Considerations and solutions

Constipation in breast-fed or formula-fed infants less than one year old is believed to be common. In the first weeks of life, breastfed babies generally have more bowel movements than those who are formula-fed,. Yet, they should usually be passing four soft or liquid bowel movements each day. Constipation during this time is not normal. However, as they grow and the diet changes, constipation may arise.

Because their body is busy making more baby less poop, they may have a movement once a day — their gut lining is also ultra-permeable, allowing for each drop of food to be fully utilised. Keep in mind that the normal amount of bowel movements an infant passes varies depending on his age and what he is eating.

Constipation may, in fact, be a sign that the baby is not eating enough.

Infant constipation may also become noticeable when you start feeding your baby solids. Understandably, it can be a source of concern for you. Your baby may not really be constipated, his body is simply adjusting and setting its own schedule for having a bowel movement. 

An infant's stool is generally soft and easily passed. Infants also have weak abdominal muscles and often strain during bowel movements. However, constipation is unlikely if your baby passes a soft bowel movement after a few minutes of straining. 

Even if an infant is not usually constipated, his bowel movements may be irregular. It is, therefore, important to look at the signs and identify problems. Also, you may consider side-effects of certain drugs by reading the leaflets. Share concerns with your doctor, especially if constipation is severe enough to be a problem.

Considerations

Constipation generally resolves with changes in diet or behaviour, as well as identifying the right amount you should feed your baby. If you do not produce enough milk, you may supplement his diet with a formula. 

Signs of constipation in infants and children:

• Being very fussy eaters, spitting up more than usual

• Moving body in different positions

• Being dehydrated

• Belly pain and bloating. Remember that your baby’s gut microbiota is developing and may produce gas that can lead to mild or severe discomfort.

• Difficulty passing stools, seeming uncomfortable, straining for over 10 minutes, crying, or getting red in the face when they have a bowel movement; stools appearing like small, dry pebbles, or large and wide, and hard and dry (if soft, it is not constipation).

• Liquid stool that may be passing around solid stool

Constipated infants and children may develop unusual habits when the urge to have a bowel movement starts, like:

• Arching their back, tightening their buttocks, and cry.

• Rocking back and forth while stiffening their buttocks and legs, wriggling or fidgeting, or they may squat or get into other unusual positions.

Although it may appear your child is trying, he may also be trying NOT to have a bowel movement.

Children starting kindergarten may not feel comfortable asking to go to the toilets and ignore the urge to have a bowel movement. They may also have had previous painful bowel movements and want to avoid them, or they don't want to use a school or public toilet. 

Newly set habits around school schedule may also have an impact on bowel movements and so your child may develop mechanisms associated with ‘holding it in’, which are in contradiction with — and disturbing — the natural movements (peristalsis) of the bowel.   

Causes

Constipation occurs when stools remain in the colon for too long. Too much water gets absorbed by the colon, leaving hard, dry stools. Often the causes are:

• Switching from breast milk to formula

• Switching to solid foods

• Reacting to certain foods

• Dehydration (not taking in enough fluids)

• Change (e.g., travelling, starting school, or stressful events)

In children, causes can also include: 

• They’re not drinking enough fluid, or eating enough fibre

• They are not ready for toilet training

• They are learning to control their bowel movements

• They want to hold it in to avoid the pain they have experienced with previous difficult bowel movements

• They don't want to use a school/public toilet

The use of medicines or certain medical conditions can lead to your infant or child being constipated and have painful bowel movements. 

You should contact you doctor if your baby (under 8 weeks) is constipated, or If your child has not had a bowel movement in 3 days, is vomiting, or appears to be in pain and/or irritable, or constipation doesn’t improve with changes in diet. 

You must seek immediate medical advice if you see blood in the stools.

Home care

If you’re noticing your infant or child is constipated, you can try home remedies to encourage bowel movement. 

