Infant Constipation

Causes, Diagnosis And Treatment of Constipation In Babies Under 1 Year of Age

Infant constipation or constipation in babies under 1 year of age and especially constipation in babies on formula milk are not uncommon. What are the causes of constipation in this age group, what exactly is constipation and what are the treatment options for a baby with constipation?

Infant Constipation A Few days After Birth

It could be quite frustrating to watch your child groan in pain, as they try to open their bowel or poo. It is even more so to watch this happen in a newborn or a child only a few days or weeks old.

It is important that a baby with constipation should be recognized and treated early to prevent avoidable suffering and other complications like urinary tract infection, poor appetite and thus interference with healthy growth.

It is also very important that any child with constipation should be properly examined to exclude serious causes of constipation, which may require specialist treatment.

What Is Constipation

Constipation is not just the passage of stools infrequently, or a reduction in the number of soiled nappies. A child less than 12 months old is constipated if there are two or more of any of the following:

  • Fewer than three stools in a week
  • Passage of hard formed large stools or small pellets of tools that looks like "Rabbit droppings"
  • Distress on passing stool, like grunting or crying. It is normal for newborn babies to grunt and strain, with their face going red when passing stool. It is only a problem if this happens with the passage of hard stools or blood in the nappy
  • Blood in nappy associated with passage of hard stools
  • Difficulty in passing stools in a child known with constipation in the past.

So what if my child is not passing stools frequently? What is the normal frequency to be expected in children under age 1?

Normal Frequency Of Bowel Movement In Children Under A Year Old

Understanding what a normal bowel movement in a baby is, is very important because healthy infants do have a very wide range of variations in the frequency at which they open their bowel or poo. Such variation is influenced by the child's age, type of diet they are having, as well as associated social habits.

Breastfed babies usually open their bowel with each breast feeding, and could pass stool up to 5 times a day. Constipation is very rare in exclusively breastfed babies.

Bottle fed babies on the other hand can pass stool only once or twice a day or even once every two or three days, and this is still considered normal for them.

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.

The following are the normal frequency of bowel movements in children under 1 year of age:

  • Newborns. From age 0 to 3 months, breast feed babies are expected to open their bowel from 3 to 5 times a day, and bottle feed babies are expected to open their bowel from 1 to 3 times a day or less
  • Age 3 to 6 months. At this time, most kids would already have had formula milk introduced. The frequency of bowel movement at this age could be from zero a day up to four times a day, or as low as twice a week.
  • 6 to 12 months. The frequency of bowel movement in a child aged 6 to 12 months should be anything from zero to three times a day or three or more times a week.

Symptoms Of Infant Constipation

The symptoms of constipation in infants will depend largely on how old they are.

Constipation: First Few Days Of Life

Most children especially those born after 37 completed weeks of pregnancy, should poo within a day. Their stool colour is normally tarry black to dark green. This is normal, and it is called meconium stool. They could pass stools up to 6 times a day in those first few days to a week.

  • If a newborn baby has not passed stool after two days of birth, it is important to get him or her seen by a doctor or appropriate healthcare provider.

After the first two days, most newborn babies will start passing normal coloured poo - cheesy yellow to greenish yellow.

  • If your baby is passing hard looking pellets of stools, with pain - crying or grunting excessively on passing stool, he or she must be suffering with infant constipation
  • If there is passage of hard stool with blood stain in the nappy or poop, then your child may be suffering with constipation too.

Constipation: Age 3 to 6 Months

The symptoms of constipation in a baby between the ages of 3 to 6montsh include:

  • Passage of hard large stools after a couple of days, associated with painful groaning
  • Poor feeding
  • The abdomen may become bigger than normal
  • Passage of small loose watery stools after days of not opening their bowel. Mothers and other caregivers may confuse this for diarrhoea. It is in fact called "over flow diarrhoea". The loose stool happens because in constipated individuals, because the bowel is not emptied, stool accumulate, and the bacteria in the stool starts decomposing the stool from the surface of the lump. This decomposed stool becomes liquid and flows out as if the sufferer has diarrhoea. This may also be seen as a very strong offensive smelling soiling of clothes or underwear
  • Restlessness
  • Vomiting.

