Causes for constipation in newborns

Constipation in infants and children: MedlinePlus Medical Encyclopedia

Constipation in infants and children occurs when they have hard stools or have problems passing stools. A child may have pain while passing stools or may be unable to have a bowel movement after straining or pushing.

Constipation is common in children. However, normal bowel movements are different for each child.

In the first month, infants tend to have bowel movements about once a day. After that, babies can go a few days or even a week between bowel movements. It's also difficult to pass stools because their abdominal muscles are weak. So babies tend to strain, cry, and get red in the face when they have a bowel movement. This does not mean they are constipated. If bowel movements are soft, then there is likely no problem.

Signs of constipation in infants and children may include:

Being very fussy and spitting up more often (infants)
Difficulty passing stools or seeming uncomfortable
Hard, dry stools
Pain when having a bowel movement
Belly pain and bloating
Large, wide stools
Blood on the stool or on toilet paper
Traces of liquid or stool in a child's underwear (a sign of fecal impaction)
Having less than 3 bowel movements a week (children)
Moving their body in different positions or clenching their buttocks

Make sure your infant or child has a problem before treating constipation:

Some children do not have a bowel movement every day.
Also, some healthy children always have very soft stools.
Other children have firm stools, but are able to pass them without problems.

Constipation occurs when the stool remains in the colon for too long. Too much water gets absorbed by the colon, leaving hard, dry stools.

Constipation may be caused by:

Ignoring the urge to use the toilet
Not eating enough fiber
Not drinking enough fluids
Switching to solid foods or from breast milk to formula (infants)
Changes in situation, such as travel, starting school, or stressful events

Medical causes of constipation may include:

Diseases of the bowel, such as those that affect the bowel muscles or nerves
Other medical conditions that affect the bowel
Use of certain medicines

Children may ignore the urge to have a bowel movement because:

They are not ready for toilet training
They are learning to control their bowel movements
They have had previous painful bowel movements and want to avoid them
They don't want to use a school or public toilet

Lifestyle changes can help your child avoid constipation. These changes can also be used to treat it.

For infants:

Give your baby extra water or juice during the day in between feedings. Juice can help bring water to the colon.
Over 2 months old: Try 2 to 4 ounces (59 to 118 mL) of fruit juice (grape, pear, apple, cherry, or prune) twice a day.
Over 4 months old: If the baby has started to eat solid foods, try baby foods with high-fiber content such as peas, beans, apricots, prunes, peaches, pears, plums, and spinach twice a day.

For children:

Drink plenty of fluids each day. Your child's health care provider can tell you how much.
Eat more fruits and vegetables and foods high in fiber, such as whole grains.
Avoid certain foods such as cheese, fast food, prepared and processed foods, meat, and ice cream.
Stop toilet training if your child becomes constipated. Resume after your child is no longer constipated.
Teach older children to use the toilet right after eating a meal.

Stool softeners (such as those containing docusate sodium) may help for older children. Bulk laxatives such as psyllium may help add fluid and bulk to the stool. Suppositories or gentle laxatives may help your child have regular bowel movements. Electrolyte solutions like Miralax can also be effective.

Some children may need enemas or prescription laxatives. These methods should be used only if fiber, fluids, and stool softeners do not provide enough relief.

Do NOT give laxatives or enemas to children without first asking your provider.

Call your child's provider right away if:

An infant (except those who are only breastfed) goes 3 days without a stool and is vomiting or irritable

Also call your child's provider if:

An infant younger than 2 months is constipated
Non-breastfeeding infants go 3 days without having a bowel movement (call right away if there is vomiting or irritability)
A child is holding back bowel movements to resist toilet training
There is blood in the stools

Your child's provider will perform a physical exam. This may include a rectal exam.

The provider may ask you questions about your child's diet, symptoms, and bowel habits.

The following tests may help find the cause of constipation:

Blood tests such as a complete blood count (CBC)
X-rays of the abdomen

The provider may recommend the use of stool softeners or laxatives. If stools are impacted, glycerin suppositories or saline enemas may be recommended also.

