Welcome to the world of parenting where no topic is out of bounds! For instance, how and when your baby does a poo can become a point of endless discussion and sometimes worry for parents and carers. Ternity Group’s Nourish Baby Health Writer, Jane Barry explains what you can do to support your baby.

What’s normal when it comes to your baby’s poo?

There’s a wide variety in ‘normal’ when it comes to your baby’s pooing habits. Some babies poo many times a day, for others it’s only every few days.

If your baby is breastfed, they’ll generally poo a lot in the early weeks and months after they’re born. Their poo is usually soft, a mustard or yellow colour, and may contain small white fat curds (which look like sesame seeds). As they get older, they may not poo for several days (even up to a week can be quite normal). As a general guide, it’s uncommon for breastfed babies to be constipated, but they can pass very smelly wind if they’ve not pooed for a couple of days. When they do poo, it’s still soft and looks normal.

If your baby is formula fed, their poos will tend to be firmer and pastier in consistency, and it can range in colour from yellow to khaki green. Constipation is more common in babies who are formula fed and if they are constipated, their poos will be dry, hard and pebbly and they may cry when passing one.

How it works (the mechanics!)

Pooing requires two coordinated processes: the pelvic floor needs to relax and there needs to be an increase in intra-abdominal pressure (pushing). So it can take babies some time to develop the coordination skills they need to poo easily. While they’re doing this, crying (rather than bearing down) is a way of increasing intra-abdominal pressure. In this situation, they’re not crying because they’re in pain, but it’s their body’s solution to help them pass a poo (called infant dyschezia).

Babies may also struggle to pass their poo, because if they’re lying down, they don’t have gravity to help them. Also, because the poo can be so soft, it doesn’t create much pressure in the baby’s rectum.

Every baby and child will have their own individual pattern of pooing, but what’s important is the consistency of the poo, not the frequency. A dry, hard, pebbly poo is a sign that it contains little water.

When is constipation more likely?

Constipation is very common in infancy and is not generally caused by a medical condition. Some causes can be:

• Changing from breast milk to formula. It’s often the addition of iron in formula which causes constipation, so make sure you’re using the correct formula for your baby’s age.
• Introducing solid food. Even though you may be offering your baby solids with increased fibre, this won’t help their poos to soften unless they have extra fluid as well (fibre only works to help constipation if it’s combined with extra fluid intake).
• When a baby has been sick and/or vomiting. Having an increased temperature can also increase the risk of constipation.
• Dietary factors. Some food (particularly highly processed food like white bread and pasta) is more likely to cause constipation.
• When a baby isn’t getting enough nutrition. Poo is a sign that the gut is working and that food and fluid is passing out of the gut.
• When a baby is constipated and their poo is dry, hard and pebbly. This can cause a small tear in their anus which leads to them holding on to their poo, making it even harder to push out.

What to do if your baby is constipated

Constipation is commonly caused by low water or fibre intake (or a combination of both) so it can usually be easily fixed with a few dietary changes.

If you’re breastfeeding:

• Offer more frequent feeds. Extra fluid generally helps to soften poos so offer extra feeds.

If you’re formula feeding:

• Make sure you’re preparing the formula as recommended by the manufacturer. Don’t heap or pack the scoop with formula and make sure you’re using the correct number of scoops to water ratio. Put water into the bottles first, then add the formula.
• You can offer some cooled, boiled water between their feeds, from 6 months of age, if needed. Small sips of water from a cup can be helpful (but make sure you don’t give them more than a few millilitres, to avoid filling them up). Water shouldn't replace milk (their primary source of nutrition) until after 12 months of age.

You can also try:

• Giving your baby a gentle tummy massage in a clockwise direction. Move their legs in a bicycle movement and give them some time to kick freely with their nappy off.
• Talk to your doctor or family health nurse about a stool softener if your baby is aged two or older. This helps the poo to absorb more water when it’s sitting in the bowel.
• Offer more vegetables and pureed fruits, especially pear and apple, if they’re old enough to eat solid food (around six months). Rice cereal can cause constipation, so make sure you’re mixing it with plenty of water, expressed breast milk or formula.

What NOT to do if your baby is constipated

• Give them any medicine such as a laxative or stool softener unless you’re advised to by a health professional.
• Put anything in their bottom or try to prise out the poo. If you think your baby has hard poo stuck in their bottom, see your doctor.
• Make big changes in their feeding. Too many changes at once can overload your baby’s gut, so it’s better to make one change at a time and see if that helps before moving onto something else.

When should you see a doctor?

Chat to your GP and family health nurse if:

• You’re worried and feel that something isn’t right
• There’s blood in your baby’s poo
• Your baby seems to be in pain when they’re pooing
• Their poo is still hard and pebbly after you’ve increased their feeds and fibre intake
• They’re vomiting, have an elevated temperature or don’t seem well.

References:
Constipation in babies and children | Raising Children Network
Infant Dyschezia - About Kids GI
Managing number twos in under ones - Healthed

Ternity Group supports Teachers Health members through the New Families Program.

Nourish Baby Health Writer Jane Barry has qualifications in general, paediatric, immunisation, midwifery and child health nursing. She holds a Bachelor Degree in Applied Science (Nursing) and has almost 35 years specialist experience in child health nursing.