Constipation, tummy pain and the 3am wake
They wake at almost exactly the same time each night, screaming, with their legs pulled up. That precision is worth paying attention to - habit wakes drift, and digestive ones tend not to.
3 min read
A regular, sharply timed night waking with obvious distress often has a physical driver rather than a behavioural one. Digestion, wind and constipation all follow the clock in a way that habit does not, because they follow the timing of feeds and meals.
The signs to look for are the ones that go with pain rather than protest: drawn-up legs, arching, a hard or distended tummy, a cry that is sharper than usual and does not respond to the things that normally work.
Constipation
What to look for. Hard, pellet-like or very large stools, straining and crying when passing them, fewer than three a week in a formula-fed or weaned baby, or a hard tummy.
When it starts. Most often after starting solids, after a switch of formula, or during a hot spell or illness when fluid intake drops.
Breastfed babies are different. They can go many days without a stool and be entirely well, provided it is soft when it comes and they are otherwise content.
What helps. More fluids, more fibre once on solids - fruit and vegetables - and gentle tummy massage or bicycling the legs. Discuss anything beyond that with your GP or health visitor before trying it.
Wind and colic
In the first three or four months, evening and night crying with drawn-up legs is common and often called colic. Thorough winding, upright holding after feeds, checking the latch or teat flow, and paced bottle feeding all help to some degree. It resolves on its own by around four months.
Reflux presents similarly but tends to come with arching, spitting up and distress specifically during or shortly after feeds.
Habit wakes drift by half an hour. Digestive ones keep to the clock, and that is the clue.
Working out whether it is this
Keep a note for a week of when they wake, what their nappies look like, what they ate, and how they behaved. A pattern usually becomes obvious within days - a new food, a change in formula, a wake that arrives ninety minutes after dinner every time.
And do not start any sleep work while this is unresolved. A baby in abdominal pain cannot settle, and the failure will look like a failure of the method.
Keeping the record that identifies it
A week of notes usually settles this, and the columns matter: time of each wake, what the nappies looked like, what they ate and when, and how they behaved. Patterns emerge quickly - a wake ninety minutes after dinner every night, or two bad nights after every day with a particular food, or waking that stopped for three days when the nappies were softer.
That record is also what makes a GP appointment productive. Abdominal problems in babies are difficult to assess in a ten-minute consultation with a currently comfortable child, and a week of specific observations is worth considerably more than a description of how bad the nights have been.
What normal nappies look like
Exclusively breastfed babies can go several days without a stool and be entirely well, provided it is soft when it comes and they are content. Formula-fed and weaned babies usually go more regularly, and hard, pellet-like or very large stools are the sign worth acting on rather than the frequency.
After starting solids, a change is expected - firmer, different colour, sometimes recognisable pieces of food. What is not expected is straining and crying, blood, or a hard tummy. Those are worth a GP appointment rather than a dietary experiment.
When to stop troubleshooting
See your GP for blood in the stool, persistent vomiting - particularly green vomit - a swollen or hard tummy, poor weight gain, constipation that does not respond to simple measures, or a baby who is inconsolable and seems in severe pain. Green vomit and a distended tummy need urgent assessment.
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