Question:

My son is six months old. We give him water each day with his formula. But sometimes his bowel movements are very hard. I think he is constipated because he cries when it’s too hard. What can I do to help? Sometimes he won’t drink the water.

Answer:

To answer your question I turned to a recent article in the Journal of Pediatric Health Care by pharmacists Allison Beck Blackmer  and Elizabeth Anne Farrington. Constipation can be defined three ways:

  • a stool that is hard
  • pain associated with defecation
  • the passage of fewer than three stools per week.  

The most common cause of constipation is functional, but there can be anatomic, neurologic, obstructive, endocrine, metabolic and medicinal causes as well. As always it is important to review the history with your physician and have a physical exam.

The pebble-like, hard stools you describe are very common with functional constipation. It is also important to remember that how often babies pass stools will depend on their age. Diet is another important factor that will also impact on bowel movements in this age group. A baby who is fed with breast milk can have multiple stools a day. A formula-fed baby may have significantly fewer stools with an entirely different consistency.

Once your doctor has ruled out any underlying causes for constipation, we likely can turn to the diet. You mention that you offer water and sometimes the baby refuses it. You are correct that dehydration can be a cause of constipation but that is not likely to be the only cause of these hard stools.

At six months of age your baby should be on solid foods, so the question is – what solids is he eating? If you have just initiated solids, rice cereal is often the first cereal we suggest.

Look to changing the cereal to barley and with the guidance of your primary care provider, you can start offering vegetables that have higher levels of fibre. When we add more fibre, it is important to add more water as well.

Since your baby is six months old, you can also add prune juice. You can dilute it with water or purchase a baby preparation of prune juice. It contains non-digestible sugars that can soften the stools as well. Apple and pear juices can do the same. Do not use a home recipe that includes honey as this review cautions on the possibility of the presence of botulinum spores.

Click here to submit your question for consideration by Dr. Marla.