If your baby is still on breast milk or formula, you may need to contact your doctor or child’s nurse for advice. Infants over 6 months (or on solid foods) can be given the following to help:

• Increase hydration. Give a little organic 100% prune, apple or pear juice (50 ml — other juices are not as helpful). This can be repeated once or twice a day. Children can be given a little more juice. They must be given the opportunity to drink often (to prevent dehydration), and set lifelong habits.

• Add fibre to their diet. If your infant is already on solid foods, you can give him fruits and vegetable purées. Think sweet potatoes, carrots, peas, or broccoli. You can also add a touch of prune juice to fruits purées. In fussy children, it may useful to identify why they may not want vegetables. It could be a sign that they have colic, and prefer to avoid this group of food altogether than dealing with pain later.

• Avoid giving your child certain foods, including cow's milk and derivatives, such as yogurt, cheese, and ice cream. It may be useful to identify food intolerances if constipation is a regular problem (e.g., gluten, lactose, etc.).

• Encourage healthy toilet habits. child is more likely to have a bowel movement after a meal, especially breakfast. So, encourage to sit on the toilet for 10 minutes once or twice a day after eating.

Recurent constipation  

If your infant or child suffers from recurrent (repeated episodes of) constipation, you may need to identify the cause. Again, testing for food hypersensitivities may be the key to detect early on which foods your child may not be able to digest, and which is causing a lot of discomfort and, in severe cases, pain. If your child refuses a particular, this could be a tale-tell sign.

Sometimes, your child may appear to have diarrhoea; however, it may also be an indication that a large or compacted stool is blocking the bowel, and so only liquid stools can ‘leak’ round. A faecal mass palpable on abdominal examination can often be identified.

You may be recommended glycerine suppositories (work like a gentle enema) or even laxatives; however, the aim should be to prevent long-term problems with constipation — by breaking the cycle of pain and withholding and helping the child to develop healthy toileting habits, especially if drinking extra fluids and increasing fibre intake are not enough to treat repeated episodes of constipation.

If your child doesn’t like to use toilets outside of home, you may want to talk to your child to better understand why. Every time, they go to the toilets when they need (particularly) outside of home, you can use a (healthy) reward system to recognise their efforts. 

Again, sitting your child on the toilet after a meal for 10 minutes may often help. So that they understand they need to go. 

If you think that episodes of constipation are occurring often, you may want to keep a diary. List all drugs, foods, consistency of stools, and occurrences of pain or accidents. to identify triggers. 

Idiopathic constipation (functional) is a term used for recurrent constipation that cannot be explained by any anatomical or physiological abnormality. Usually, your doctor will recommend laxatives1 for many months — until it appears to be resolved. It is, therefore, essential to identify the cause(s) of recurrent constipation before medicating. 

According to NICE, doctors should not prescribe laxatives if there is suspected:

• Intestinal obstruction or perforation.

• Paralytic ileus (due to lack of peristalsis or mechanical obstruction).

• Crohn's disease or ulcerative colitis.

• Toxic megacolon.

• Galactosaemia (inability to metabolise galactose, a type of sugar).

They should prescribe laxatives with caution if there is:

• Fluid and electrolyte disturbance (discontinue if there are symptoms of fluid and electrolyte disturbance).

• A history of prolonged use — owing to the risk of electrolyte imbalance, such as hypokalaemia.

• A history of lactose intolerance.

• Ischaemic colitis (inflammation and injury to the colon due to poor blood supply).

Laxatives are also known to have several side effects:

• Macrogol (polyethylene glycol) — abdominal pain, bloating, flatulence, nausea and vomiting.

• Lactulose — nausea (can be reduced by giving with water, fruit juice, or meals), vomiting, flatulence, cramps, and bloating.

• Stimulant laxatives (cause peristalsis by stimulating the colonic and rectal nerves. e.g., Senna, Docusate, Bisacodyl, and Sodium picosulfate) — abdominal cramps, diarrhoea, nausea and vomiting.

Important tip: 

Always ensure that your child is well-hydrated and that their diet is rich in fibre. 

Some vegetables may cause colics, and so your child may reject these foods. Replace with other high-fibre vegetables. Remember it’s only a passing phase, and vegetables will need to be reintroduced in the die