Constipation in babies
How can I tell if my baby is constipated?
First, consider what’s normal for your baby. She may have a bowel movement after every feeding, or she may wait a day or more in between. Your baby’s individual pattern depends on what she eats and drinks, how active she is, and how quickly she digests food.
If your baby drinks formula or eats solid food, she’ll probably have a regular bowel movement at least once a day. If your baby is breastfed, there’s no “normal” number or schedule – only what’s typical for your baby. It’s not unheard of for breastfed babies to have one bowel movement a week.
After a while, you’ll be tuned in to your baby’s unique habits. If you’re concerned that your baby may be constipated, watch for these signs:
- Less frequent bowel movements than usual, especially if your baby hasn’t had one for three or more days and is obviously uncomfortable when she does
- Hard, dry stools that are difficult for her to pass – no matter how frequently
Why is my baby getting constipated?
There are several possible causes:
Solid food. Don’t be surprised if your baby becomes mildly constipated as he eats more solid food. That’s often because rice cereal, usually the first food given during this transition period, is low in fiber. Constipation can also happen when you weanyour baby from breast milk because this sometimes leads to dehydration.
Formula. Babies who breastfeed exclusively are rarely constipated. Breast milk has the perfect balance of fat and protein, so it produces stools that are almost always soft – even if your baby hasn’t had one for several days.
If your baby is on formula, it’s possible that something in his formula is making him constipated. It’s not uncommon for the protein component in different formulas to cause constipation. Ask your baby’s doctor about switching brands.
(Despite what you may have heard, the amount of iron in formula doesn’t cause constipation.)
Dehydration. If your baby becomes dehydrated, his system will respond by absorbing more fluid from whatever he eats or drinks – and also from the waste in his bowels. The result is hard, dry stools that are difficult to pass.
Illness or a medical condition. Although it’s uncommon, constipation can be caused by an underlying medical condition such as hypothyroidism, botulism, and certain food allergies and metabolic disorders. Rarely, constipation is caused by Hirschsprung’s disease, a condition caused by a birth defect that prevents a baby’s gut from functioning properly.
If there doesn’t seem to be a reason why your baby passes hard, painful stools, have his doctor rule out these conditions.
How can I treat my baby’s constipation?
- Help her get some exercise. If your baby’s a crawler, encourage her to do a few laps. If she’s not crawling yet, try pumping her legs instead. While she’s lying on her back, gently move her legs in a forward, circular motion as if she were pedaling a bicycle.
- Massage your baby’s belly. Measure three finger-widths below her navel on the lower left side and apply gentle but firm pressure there with your fingertips. Press until you feel a firmness or mass. Maintain gentle but constant pressure for about three minutes.
- If you feed your baby formula, ask her doctor about switching to a different brand. Sometimes adding dark corn syrup to the formula also does the trick: Start with 1/4 teaspoon per 4 ounces of formula. If that doesn’t help, gradually increase the amount. Don’t give her more than 1 teaspoon per 4 ounces.
- Add a little prune juice to formula or breast milk if your baby is at least 4 weeks old. Normally, it isn’t necessary to give your baby juice, but a little is okay to help relieve constipation. (Try apple or pear juice if your baby doesn’t like the taste of prunes.) Give her an ounce a day for each month of life, up to 4 ounces for a 4-month-old. After 8 months, your baby can have as much as 6 ounces of juice a day to treat constipation.
- If your baby is old enough to eat a variety of solid foods, cut down on constipating foods like rice, bananas, and cooked carrots. Try giving her a few tablespoons of pureed prunes, apricots, or pears to help loosen her bowel movements. For the best result, give your baby a belly massage first, then some high fiber food.
- Talk to your baby’s doctor about other treatment options. Ask about using an over-the-counter stool softener to make it more comfortable for your baby to have a bowel movement, but never give her a laxative without her doctor’s approval. The doctor may also suggest you try a glycerin suppository if your baby is severely constipated. The suppository stimulates your baby’s rectum and helps her pass a stool. Using a suppository occasionally is fine, but don’t do it on a regular basis because your baby could wind up relying on them to have a bowel movement.
- If your baby is passing such hard, dry stools that you see a little blood or even slight tears (fissures) in the delicate skin near the opening of her anus, you can apply some aloe vera lotion to the area to help it heal. Keep the area as clean and dry as possible, and mention the fissures to your baby’s doctor.
What causes constipation?
There are several possible reasons why your baby may be constipated:
- Formula milk. A formula-fed baby is more prone to constipation because formula can be harder to digest than breastmilk, causing poo to be firm and bulky. A breastfed baby is unlikely to get constipated. Breastmilk produces poo that is almost always soft, even if a baby hasn’t done a poo for a few days.
