efforts to adjust his or her diet, this is another good reason to discuss the situation with a pediatrician. Your baby may be allergic to milk protein or lactose intolerant, for example, and need a new type of formula. (Read more about milk protein allergy and different formulas here.

Don't use baby laxatives or glycerin suppositories without consulting a doctor first. It may be completely unnecessary.


I wish you and your baby good luck!

Paula
(Answer approved by our Medical Reference Team)

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More On Constipation In Babies

• No Poo For Newborn


• What Can I Give My Baby For Constipation?


• Pooping Difficult For Preemie

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