Infant Constipation
Helping Your Child To Open Bowel Better

It is however very important to understand that healthy infants do have a very wide range of variations in the frequency at which they open their bowel.

This variation is influenced by the type of diet they are having, their age as well as social habits.

Constipation in a child is said to occur only if he or she is passing painful infrequent hard stools.

If the stool looks well formed, but passed after every other day or a few days apart, without causing any distress to the child, it is not constipation, and may be normal for the child.

The message here is that constipation should not be diagnosed based on what the mother's expectation of normal frequency of bowel movement for an infant are. It varies for every child, even from the same family.

It is therefore important to have an idea of what is medically considered a normal frequency of bowel movement (or the number of times a child is expected to poop) in a day or over a period of time.

Normal frequency of bowel movements in infants

Bottle fed babies on the other hand can pass stool only once or twice a day or even once every two or three days.

Each child, be it a newborn, infant or older child, comes up with what is normal for him or her within a range of passing stool from zero up to 5 times a day to passing stool only once in 3 or 5 days.

Between the first months to the first year of life, the bowel habit of a child could change considerably, reflecting changes in feeding patterns, constituents and consistency.

An infant bowel movement frequency considered to be within a normal range is as follows (it is very important to be clear in our mind that the term infant when used in the medical parlance refers to a child up to age one):

• Newborns. From age 0 to 3 months, breast feed babies are expected to open their bowel from 3 to 6 times a day, and bottle feed babies are expected to open their bowel from 2 to 4 times a day
• Age 3 to 6 months. At this time, most kids would already have had formula milk introduced. Babies bowel movement frequency could be from zero a day up to four times a day, or as low as twice a week. Any frequency of bowel movements less than this should warrant a medical opinion
• 6 to 12 months. Bowel movement frequency a child of this age is more settling into a pattern, and should be anything from zero to three times a day or three to twenty one times a week.

Causes of Infant Constipation

• Changing over from breast milk to bottle feeds, or to solid meals. If this is the case, and the right amount of milk to water mix is achieved, over time, the bowel settles to the new regime, and the baby will become adapted to a new frequency of bowel opening normal for it

• Fever. Infant constipation often follows an episode of fever and high temperature, and will resolve once the cause of fever has settle, and the child is back to normal eating habits

• Potty training anxiety. This is especially common in toddlers and older children. Parents should not be too harsh with potty training. It could cause the kids to resist opening their bowel

• Emotional distress in a child, or even between parents can trigger constipation in infants

• Playing and not like getting distracted by the urge to poop, thus they resist going to the loo and over time, become constipated

• Eating food not rich in fibre: eating too much desserts and candy or chocolate

• Not drinking enough water or fluids is another common cause of infant constipation.

• Medications. Some kiddie’s medication like certain cough medicine can cause constipation.

Medical conditions which cause infant constipation are often as a result of defects arising from birth. They include:

• Down’s Syndrome
• Lack of or blocked anus from birth (anal stenosis)
• Hirschsprung’s disease… this is a problem from birth where the child does not have the type of nerve cells that connect the brain to the gut. The brain can not therefore communicate with the gut to go to toilet.

  The child becomes severely constipated and the belly distended. The disease is usually diagnosed from very early childhood, a few days after birth. Treatment is by operation.

Other medical abnormalities that could cause infant constipation include:

• Anal Fissure - a small tear in the anus of the child, usually following heavy straining, or sometimes they just occur
• Cystic fibrosis
• Prune belly syndrome
• Low thyroid function
• Diabetes
• Lead poisoning
• Reduced or excessive body electrolyte
• Sexual abuse.

If your child is having constipation, try to understand what may be causing the constipation and help resolve it.

If in a newborn baby (only a few days old), discuss with your doctor immediately. Constipation in this age group if on breast milk may be due to a medical problem.

Symptoms of Infant Constipation

• Difficulties with pooping, including poop avoidance and crying during the process leading to a vicious cycle, propagating infant constipation

• Abdominal pain - usually central or left side abdominal pain

• Loss of appetite for food

• They may even vomit

• Recurrent passage of wind (farting) - with very offensive odour

• Passage of small loose watery stools after days of distress and not opening bowel

• Feeling unhappy and generally unwell

If you think your child may be suffering with troublesome constipation, see what treatments may help with this.

Treatment of Infant Constipation

• For a newborn baby of age 0 to 3 months, who is bottle fed, the first step to remedy constipation is to give water generously in-between feeds

• For children just weaned, they may settle to become used to their new meal. They may otherwise need more fiber rich diet.

• In a older child, a diet rich in fiber is highly recommended, containing pulses, vegetables, oats, beans, and fruits.

With non medical constipation, good potty training, encouraging the child to drink liquid that has some bulk to it like corn syrup, or fruit juice may help.

Karo, Movicol, Senna and Lactulose could be used at the advice of a qualified medical doctor. Always check from your doctor. Infant constipation do not usually require laxatives initially.

Where treatment is required, lactulose oral laxative is the recommended drug of first choice. This can be used in babies one month and older.

• For an infant 1 month to 1 year, lactulose at a dose of 2.5mL can be given twice a day and can be increased to 5mL twice a day in children older than 6 months of age, if the desired effect was not achieved.

• The best time to give lactulose is usually in the morning and at night

• It may take 2 to 3 days before the desired effect is achieved.

If no effect after increasing the dose of lactulose, the next medicine recommended by doctors is movicol. This is only licensed for use in chronic constipation above age 2 and for faecal impaction above age 5. Infant Constipation Misery? Get lactulose or movicol from Express Chemist They deliver medications world wide.

If your child suffers with severe constipation and you looking for further expert information, Dr. Anthony Cohn's (a Consultant Paediatrician working in Hertfordshire and London) book: Constipation, Withholding and Your Child: A Family Guide to Soiling and Wetting is a must read. It deals with diet, habits, medications, and subtle causes of infant and childhood constipation many many mothers have found useful. Click on the link above to get it from amazon.

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