- Introducing solids. Babies often become constipated when they start solids, as their bodies learn how to manage new foods. Low-fibre foods and not enough fluids also contribute to constipation.
- Dehydration. Your baby may be refusing milk because she’s teething, has thrush, a throat infection, a cold, or an ear infection. Or your older baby may not be drinking enough milk or water with her solid foods. Whatever the reason, if your baby isn’t getting enough fluids, she may become dehydrated. This can cause dry, hard poo that is difficult to pass.
- A medical condition or illness. Occasionally, constipation can be a symptom of a food allergy, food poisoning (such as botulism), or a problem with the way the body absorbs food, known as a metabolic disorder.
Very rarely, constipation in babies can be caused by congenital conditions. These can include a disease where the large intestine doesn’t function properly (Hirschsprung’s disease), a condition where the anus and rectum have not formed properly (anorectal malformation), spina bifida and cystic fibrosis.
I think my baby is constipated. What should I do?
First of all, it’s worth checking that your baby really is constipated. If your baby is straining to do a poo, it doesn’t necessarily mean that there’s a problem. Babies’ bowel patterns vary, and their poo tends to change in texture from day to day.
Check with your doctor or health visitor before trying anything to ease your baby’s discomfort. They may ask you whether your baby:
- is crying and irritable, and seems in pain when she poos
- has lost her appetite
- has a hard belly
- has done fewer than three poos in a week
- is doing dry, hard, pellet-like poos that seem difficult to pass
- is passing foul-smelling poo and wind
These are all signs that your baby is constipated.
As odd as it sounds, very liquid poo can also be a sign of constipation, rather than diarrhoea. This may be because liquid poo has slipped past the hard blockage that’s in your baby’s lower intestine.
If your baby is truly constipated, your doctor may suggest that you gently move her legs in a bicycling motion. This can help to move the hard poo along her intestine.
If your baby is formula-fed, she’ll be more prone to constipation than if she’s breastfed. Give her extra cooled, boiled water between feeds, but don’t dilute the formula.
Don’t use more than the recommended amount of milk powder when making up a bottle, as too much can dehydrate your baby, making her constipation worse. Your doctor may also recommend trying a different brand of formula milk.
Foods that are high in fibre will help too. Pureed or chopped apples, apricots, blueberries, grapes, pears, plums, prunes, raspberries and strawberries are all high in fibre. You could also add a small amount of high-fibre cereal to your baby’s usual breakfast cereal.
If these home treatments don’t work, or if your baby’s constipation is severe, your doctor may suggest a laxative such as lactulose.
Try not to worry if your baby becomes constipated. It’s likely to happen now and then. With your attention, your doctor’s recommended treatment, and a bit of time, her discomfort will soon be eased.
When should I call the doctor?
Call the doctor if your baby isn’t eating, loses weight, or has blood in his stool. Or if basic treatments, such as adjusting his diet, aren’t helping his condition. And if he’s younger than 4 months old, call his doctor if he has very hard stools or hasn’t had a bowel movement within 24 hours of when he usually goes. Don’t give your baby a laxative or suppository without consulting his doctor first.
Home Treatments for Constipation
For Infants and Toddlers:
- Fruit juice: Prune, apple, or pear juices contain sugars which are poorly absorbed, pass through the intestine unabsorbed, and hold water in the poop. Other juices are helpful because their sugars are better absorbed. A baby or toddler constipated may be helped by giving 2-4 ounces of one these juice once a day and 4-6 ounces once a day for older infants. In the case of pear or apple juice, it is important that the juice be 100% fruit juice (not watered down) or the sugars are not in high enough concentration to do their job. Prune juice contains more unabsorbed sugars so with prune juice use less and water it down somewhat (e.g. start with 1 ounce and add 1 ounce of water for a total of 2 ounces). Some children may develop gas or bloating with this treatment and become fussy. Seek evaluation from your clinician if the juice is not helping or your child is not tolerating it. With the exception of prune juice, juice is not very helpful for older children (above age 2-3) because their intestines are more efficient and absorb most of the sugars.
- High-fiber foods: If your infant has started eating solid foods, you can substitute whole grain cereals for white or refined cereals (white rice cereal). You can also offer other high-fiber fruit and vegetable to your baby or foods including apricots, sweet potatoes, pears, prunes, peaches, plums, beans, peas, broccoli or spinach. Banana, applesauce and carrot baby food and baby foods thickened with tapioca can be constipating so reduce these foods in your child’s diet. For older children, dairy products can be constipating. If your toddler is eating excessive amounts of cheese, milk (>16-20 ounces per day), or refined carbohydrates; try to reduce these in the diet and substitute higher fiber alternative such as whole grain breads and cereals, fruits and vegetables.
