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Constipation (baby and infant)

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Constipation (baby and infant)


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Gastrointestinal system
The number of times that a baby or infant does a poo and the type of poo produced can often be a cause for concern for parents. A change in the colour and type of poo and a change in the number of times that the baby or infant produces a dirty nappy may be a sign that the child is having difficulty pooing, or in other words is constipated.
To recognise whether a baby or infant is constipated, it first perhaps helps to understand what is normal during the early period of a child's development.

he first poo that a baby produces is called meconium. Meconium is a sticky, dark green, odourless material that the baby produces in the first or second day after being born. It is produced from the materials that the baby has swallowed while developing in the uterus.

Two or three days after being born, the baby's poo becomes lighter in colour as any remaining meconium is removed and more of the baby's feeds work through the baby's digestive system.

Once a regular feeding pattern starts to become established, the baby's bowel movements will become more regular and the poo will become more consistent in its amount, texture and colour.

Babies who are breast fed tend to poo more frequently than babies who are fed on formula milk. In their first few weeks, breast fed babies will often fill their nappy after each feed. Their poo is usually light yellow in colour, soft and easy for them to pass. In the next few months, the number of times that breast fed babies fill their nappies decreases, usually to once a day. Any increase or decrease in the number of dirty nappies or in the colour and softness of the poo is usually a reflection of their mothers' diet. For example, if a breast feeding mother eats a lot of plums or rhubarb, or has a spicy meal such as curry, some of the substances in these foods that make the mother go to the toilet are transferred to the baby in the breast milk, stimulating the baby to poo more often. Breast fed babies hardly ever become constipated because breast milk is so easily digested.

Formula fed babies tend to poo less frequently than babies who are breast fed. Their poo is usually light brown in colour and thicker than the poo of breast fed babies. Formula fed babies are more likely to become constipated than breast fed babies. This is because formula milk is more difficult to digest than breast milk, and because formula fed babies do not have the same type of friendly bacteria in their intestines as breast fed babies that help break down some of the proteins in milk. Making up formula milk incorrectly by adding too much powder or too little water can also lead to constipation. It is important that the instructions on the pack are followed carefully, particularly if changing from one formula to another, or from one brand to another.

When solids are introduced into babies' diets, the number of dirty nappies and the colour and the texture of the poo will change according to the type of food, just as it does in adults. The poo also smells like that of an adult's stools (faeces) or bowel movement. As the infant's digestive system adapts to the new types of food, the child may have a bowel movement once a day, or every two or three days. If the infant becomes constipated at this time, it may be an indication that the child does not have enough water, or there is not enough fibre in the child's diet. The poo or stools becomes harder and may form into small rounded pellets that are difficult to pass.

As hard stools can be difficult and painful to pass, the child may ignore the urge to go and stop straining to avoid the pain. Unfortunately, this may only make things worse. The longer that the stools remain in the child's intestine, the more water is reabsorbed from them so that they become even harder and larger and more painful to pass. So, the infant becomes more constipated.

A similar thing can occur at this time when infants are being potty trained or toilet trained. If the infant does not like the experience of sitting on a potty or sitting on a toilet, he or she may avoid the urge to go. As constipation develops, the child may associate the pain of a bowel movement with the potty or toilet and be reluctant to go. A child should never be forced to use a potty or toilet. Instead, if potty or toilet training is turned into a game, for example by rewarding the child by clapping or by putting a star on a chart each time, the infant soon associates it with fun and learns to use the potty or toilet without fuss.

Attending play school or nursery for the first time may upset a child because everything is new and strange, meal times may change and perhaps the child is not drinking as much as he or she would do at home. All of these changes can upset a child's routine and so affect the number of times a child poos. Although constipation in babies and infants can usually be explained by a change in diet, because of insufficient liquids or a change in routine, it can in rare cases by a symptom of a more serious medical condition. If a child is not gaining weight, if any blood appears in a baby's or infant's poo, or if there are any concerns about a child being constipated, it is always advisable to seek advice from a health visitor, doctor, nurse or pharmacist.
It is quite normal for babies and infants to grunt and strain and to go red in the face when passing a poo. It does not mean that the child is constipated. However, if the child continues to struggle without passing anything then it is likely that the child is constipated.

A change in the number of times a baby or infant poos is not always a sign of constipation. However, if the baby or infant has usually had a bowel movement each day but then has one every two or three days, it may be a sign of early constipation.

The texture and colour of the child's poo is a better sign of constipation. If the texture of the poo becomes harder and darker than it is normally, or if it forms into small pea-sized pellets, it indicates that the child is likely to be constipated.

