Formula and constipation: Causes, relief tips, and when to seek help

As a parent, you may find yourself deeply interested in your baby’s poop — to a degree that you never thought possible. Questions like, “Is this color normal?” and “Is it supposed to be this stringy?” may swirl through your head. 

Then, sometimes you may find your baby isn’t pooping frequently and that opens a whole different set of questions and concerns. While constipation can be a challenge for all babies, formula-fed little ones may be more likely to experience it due to various factors including the water content and the digestibility of the formula [].

Here, we’ll explain why formula may lead to constipation in some infants, show you some signs to look out for, and provide tips to relieve infant constipation. 

IN THIS ARTICLE:

Why formula feeding may cause constipation

In general, formula takes longer for babies to digest than breast milk. Sometimes, this leads to constipation []. There are two proteins in breast milk and formula: whey and casein. Breast milk tends to have more whey, which stays liquid in the stomach and is often easier to digest. Formula tends to be higher in casein, which can clump in the stomach and be harder for babies to digest [].

Different types of formula may have different effects on your baby. For example, some formulas have a lower water content than others and may be associated with constipation []. If you think your baby’s formula has a low water content, ask their healthcare provider for alternative recommendations. Note: It’s never safe to add extra water to any type of formula above what the directions specify.

Sometimes, people assume that iron in baby formula can cause constipation because there is a link between iron and constipation in adults. However, the AAP notes that the iron content in formula does not cause constipation. Instead, iron fortification can help prevent iron deficiency [].

Signs of constipation in formula-fed babies

Less frequent bowel movements 

The frequency of baby bowel movements can vary, depending on your child’s age and other factors. However, most formula-fed babies will poop once per day, or every 1 - 2 days []. 

After the first week of life, it can be common for your baby's bowel movement patterns to slow down []. As long as your baby is eating and growing adequately, going multiple days without pooping may not be concerning. Tracking your baby's bowel movements (try it with the free Huckleberry app!) and monitoring their pooping pattern can help determine if your baby is having difficulty with constipation. If your baby suddenly has fewer bowel movements, or difficulty passing stool, they may be experiencing constipation. 

Hard, dry stools

Typically, you want your baby’s poop to be soft and mushy. Hard, dry stools (that look like small pebbles or one large ball) may be a sign of constipation [].

Straining during bowel movements

Many babies strain when they have bowel movements even if they aren’t constipated. After all, it’s hard work! However, if your baby is straining for at least 10 minutes without successfully pooping, that could be a sign of constipation []. Additionally, you might notice your baby straining more than usual when they do have a bowel movement []. 

Fussiness or discomfort 

Constipation can be painful —  for adults too. Babies who are constipated might be gassy, bloated, or crampy. Understandably, this could lead them to be fussy and uncomfortable []. You might even notice that the pain disrupts their sleep. They may have a hard time falling asleep and/or wake up more frequently overnight. 

Tips to relieve constipation in formula-fed babies

Tip 1: Make sure your baby is hydrated

If you think their baby is constipated, discuss your baby's feeding routine and volume with your pediatrician to ensure your baby is taking enough volume in each day. The American Academy of Pediatrics (AAP) recommends babies eat about 2½ ounces (75 mL) of formula a day for every pound (453 g) of body weight [].

Tip #2: Add fiber-rich foods (for babies eating solids) 

If your little one is old enough for solids, consider adding foods high in fiber to their diet. Have you heard of the “P fruits” for constipation? Many fruits that begin with the letter “P” (like pears, plums, prunes) have lots of fiber and may help your little one poop more easily. 

Tip #3: Try baby massage 

and gentle tummy exercises can help move things along in your baby’s intestines. You can even try giving them a warm bath before the massage to help them relax []. A is to lie your baby flat on their back and gently rub their tummy in a clockwise motion []. You can also try moving their legs like they’re riding a bicycle. 

Tip #4: Try water or juice (after consulting their healthcare provider)

Some sources recommend giving your baby a small amount of water or 100% fruit juice if they are at least 1 month old []. The AAP recommends apple or pear juice []. The fluid from the juice can help loosen your baby’s stool. Because babies should only consume formula or breast milk for about the first 6 months of their life in most cases [], talk to your child’s healthcare provider before offering juice. 

When to seek help

Parents are often able to manage infant constipation at home without needing to see a healthcare provider. However, there are some instances when it’s a good idea to get your baby checked out and get extra help before you consider switching their formula []. Seek help from your baby’s healthcare provider in the following situations []:

• They have persistent constipation that doesn’t improve with home remedies

• They have severe discomfort, bloating, or vomiting

• You notice blood in their stool

• They suddenly have fewer bowel movements than their normal pattern

Takeaway

• Formula-fed babies can become constipated as it usually takes longer to digest than breast milk. However, all babies may experience constipation. 

• Signs that your baby might be experiencing constipation include hard, dry stools; less frequent bowel movements; excessive straining during bowel movements; and fussiness. 

• To help your baby poop more regularly, ensure they are well hydrated. You can also try a warm bath and baby massage. Sometimes, changing to a different formula helps constipated babies, but talk to their healthcare provider before switching.