Baby Constipation: Signs, Causes & Natural Relief for Newborns and Infants

Baby Constipation: Signs, Causes & Natural Relief for Newborns and Infants

Your baby has not pooped in three days. They are grunting, pulling their legs up, and turning red in the face. Surely something is wrong?

Actually — it depends entirely on what kind of baby you have, how old they are, and what the stool looks like when it finally arrives. Baby constipation is one of the most common reasons parents call the pediatrician — and one of the most frequently misidentified conditions in infancy.

This guide gives you the full picture: what is and is not actually constipation in a baby, what causes it, every safe natural remedy, when to see a doctor, and what Pakistani parents need to know about castor oil, Hamdard Ghutti, formula brand choices, and early solids.

Normal Bowel Patterns by Age: What Is Actually Normal?

Before diagnosing constipation, you need to know what is normal — and the answer changes significantly depending on your baby's age and how they are fed.

Key insight from the AAP and Johns Hopkins Pediatric Chronic Constipation Clinic: A breastfed baby going 7 days without pooping is not constipated — as long as the stool, when it arrives, is soft. Breast milk is absorbed so efficiently that some babies simply have very little waste to expel. "Some can go up to three or four days — or maybe even a week — without pooping. But as long as when they finally do go it's soft, pain-free, and blood-free, it's all good," says Lisa Santo Domingo, pediatric nurse practitioner and medical director of Johns Hopkins Hospital's Pediatric Chronic Constipation Clinic.

One important exception: During the first month of life, a breastfed baby stooling less than once a day may mean they are not getting enough milk. If your newborn under 4 weeks is not pooping at least once per day, consult your pediatrician — this could signal insufficient feeding volume, not just normal variation.

True Constipation vs. Normal Infrequent Stools: How to Tell the Difference

The most important thing to understand: constipation is not defined by how often your baby poops. It is defined by the consistency and difficulty of the stool. The AAP is clear on this — stool frequency is only one piece of the picture. Consistency and comfort matter more.

What Is Infant Dyschezia? (Why Your Baby Strains Without Being Constipated)

Many parents bring their baby to the doctor convinced of constipation — only to be told something else entirely is happening: infant dyschezia.

Dyschezia is not constipation. It is the normal and temporary difficulty a young baby experiences while learning to coordinate the muscle actions needed for a bowel movement. Specifically, to poop, a baby must simultaneously relax the anal sphincter while increasing abdominal pressure — two opposing muscular actions that take weeks to coordinate properly. Until the nervous system figures this out, your baby strains, grunts, turns red, and cries — but the stool that eventually arrives is completely soft.

Dyschezia does not need treatment. It resolves on its own as the nervous system matures, typically by 3–4 months. The only intervention that matters: do not stimulate with a thermometer or suppository to "help" — this actually interferes with the baby learning to coordinate the process naturally, according to Pediatric Associates.

Paradoxical Diarrhea: When Constipation Looks Like the Opposite

Here is something that confuses many parents: a baby can appear to have diarrhea — loose, watery stool — and be severely constipated at the same time. This is called paradoxical diarrhea, and it happens when liquid stool leaks around a large, impacted mass of hard stool stuck in the colon.

What this means practically: If your baby is passing very frequent watery stools but also seems uncomfortable, has a hard or distended belly, and has not passed a proper stool in several days — do not assume the diarrhea means they are clearing out. See your pediatrician. This is one of the situations where home treatment is not appropriate.

