Key takeaways: Grunting and straining with soft stools is normal (infant dyschezia). Breastfed babies over 6 weeks may go several days without a stool. Constipation means hard, dry, painful stools. Common triggers are formula changes and starting solids.
Watching your baby strain, grunt, and turn red can make you worry they’re constipated. Often they’re not. Here’s how to tell the difference.
Normal Straining (Infant Dyschezia)
Many babies under 6 months strain, cry, and turn red for 10 minutes or more before passing a soft stool. This is called infant dyschezia. It happens because babies are still learning to coordinate tightening their belly muscles while relaxing the pelvic floor. It’s normal and improves on its own. Avoid rectal stimulation, which can delay learning.
How Often Should Babies Poop?
- Breastfed newborns: often 3 or more stools a day in the first weeks.
- Breastfed babies after about 6 weeks: frequency can drop a lot. Some go 7 to 10 days without a stool. If the stool is soft when it comes and your baby is feeding well, growing, and comfortable, this can be normal.
- Formula-fed babies: often 1 to 3 stools a day, sometimes less. Stools are usually firmer than breastfed stools.
Signs of True Constipation
- Hard, dry, pebble-like stools.
- Pain or crying with stools, along with hard stools.
- Small streaks of blood on the outside of hard stools (from a small tear).
- A hard, swollen belly.
- Fewer stools than usual along with hard stools.
Common Causes
- Switching formula or from breast milk to formula.
- Starting solid foods, especially rice cereal, bananas, and applesauce.
- Not enough fluid, such as during illness.
- Formula prepared with too little water.
- Rarely, medical conditions.
What Helps
Under 6 months:
- Make sure formula is prepared correctly.
- Gentle tummy massage and “bicycle legs.”
- A warm bath to help relax.
- Talk with your doctor before giving any juice, water, or medicine.
Over 6 months (eating solids):
- Offer small amounts of water with meals.
- Offer high-fiber foods: pureed prunes, pears, peas, plums, and whole grains like oatmeal.
- Small amounts of 100 percent prune, pear, or apple juice may help occasionally as a short-term remedy, as recommended by your doctor.
- Reduce constipating foods like rice cereal and bananas temporarily.
What to Avoid
- Laxatives, suppositories, enemas, or mineral oil without your doctor’s guidance.
- Honey or corn syrup (honey is unsafe before 12 months).
- Frequent rectal stimulation with thermometers or cotton swabs.
Call your baby’s doctor if your baby:
- Is under 1 month and hasn’t had a stool in more than 2 days, or hasn’t passed meconium within 48 hours of birth.
- Has hard stools with blood, or blood in the stool.
- Has a swollen belly, vomiting (especially green), or refuses to feed.
- Has fever with constipation.
- Has constipation that doesn’t improve with simple changes.
- Is losing weight or not growing well.
The Bottom Line
Straining with soft stools is normal, and infrequent stools can be normal for breastfed babies. True constipation means hard, painful stools. Simple diet changes often help; call your doctor for warning signs.
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Sources
- Tabbers MM, DiLorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58(2):258-274.
- Benninga MA, Nurko S, Faure C, Hyman PE, St James Roberts I, Schechter NL. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2016;150(6):1443-1455.
- Courdent M, Beghin L, Akré J, Turck D. Infrequent stools in exclusively breastfed infants. Breastfeed Med. 2014;9(9):442-445.
- American Academy of Pediatrics. Constipation in babies. HealthyChildren.org. https://www.healthychildren.org
- Heyman MB, Abrams SA; Section on Gastroenterology, Hepatology, and Nutrition; Committee on Nutrition. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 2017;139(6):e20170967.
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