- Formulas: Some formulas may be constipating. Formulas which are higher in casein and formulas that have been thickened with rice cereal can be more problematic. Consider changing formula if you baby is having a persistent problem with constipation. Iron in infant formula does not contribute to constipation.
- Mild osmotic laxative: may be recommended by your baby’s clinician if the constipation does not respond to these interventions.
- Not Recommended:
- Dark Corn Syrup: Dark Corn syrup has been used in the past but most modern preparations of dark corn syrup do not contain the osmotically active substances to treat constipation and will not work. Additionally, there has been some concern about the potential for carrying botulinum spores similar to honey.
- On occasion, using a glycerin suppository or providing some rectal stimulation may give your baby relief from constipation but these are not something that should be used frequently. If you have to use these frequently, discuss with your clinician.
- Mineral oil and stimulant laxatives should not be used in young babies.
- Diet recommendations: Include whole grain foods, fruits and vegetables in you and your child’s diet. Your child is more likely to accept these foods if your child sees them in your diet. While you can offer your child these foods, if they don’t want them, making them eat them will only increase their resistance. You should also reduce constipating foods in your child’s diet including excessive milk, other dairy products (e.g. cheese and ice cream) and refined carbohydrates such as white rice, white pasta and white bread. Some children must eliminate milk from their diet to get control of their constipation. These children will need to get calcium from other dietary sources or a calcium supplement and need to take a multivitamin or vitamin D supplement since milk is the primary source of these nutrients.
- Fluids: It is important for children to keep themselves well hydrated. If a child does not drink adequate fluids, he/she is more likely to get constipated. Beyond good hydration, excessive amounts of water are unlikely to resolve constipation.
- Probiotics: Some children benefit from probiotics although there is not conclusive evidence about their role in treating constipation. Probiotics may be given by feeding certain brands of yogurt high in probiotics or by giving the child probiotic supplements which can be purchased over the counter at most pharmacies and health food stores.
- Medications: Osmotic laxatives (polyethylene glycol and lactulose), stimulant laxatives (e.g. senekot, bisacodyl), mineral oil and fiber supplements may be recommended by your clinician if the above interventions are not resolving the constipation. Mineral oil should not be used in children with risk of aspiration.
- Encourage your child to poop: If you are toilet training and your child develops significant constipation, back off till the constipation is controlled. The most important thing is for your child to poop regularly even if that’s in a diaper. For older children, establish a bowel sitting program such as 10 minutes sitting on the toilet once a day. The best time to do this is within 30 minutes after a meal such as breakfast or dinner. If your child has a natural tendency to poop at a particular time that would be a good time to have his/her bowel sitting program. Give your child something to do during the bowel sitting so they are not bored or aversive to the program. If your child is afraid of the bathroom, help your child gradually overcome their fears. You may need to stay with the child in the bathroom if they are anxious.
- Proper Position: Insure good position on the toilet. This means the feet must be supported on the floor or a step stool.
- Special needs: Some children may need support for anxiety, sensory processing disorder, or other behavioral concerns. Some older children with feeding concerns use special formulas. Some of these formulas may be more likely to lead to constipation than others related to their protein and micronutrient content. Some formulas have fiber added which can be helpful for constipation in some children but can actually contribute to constipation in other children. Talk with your clinician or dietician about your child’s formula. For some children with developmental disabilities, specialized toilet seats may be necessary to provide adequate support. Finally, some children are on medications for other medical problems (such as certain seizure and pain medications) which may be contributing to the constipation and need to be adjusted.
Medical Evaluation of Constipation
Most children with constipation do not have an underlying medical problem (such as low thyroid or a bowel anatomic abnormality) however if a child has persistent problems with constipation, it is important for a health care provider to carefully consider any possible underlying problem. Most problems can be excluded by a history and physical exam. This includes a careful abdominal and neurologic exam and typically a rectal examination. Special tests are ordered only if there are concerns from the child’s history or exam that suggest an underlying medical problem.
Functional constipation (constipation which is not due to an underlying medical problem…..most constipation) is treated by modifying lifestyle as discussed in the section above, by cleaning out the bowel if the constipation has been long standing (with higher doses of laxatives and in some cases enemas) and then through the use of daily stool softeners and laxatives to keep the bowel movements soft and daily. When a child has had chronic constipation, it is very common for it to recur. This is particularly true for children with encopresis. Those caring for the child must be vigilant in keeping the stool soft through daily medication and insuring a daily bowel movement. The clinician will give the family an “action plan” to escalate treatment if the child starts having hard bowel movements or skipping days. Thanks To: babycenter.com