Other signs are:
  • Strong smelling wind and poo
  • Crying and discomfort before doing a poo
  • Loss of appetite
  • A hard or swollen tummy
  • Watery brown coloured liquid (not to be confused with diarrhoea, but an overflow of liquid that has managed to get past the hard poo)
As long as a baby or infant is passing soft stools reasonably frequently, parents should have little cause for concern. However, if parents are worried about their child's bowel movements, they should seek advice from their health visitor, doctor, nurse or pharmacist.

Breast fed babies very rarely become constipated. If it does happen, it may be a sign that the baby has become slightly dehydrated, possibly because a cold has stopped the baby suckling properly or has made the baby sick and bring up all of its feed. Mothers should continue to breast feed normally, perhaps also offering the baby freshly boiled and cooled water between breast feeds.

Formula fed babies who become constipated should be given plenty of freshly boiled and cooled water to drink between feeds. The formula milk must continue to be made up according to instructions, not stronger and not weaker.

If the baby is older than 6 months, fruit juices such as apple juice, orange juice and prune juice may be tried to stimulate a bowel movement. However, care must be taken in the choice of product given to the baby, and it is advisable to read the product's label carefully. Anything other than pure fruit juice (100% fruit juice) contains sulphites as preservatives, added sugar and colouring agents. None of these is suitable for a young baby. It is also important that fruit juices are only used for are a short time before the baby is weaned, and that they are not given as a replacement for breast milk or formula milk.

If the baby has started on solids, it is important to ensure that there is plenty of fibre in the diet and that the baby always has plenty of water to drink. Gradually introducing fibre-rich foods such as pureed fruit (apricots, apples, prunes, pears, plums, blueberries, raspberries), pureed vegetables (carrots, broccoli, cabbage, sprouts) and cereals such as porridge will all help prevent constipation. Too many bananas and low-fibre foods based on white rice cereal should be avoided as they can cause constipation. All babies should be given plenty to drink, particularly in warm weather. Freshly boiled and cooled water is best, but diluted baby juices can be used if the baby is older than 6 months.

Other methods of easing constipation in babies are by some simple exercises such as gently rubbing the baby's tummy in a circular motion (a little baby oil on the fingers helps), moving the baby's legs in a cycling motion and by giving the baby a warm bath.

If constipation develops in infants it can be treated in a similar way to babies by increasing the amount of fibre and fluids in the diet and through exercise. Encouraging infants to develop a healthy diet with five pieces of fruit and vegetables each day, avoiding processed, low fibre, high fat foods and getting them to participate in regular exercise not only helps protect against constipation, but will also help protect against a whole range of other diseases later in life.

The use of laxatives to ease constipation in babies and infants is discouraged unless prescribed by a doctor. Laxatives that have been bought or prescribed for other members of the family must not be used to treat a baby or an infant.
When to consult your pharmacist
Talk to your pharmacist if you want advice about constipation in babies and infants. Your pharmacist will want to know the age of the child affected and how long he or she has been constipated. Your pharmacist will ask you questions about your child's diet and will want to know if you or your child is taking any medicines to treat other illnesses.

Your pharmacist will talk to you about diet and will be able to advise you if any of the medicines you or your child is taking could be responsible for causing constipation.

Depending on the age of your baby or infant, the number of times and the length of time he or she has been constipated, your pharmacist may suggest that you see your doctor.
When to consult your doctor
If a baby or infant suffers from prolonged or regular constipation, even though the child is well hydrated and is getting a balanced diet, it is advisable to seek advice from you doctor.

You should seek medical advice immediately if there is blood in the baby's or infant's poo as this may indicate a more serious condition. Tell your doctor if your pharmacist has advised you that some of the medicines you or your child is taking to treat another illness may be the cause of the constipation, as your doctor may decide to prescribe an alternative product.

If the doctor decides that your baby or infant requires help to clear the constipation, there are a number of laxatives that can be prescribed such as lactulose or a glycerin suppository. If the child is severely constipated, he or she may be referred to a hospital to have the poo removed while the child is sedated.
Useful Tips
There are a number of measures you can take to avoid constipation occurring:
  • Give your baby and infant plenty of freshly boiled and cooled water
  • For babies on solids and infants, introduce fibre-rich foods into the child's diet
  • Give your child a carrot or piece of apple as a snack rather than a biscuit or bag of crisps
  • Avoid, low-fibre, highly processed foods such as white rice and white bread
  • Give you baby gentle exercises such as moving his or her legs in a cycling motion
  • Encourage your infant to take regular exercise; walk rather than take the car for short journeys, go on walks together

Reviewed on 27/12/2009