Baby Constipation Causes: Why It Happens

• Formula feeding. Formula is thicker than breast milk with larger protein molecules (more casein relative to whey) that take longer to digest. This makes constipation more common in formula-fed babies than breastfed ones. Breast milk, by contrast, is a near-perfect digestive match for the infant gut and produces almost no waste.
• Transitioning from breast milk to formula. Any feeding change alters stool consistency. StatPearls notes that dietary changes — particularly from breastfeeding to formula or cow's milk — lead to dry, hard stools, sometimes with anal fissures and pain.
• Dehydration. When a baby is not getting enough fluid — particularly common in hot climates like Pakistan's summers — the colon absorbs more water from the stool to compensate, making it harder. Ensure frequent feeding. After 6 months, small sips of water between feeds help.
• Starting solid foods too early or without fiber. When solids are introduced before the gut is ready, or consist primarily of low-fiber, binding foods (rice, white bread, banana), constipation can follow quickly. See the Pakistan-specific section below for locally relevant examples.
• Low-fiber solid foods after 6 months. Rice-based cereals, banana, and processed white carbohydrates are all binding foods that slow gut transit. Insufficient fruits and vegetables in the complementary diet is a very common driver.
• Dehydration during illness. A baby who is unwell, feverish, or vomiting is taking in less fluid — leading directly to harder stools.
• Underlying medical causes (rare). Persistent constipation from birth — particularly if meconium was not passed within 48 hours of birth — can indicate Hirschsprung disease. Hypothyroidism and metabolic conditions can also cause constipation. These are rare but require medical diagnosis.

Natural Baby Constipation Remedies That Actually Work

1. Bicycle Leg Exercises

Lay your baby on their back on a flat, safe surface. Gently hold their legs and move them in a slow, smooth cycling motion — alternating legs as if they are pedalling a bicycle. Do this for 2–3 minutes, several times per day. The gentle movement stimulates the intestinal muscles and helps move stool through the colon. This is one of the most consistently recommended techniques by both the AAP and Pediatric Associates — and it costs nothing and has no side effects.

2. Gentle Clockwise Tummy Massage

Place your baby on their back. Using the flat of your fingers (not your fingertips), apply gentle, steady pressure and move your hand in a clockwise circle around the belly button — following the direction that food moves through the colon. Clockwise is important: moving counter-clockwise works against digestive movement. Do 10–15 slow circles, 2–3 times per day. For best results, combine with bicycle legs.

3. Warm Bath

A warm bath relaxes the smooth muscles of the digestive tract and the pelvic floor — the same muscles a baby needs to relax to have a bowel movement. Many parents find that their constipated baby passes a stool during or shortly after a warm bath. Combine with a gentle belly massage while in the bath for added effect.

4. Tummy Time

Supervised tummy time (when your baby is awake and you are watching) puts gentle pressure on the abdomen that can help stimulate bowel movement. This serves double duty — it helps with constipation and supports neck and shoulder development. Always supervise and never leave a baby face-down without watching closely.

5. Fruit Juice (Babies Over 1 Month — For Constipation Only)

The AAP HealthyChildren.org states that for babies over one month of age, a small amount of apple or pear juice can help relieve constipation by drawing water into the bowel and softening the stool. The guideline: 1 ounce per month of life, up to 4 months maximum (so a 2-month-old would receive 2 oz, a 3-month-old 3 oz).

Important: This is specifically for constipation relief only — not as a regular feed or drink. The AAP does not recommend juice for general infant nutrition. Use 100% fruit juice only (no added sugar). Prune juice is the most effective option. Stop if stools become loose.

6. P Fruits: Prunes, Pears, Peas, Papaya, Peaches, Plums (From 6 Months)

Once solids begin, the "P fruits" are the most effective dietary intervention for baby constipation remedies. These fruits contain specific sugars (sorbitol in prunes and pears) that draw water into the intestine and soften stool. Pureed prunes are the most powerful — a tablespoon of prune puree mixed into oat porridge at 6 months is a fast, effective, natural remedy.

Pair P fruits with: increased water intake (from 6 months, small sips between feeds are appropriate), fiber-rich vegetables (peas, broccoli, spinach), and oat or barley cereal instead of rice cereal, which is binding.

