Parents of newborn and small infants are usually quite concerned about the character and frequency of their child’s stools.  Elimination is an important body function but is seldom a cause for great concern.  Frequency and character of bowel movements in infancy are quite variable.  Some infants may have a stool with almost every feeding, while others only have a stool every three to four days.  Both of these patterns are normal.  Most breast fed babies tend to have frequent, watery stools.  Formula fed infants may have thicker and less frequent stools.  This is especially true for the first three weeks of life, but may not be the case thereafter.

Parents are often concerned about constipation in their infant because of straining during a bowel movement.  Part of a newborn infant’s normal behavior is grunting and straining to pass stools.  The infant will often turn red in the face and seem to be having difficulty in passing his/her stools.  This behavior is normal.  As long as your baby is having a stool every three to four days and is not having an extreme amount of difficulty in passing the stool, his/her bowel habits are normal.  If, however, the stool is extremely hard or the child has to strain excessively to push out firm balls, he/she is probably constipated.

Treatment for Infants

Since constipation by definition is having hard stools which are difficult to pass, the treatment is aimed at softening the stools.  If your baby’s stools are soft, he/she needs no treatment for constipation.

The following measures are usually helpful for constipation.

  1. If your infant is crying in pain from a hard stool which is difficult for him/her to pass, one-half of a glycerin suppository can be inserted.  These can be obtained without a prescription, but should not be used often.
  2. To loosen the stool in older infants, give prune juice which is diluted half with water three times per day.  Other juices like apple juice can also be effective.
  3. If juice is not effective, or in younger infants, try Milk of Magnesia, starting at a dose of one-half teaspoon daily.  These can be mixed with the baby’s formula and given in a bottle.

Honey is no longer recommended in the treatment of constipation because of the potential for infant botulism poisoning.   

Constipation in Older Children

Occasional constipation in older children can be safely treated with a lubricant laxative like Milk of Magnesia, with a daily dose of one to three teaspoons until soft, non-painful bowel movements are achieved.  More chronic constipation may require a significant long term increase in dietary fiber and/or a bulk laxative such as Metamucil (one heaping tsp. in at least an 8oz beverage daily).  Unprocessed bran is an inexpensive, effective source of  fiber and can be added to many foods including cereal (one to two tsp.), hamburger, pancake batter, or any baked goods.

Less often, children can develop severe chronic constipation, sometimes with leaking of stool (encopresis).  This problem requires a more detailed evaluation and therapeutic plan, and your child’s physician should be consulted.