Irregularity of bowels; Lack of regular bowel movements

Constipation - what to ask your doctor
High-fiber foods

Sources of fiber
Digestive system organs

Kwan KY. Abdominal pain. In: Olympia RP, O'Neill RM, Silvis ML, eds. Urgent Care Medicine Secrets. Philadelphia, PA: Elsevier; 2018:chap 19.

Maqbool A, Liacouras CA. Major symptoms and signs of digestive tract disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 332.

National Institute of Diabetes and Digestive and Kidney Diseases. Constipation in children. www.niddk.nih.gov/health-information/digestive-diseases/constipation-children. Updated May 2018. Accessed October 14, 2020.

Updated by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Symptoms, Treatment and When to Call a Doctor

Nationwide Children’s Hospital

Constipation (con-sta-PA-shun) in infants can worry parents. Most of the time, your baby is not really constipated. They may not have developed a routine for pooping yet. Some babies do not develop a bowel movement (BM) pattern for a while.

An infant’s BM pattern can change if their diet changes, like switching from breastmilk to formula, starting solid foods, or drinking less formula than usual. If your baby’s stool (poop) is not soft or easily passed, then they may be constipated.

In rare cases, constipation may be caused by a lack of nerves going to the intestines or by a problem with the way the intestine formed at birth. Your baby can be tested for these conditions if your health care provider feels it is needed.

Signs of Constipation

less stools than their usual pattern
straining more than normal to have a bowel movement
a change in how the stool looks from soft and mushy to:
- small, hard pebbles, or like a large, round golf ball
- loose and watery
abdomen (belly) bloated or swollen with gas
painful cramps

Treatment

If your baby is not eating baby food yet, you may give 1 to 2 ounces of 100% fruit juice (pear, prune, cherry, or apple) once a day. Stop the juice if their stools become too loose.
If they are old enough to eat baby foods, feed them pureed pears, peaches, or prunes instead of giving them juice.
If your baby eats cereal, it may help to give oatmeal, wheat, or barley cereal. Rice cereal can cause constipation in some children.
Sometimes giving your baby a warm bath to relax them or exercising their legs, like riding a bicycle, will help stimulate the bowels to move (Picture 1).
If it has been a few days since your baby has pooped and the juice or pureed food has not worked, then you can try a glycerin suppository. Place your baby on their back. Gently push the suppository into their anus (bottom). Suppositories are meant for occasional use.
Contact your baby’s health care provider before giving them laxatives, baby mineral oil, or enemas to treat constipation.

Medical Therapy

Your child’s health care provider may order the following treatments:

Give your child medication.
Check your child’s temperature using a digital, rectal thermometer. Put a small amount of petroleum jelly (Vaseline®) on its tip before inserting into the rectum. Taking a rectal temperature may stimulate the baby to pass stool.

When to Call the Health Care Provider

Call the health care provider if any of the following occurs:

Your baby is irritable and seems to be having stomach pain. Infants will pull their legs up to their stomach and cry when they are in pain.
Your baby has constipation and develops vomiting, and their belly looks like it is bloated or filled with gas.
You see blood in their stool.
Their constipation does not get better with treatment.

If you have any questions or concerns, call your baby’s health care provider.

Constipation: Infant (PDF), Spanish (PDF), Somali (PDF), Arabic (PDF), Nepali (PDF)

Constipation in a baby - what to do, causes and symptoms of constipation in a baby

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Articles

Constipation in infants: causes and treatment For this period (at least the first 6 months), breastfeeding is recommended, which is able to fully meet the needs of the infant until the introduction of complementary foods. However, for various reasons, breastfeeding can be replaced with artificial. nine0014

There have been many comparative studies of breastfeeding and artificial feeding. Most pediatricians still insist on breastfeeding the baby, but, as experience shows, it does not guarantee complete health, and even with breastfeeding, problems with the digestive system can be observed. One of the most common problems parents face is constipation in babies. The causes of this condition can often be due to the physiological characteristics of the infant's digestive system, but are often pathological. Therefore, it is very important to pay attention to constipation in infants in time and consult a doctor. nine0003

Further in the article, we will consider such issues as: the causes of constipation in infants, the treatment of constipation, as well as the symptoms and why constipation occurs with different types of feeding.