What to Avoid

• Suppositories and laxatives without medical advice. Never use glycerin suppositories or any laxative product without explicit instruction from your pediatrician. Overuse of stimulant laxatives in infants can interfere with the natural development of bowel movement coordination (the same issue as with thermometer stimulation). These have their place — in severe or impacted constipation under medical guidance — but are not first-line home remedies.
• Water for babies under 6 months. Do not give water to babies under 6 months to relieve constipation. A young baby's kidneys cannot safely handle extra water — it can cause hyponatremia (dangerous dilution of blood sodium). The only exception: the AAP allows a very small amount of juice (noted above) in babies over 1 month for constipation specifically.
• Rice cereal as a staple first food. Rice cereal has become less recommended as a first food for multiple reasons — arsenic concern and its binding effect on the bowel being two of them. If your baby shows constipation after starting solids, switch from rice-based foods to oat or barley alternatives.

When to See a Doctor for Baby Constipation

Most infant constipation resolves within a few days with the remedies above. Contact your pediatrician if:

• Blood in the stool — dark red, bright red, or black stool (black stool in a baby no longer on meconium is a red flag)
• Significant pain — your baby is crying persistently, arching their back, or clearly in distress that does not resolve
• A hard, visibly distended belly
• Vomiting alongside constipation
• Fever accompanied by constipation
• Poor weight gain or weight loss — constipation alongside poor growth can signal an underlying condition
• Formula-fed infant under 2 months who has not had a bowel movement in 3 days — consult right away, per MedlinePlus
• No improvement after 3–5 days of consistent home management
• Any newborn younger than 2 months with constipation — this age group always warrants a doctor's opinion since functional constipation is rare this early and anatomical causes need to be ruled out
• Constipation that started at birth and the baby did not pass meconium within 48 hours of birth — this is a potential sign of Hirschsprung disease and requires immediate investigation

Pakistan Guide: Castor Oil, Ghutti, Formula Brands & Early Solids

Castor Oil for Baby Constipation: A Serious Safety Warning

Castor oil is one of the most commonly used traditional remedies for infant constipation in Pakistan and across South Asia — given either as a few drops orally or applied topically to the baby's belly. Here is the honest medical assessment:

Castor oil is not safe to give orally to infants.

Castor oil is a powerful stimulant laxative that works by triggering strong intestinal muscle contractions. In adults, it can cause severe cramping and diarrhea — effects that are manageable in a grown adult but dangerous in a small baby. The WHO and UNICEF do not recommend castor oil for infant use. Specific risks include:

• Severe intestinal cramping — causing significant pain in an infant who cannot communicate what they are feeling
• Explosive diarrhea — leading to dehydration and electrolyte imbalance, which is serious and potentially dangerous in infants
• Vomiting and aspiration risk — if a baby vomits a slippery, oil-based substance and inhales it, aspiration pneumonia can result
• Ricin contamination risk in unregulated castor oil products — ricin is one of the most toxic naturally occurring compounds known

Topical application (rubbing castor oil on the belly) is generally considered harmless, but has no documented efficacy for constipation relief. It is not dangerous — but it also does not work as a constipation treatment. If parents prefer a topical application for comfort, warm coconut oil massaged in a clockwise direction on the belly is a safer and similarly effective alternative.

Bottom line: Do not give castor oil orally to any infant under any circumstances. Use the evidence-based remedies in this guide instead. If a family member insists, show them this guidance and consult your pediatrician.

Hamdard Ghutti for Constipation: When It May Help and When It May Not

Hamdard Ghutti is a traditional Unani herbal preparation widely used in Pakistan for infant digestive issues, including constipation. It contains a blend of herbs including Senna (sana), which is a stimulant laxative with documented efficacy in adults. This is important to understand.

The concern with senna in infants: Senna stimulates the muscles of the colon to contract — producing a laxative effect. In infants, particularly those under 3 months, using a stimulant laxative regularly can interfere with the natural development of the bowel's muscle coordination. The AAP does not recommend stimulant laxatives for constipation in infants without medical supervision.