Infant Constipation: Age 6 to 12 Months

Infant constipation becomes easier to identify in older children after the age of 6 months. By this time, they would have already establish a recognized pattern of bowel movement. They would have also been weaned from breast milk if breast fed, and now taking solid food. Symptoms of infant constipation at this age will therefore include:

  • Change in the frequency of passing stools to much less the normal frequency
  • Passage of flatus frequently with associated delay in bowel opening
  • Passage of large hard stools
  • Feeling unhappy and generally unwell
  • Child may exhibit features suggesting he or she has abdominal pain
  • May come down with urine infection
  • They may be passage of very offensive loose stools confused for diarrhoea.

What are the causes of infant constipation or constipation in babies less than a year old?

Causes Of Constipation In Infants

The causes of constipation in babies are often not very serious. It is important to assess every child with constipation to exclude the more serious causes of constipation that occurs in a few number of children.

Common causes of constipation include:

  • Bottle Or Formula Feeds - bottle fed babies more prone to constipation. This does not mean you have to stop formula feeds if your baby gets constipated. There are things that can be done to relief this problem
  • Excessive formula milk to water intake . This may be during the mixing of the formula feeds outside the recommended amount by the manufacturer, or to large volume of feeds for age
  • Fever and dehydration
  • Medications. Some kiddie’s medication like certain cough medicine can cause constipation. So too are medications use in treatment for reflux like gaviscon (contains aluminum), omeprazole and ranitidine
  • Narrow anus opening.

The less common and serious causes of constipation in children under the age of one year include:

  • Completely close anus
  • Under active thyroid from birth (hypothyroidism)
  • 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.
  • Down’s Syndrome
  • Cystic fibrosis
  • Prune belly syndrome
  • Diabetes
  • Lead poisoning
  • Reduced or excessive body electrolyte
  • Infantile botulism - causes constipation, poor feeding and weakness of teh muscles.

Worrying Features To Look Out For In Infant Constipation

This section deals with signs that signals that your child's constipation might be serious. If your child has constipation along with any of the following symptoms, you must seek immediate medical advice:

  • Constipation From Birth - not poo after day two of birth
  • Constipation with swollen abdomen and vomiting
  • Passing blood in stool
  • Tear or soreness around the anus
  • Looking unwell 
  • Reduced number of wet nappies in a day
  • Loss of strength or power in the legs or arms
  • Constipation with poor growth and development
  •  Constipation with lower back problems or rash or soreness.

While some of these symptoms of constipation may indicate something serious, it is not always so. But it is very important to be extra careful and get things checked.

Treatment Of Infant Constipation

For the more common causes of constipation in babies, these can be remedied by paying attention to the possible causes and treating accordingly.

  • For bottle fed infants on formula milk, constipation in first few days or weeks of life can be made better by giving water to the child in-between feeds. It is important to continue to feed your baby adequate amount of milk for his or her age.
  • While some infant feeding expert advocate switching types of milk, there is no scientific evidence that doing so will make a lot of difference to a newborn baby constipation. More water in between feeds will.
  • If your newborn baby is on certain medications like ranitidine, omeprazole and gaviscon for reflux, these could worsen his or hr constipation. Discuss with your doctor and see if you can with draw one or two of such medications to help
  • Maltsupex or Malt-supex (a malt-barley extract), Karo syrup (corn syrup) and Metamucil (psyllium powder) are non -prescription laxatives that some parents have found useful in the treatment of their infant constipation, especially for babies under a six months of age.
  • For older children already on solid food - from 6 months of age, introducing fibre rich diet will help with constipation
  • Natural laxatives like prune juice, peaches, pears or plum juices in small amount - teaspoonful for little babies has good bowel stimulating and moving effects
  • Flax oil. This is a top one for use for infant constipation. It helps lubricate teh bowel and move things. One teaspoonful once daily for children 3 to 6 months, and up to twice a day for children 6  to 12 months may help. For chidldren less than 3 montsh old, half a teaspoon once daily may help with infant constipation. 
  • Where everything fails, your doctor might prescribe Movicol, Senna, glycerine suppository and or Lactulose.

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 worldwide.

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.

Last Updated: 20th December 2012


Infant Constipation? have Your Say!

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