Some infants will pass stools each day and others less frequently. Constipation is usually defined as infrequent, irregular bowel movements that are hard and difficult to pass – sometimes accompanied by straining and pain. Infants with constipation may also display loss of appetite, lack of energy, be irritable or have foul smelling wind & stools and abdominal pain and discomfort.
Constipation in babies is common although less so with breast fed babies as breast milk is more easily digested and stools tend to be softer. Breast fed babies also have higher levels of a hormone called motiline. This increases the movement of the bowels.
Constipation can be caused by not enough feeds or fluids. It is also a side effect of some medicines – sedating antihistamines, opioids and antiepileptics.
With toddlers, it can also be due to potty training, not being very active, diet (not enough fruit and vegetables) or emotional causes like starting nursery or a new baby in the family.
WHAT TO DO - BABIES
Babies who are not yet taking solids but have constipation should be given extra water between their usual feeds. Mothers with babies who are being fed infant formula should continue as normal. Manufacturers’ instructions for making up feeds should be followed and feeds should not be diluted. Changing to a feed like Ronalac AC that is specially formulated for constipation may help.
It may also help to gently massage baby’s abdomen. Carefully moving the baby’s legs in a cycling motion has also been suggested as helping to stimulate the bowels.
For babies who are eating solids, parents should be advised that their diet should include plenty of water or diluted fruit juice and be rich in fruit and vegetables. Apples, pears, apricots, grapes and peaches should all help with constipation as do plums, prunes, strawberries and raspberries.
If diet change fails to work, parents should consult their doctor who may prescribe a laxative. Initially, this is likely to be an osmotic laxative like lactulose or polyethylene glycol. These work by osmosis to retain fluid in the large bowel.
A stimulant laxative like senna or docusate may also be used. These act on the muscle wall of the bowel to help move stools. Bulk forming laxatives are not suitable for babies.
WHAT TO DO – TODDLERS
Parents should be encouraged to include good intakes of water, ripe fruit and vegetables in their toddler’s diet and to actively monitor it to make sure that it is being followed.
It helps if meals are given regularly and if toddlers are physically active. Small children need to be taught to ‘go’ when they need to rather than putting it off so the relevance of good toilet habits should be explained to parents.
If constipation persists after dietary change, parents should be told to consult their doctor.