When Hamdard Ghutti may be appropriate for constipation:

• In babies over 3–4 months with documented constipation (hard, painful stools) as an occasional short-term intervention
• At the dose recommended on the product label — not exceeding it
• Only after the simple mechanical interventions (bicycle legs, massage, warm bath, P fruits) have been tried first
• With your pediatrician's knowledge and approval

When not to use Ghutti for constipation: Under 6 weeks of age, as a daily remedy, in large doses, or as a substitute for finding and addressing the underlying cause (wrong formula, early solids, dehydration).

Dosing (per Hamdard Ghutti label): ½ teaspoon for newborns, up to ½ teaspoon 3 times daily for infants. Do not exceed label dosing. Discuss with your pediatrician before starting.

NAN vs Lactogen: Which Formula Causes More Constipation in Pakistani Babies?

Both NAN (Nestlé) and Lactogen (also Nestlé) are among the most widely used infant formulas in Pakistan. Parents frequently ask: does one cause more constipation than the other?

The key nutritional difference is in protein composition:

• NAN (standard NAN 1 for 0–6 months): Has a higher whey-to-casein ratio — closer to breast milk (breast milk is approximately 70:30 whey to casein). Whey protein forms softer, smaller curds in the stomach and is digested more quickly. Generally associated with fewer constipation complaints.
• Lactogen: Contains a higher proportion of casein protein relative to whey. Casein forms denser, slower-digesting curds — which is why it is associated with a feeling of "staying full longer," but also with slower gut transit and a higher likelihood of firmer, harder stools.

What this means practically: If your baby is constipated on Lactogen and home remedies are not resolving it, switching to a formula with a higher whey-to-casein ratio (such as NAN) may help. Do not switch without consulting your pediatrician first — and do not switch to a "comfort formula" or "anti-reflux formula" without medical advice, as these are formulated for specific conditions and may not be appropriate.

Also note: The AAP confirms that iron in formula does not cause constipation — despite this being a common misconception. Iron-free or low-iron formula should never be chosen in the hope of reducing constipation. Low-iron formula can cause iron deficiency, which is already very prevalent in Pakistani children.

Early Introduction of Solids (Khichdi, Daal, Suji) Before 6 Months

Introducing solid foods before 6 months — a very common practice in Pakistan, where khichdi, daal pani, suji halwa, or rice water are frequently started at 3–4 months — is a significant and frequently overlooked cause of infant constipation in Pakistani babies.

Here is the mechanism:

• The infant gut before 6 months is not ready for solids. Digestive enzymes that process complex carbohydrates and plant fibers are not fully active until around 6 months. When khichdi or daal is introduced before this point, the gut cannot digest it efficiently — and incompletely digested food is harder and drier in the stool.
• Rice and suji (semolina) are binding foods. Both are low in fiber and high in simple starch. Even at 6 months these foods can slow gut transit if they dominate the diet without accompanying higher-fiber foods.
• Early solids displace breast milk or formula. Breast milk is a natural laxative. When solids reduce breast milk intake, constipation often follows.

What to do: Follow the WHO and AAP recommendation — exclusive breast milk or formula until 6 months. If you have already introduced solids before 6 months and your baby is constipated, reduce or pause the solids temporarily, increase breast milk or formula feeds, and try the P fruits and massage techniques above. Speak to your pediatrician.

When you do introduce solids at or after 6 months: prioritize fiber-rich options — lentils (masoor dal), pureed prunes or papaya, mashed peas — rather than leading with rice or suji alone.

People Also Ask: Baby Constipation Questions Answered

How do I know if my newborn is constipated?

A constipated newborn will have hard, dry, pellet-like or round golf-ball stools that are difficult or painful to pass. Signs to look for: persistent crying or significant distress during straining, a visibly hard or distended belly, legs pulling up toward the abdomen, arching of the back, and stools that look like small hard balls rather than soft and mushy. Infrequent stools alone are not constipation — a breastfed baby going 7 days between soft stools is normal. Constipation is about the stool type and the pain, not just the days between.

What causes constipation in formula-fed babies?

