Constipation
Constipation is defined as a decrease in the frequency of bowel movements characterised by the passing of hardened stools which may be large and associated with straining and pain.1 There is a wide variation in bowel movement frequency among infants – some pass stools several times a day, others only a few times a week. Parents will learn to recognise the patterns specific to their baby.
Common signs of constipation in infants can include2,3:
- Straining
- Hard large stools
- Being irritable, or unhappy
- Foul-smelling wind and stools
- Abdominal pain and discomfort
NICE recommendations advise that dietary changes and ensuring adequate fluid should be in combination with medical and behavioural treatments. Dietary intervention should not be used as first line treatment.2
Parents should seek advice from their GP. A laxative (usually an osmotic) may be prescribed – followed, if necessary, by a stimulant.2
Functional constipation (chronic constipation without a known cause), is common in childhood and has been reported to affect up to one-third of children.2 In a large proportion of children constipation presents in the first year of life.4
The most likely triggers for functional constipation are:
- Progressing from breastmilk to formula milk or weaning
- Starting nursery or school
- Potty training
These may result in firmer stool consistency, the altered sensation when passing stools or stool withholding, which trigger a cycle of large, difficult to pass stools, pain, fear and further stool withholding.
The diagnosis of functional constipation is based on the ROME IV criteria for functional gastro-intestinal disorders.5
- NICE. Clinical Knowledge Summary (CKS): Constipation in children. Available at https://cks.nice.org.uk/topics/constipation-in-children/ (Accessed July 2025.)
- NICE (2010). Constipation in children and young people: diagnosis and management. Clinical guideline. Available at: http://www.nice.org.uk/guidance/cg99/resources/constipation-in-children… (Accessed July 2025.)
- NHS. Constipation and bottle feeding. Available at https://www.nhs.uk/start-for-life/baby/feeding-your-baby/bottle-feeding/bottle-feeding-challenges/constipation-and-bottle-feeding/ (Accessed July 2025).
- Tabbers MM. et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN JPGN 2014;58: 258–274.
- Zeevenhooven J, Koppen IJ, Benninga MA. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. PGHN 2017 Mar;20(1):1-13.