Formula is thicker than breast milk with larger casein protein molecules that take longer to digest and move through the gut. This slows gut transit and results in harder, less frequent stools than breastfed babies. Constipation is significantly more common in formula-fed infants — but it is manageable. Ensuring the correct water-to-powder ratio (never add less water than instructed — this concentrates the formula and worsens constipation), and using bicycle legs, warm baths, and belly massage are first-line approaches.

Is it safe to give castor oil to a baby for constipation?

No. Castor oil is not safe to give orally to infants. It is a powerful stimulant laxative that causes severe intestinal cramping, explosive diarrhea, and dehydration in small babies. Vomiting of an oily substance carries aspiration risk. Unregulated castor oil also carries ricin contamination risk. The WHO and UNICEF do not recommend castor oil for infant use. Use bicycle legs, warm baths, clockwise belly massage, and — after consulting your pediatrician — a small amount of prune or pear juice for babies over 1 month.

What are P fruits for baby constipation?

P fruits are a set of fruits whose names begin with P and that are particularly effective for relieving and preventing constipation in babies. They include: prunes, pears, plums, peaches, peas, and papaya. These fruits contain sorbitol — a natural sugar that draws water into the intestine and softens stool — and soluble fiber that supports gut motility. Pureed prunes are the most potent. Papaya is also highly effective and widely available in Pakistan year-round. For babies under 6 months, a small amount of pear or prune juice (1 oz per month of age) can be used for constipation. For babies on solids, pureed P fruits at meals are the dietary intervention of choice.

Why does my baby grunt and strain without being constipated?

This is a condition called infant dyschezia — and it is completely normal. Young babies have not yet learned to coordinate relaxing the anal sphincter while increasing abdominal pressure. Until the nervous system figures this out (usually by 3–4 months), babies strain, grunt, turn red, and cry before every bowel movement — even when the stool that arrives is perfectly soft. No treatment is needed and none should be used. Stimulating with a thermometer or suppository actually interferes with the baby learning to do this naturally.

Which formula is better for constipated babies — NAN or Lactogen?

NAN has a higher whey-to-casein protein ratio — closer to breast milk — and is generally associated with softer stools and fewer constipation complaints compared to Lactogen, which has a higher casein proportion and slower digestive transit. If your baby is constipated on Lactogen and other remedies are not working, discuss switching to NAN or another whey-dominant formula with your pediatrician. Do not switch formulas without medical guidance.

Is Hamdard Ghutti safe for infant constipation?

Hamdard Ghutti contains senna, a stimulant laxative. In older infants (over 3–4 months), at label doses, it may provide relief for constipation as an occasional short-term intervention. It should not be used regularly, in newborns, or in large doses, as stimulant laxatives can interfere with natural bowel muscle development. Try the mechanical and dietary remedies first. If you decide to use Ghutti, use the label dose and discuss with your pediatrician.

When should I be worried about my baby not pooping?

See your doctor if your baby has blood in the stool, significant pain or distress, a hard distended belly, vomiting alongside no bowel movements, poor weight gain, or has not pooped in 3 days and is formula-fed with irritability. Also see your doctor if home remedies are not working after 3–5 days, if your baby is under 2 months old with any constipation, or if constipation has been present since birth (possible Hirschsprung disease). Breastfed babies going up to 7 days between soft, pain-free stools do not need medical attention as long as feeding and growth are normal.

Final Thoughts: Know What's Normal First, Then Treat What Actually Is Constipation

Most "constipated baby" calls to the pediatrician turn out to be completely normal variation — particularly in breastfed babies, or babies going through infant dyschezia. Baby constipation is real when it occurs, and it responds well to simple, evidence-based remedies. But it is important to identify true constipation before treating it.

The checklist is simple: is the stool hard? Is your baby in real pain? Then treat it — bicycle legs, clockwise massage, warm bath, P fruits, and if needed, a small amount of pear or prune juice under one year. For Pakistani parents: avoid castor oil, be cautious with Ghutti in very young infants, choose formula wisely, and follow the 6-month rule for solid foods.

Have a question about your baby's specific situation? Drop it in the comments — our team responds to every question.