Causes of constipation in babies

Before listing the causes of constipation in infants, you should familiarize yourself with the features of the structure and functioning of its digestive system. This will help you better understand why a baby is constipated.

The first feature of the digestive system of infants is the small size of the stomach (in the first month of life its volume is about 100 ml, and then gradually increases) and its horizontal arrangement . Food in infants is delayed for about 2.5-3 hours, and with artificial feeding - a little longer. But the main feature that contributes to the development of such a problem as constipation in an infant is a long intestine and weak abdominal muscles. nine0003

So, normally, the frequency of stool in infants of the first year of life can coincide with the frequency of feeding (up to 6 times). With age, it decreases and by the time of the introduction of complementary foods it is approximately 2 times a day, and in children on artificial feeding - 1 time per day. Normally, babies have mushy feces.

Constipation is considered to be: if the interval between defecation acts in an infant increases, if the emptying is systematic, but insufficient, and the feces themselves are not mushy, but dense, fragmented. nine0014

It is customary to talk about constipation in children under 3 years old if the number of bowel movements is less than 6 times a week.

The most common causes of constipation in infants are as follows:

Genetic predisposition.

Perinatal encephalopathy, for example, as a result of hypoxia, or trauma (cerebral palsy).

Incorrect daily routine and nutrition of a nursing mother.

Violation of feeding and drinking regimen. nine0047
Congenital pathology and developmental anomalies.

Immaturity of the digestive system of the baby.

Violation of intestinal microbiocenosis.

Use of certain medications.

Metabolic disorders.

Diseases of the spinal cord.

Grischsprung's disease, etc.

What causes constipation in babies with different types of feeding

Above were listed the main reasons why the baby has constipation. As you can see, such a problem can arise regardless of the type of feeding - constipation is often found in infants on breastfeeding, on mixed and even on completely artificial. nine0003
Constipation can occur during breastfeeding due to various causes, including:

Excess consumption of animal fats by a nursing woman (butter, pork and other fatty meats) and lack of fermented milk products, dietary fiber in the diet.

Underfeeding or overfeeding a child.

Maternal hypogalactia.

The presence of defects in the oral cavity of the baby, sluggish sucking, regurgitation. nine0047
Dehydration (non-compliance with the drinking regime, fever, etc.).

Lactose intolerance.

Breastfeeding mother taking certain medications.

Very often there is constipation in infants on mixed feeding. The reasons for this may lie in the following:

Mixture too thick.

Incorrect mix.

Non-compliance with the drinking regime, etc.

Very often, constipation develops after the introduction of complementary foods, especially if the first complementary foods were introduced abruptly and in large quantities.

What foods can cause constipation in babies? The development of constipation can provoke the introduction of cereals and solid foods, applesauce, pear puree, pasta, eggplant, fatty meats, eggs, caffeinated foods, etc. into the baby’s diet.

Symptoms of constipation in an infant

Constipation in a baby for a long time may not attract the attention of parents. First of all, this may be due to the lack of ideas about how many times a day a baby should have feces and what kind of character it should be. With a problem such as constipation in infants, the symptoms may be mild, and often accompanied by non-specific symptoms. So, when can you suspect constipation in the baby? nine0003
The symptoms of constipation are as follows:

Decrease in the number of bowel movements (less than 6 times a week).

The baby often cries for no apparent reason and pulls his legs up to his stomach;

Stool formed, hard, fragmented, dry;

The child is not gaining weight;

Stone anointing.

Rumbling in the abdomen, increased flatulence.
nine0046 Signs of inflammation or irritation around the anus.
Sleep disturbance.

If defecation occurs less frequently than usual, but the child eats well, is not naughty, none of the above is observed, then the infant is most likely not constipated. But what if the baby is still constipated?

What should I do if my baby is constipated?

Many parents do not know what to do if the child has constipation, although they can recognize it on their own. First of all, it is necessary to review the diet of the baby and the nursing mother, exclude foods that contribute to constipation, adjust the frequency and volume of feedings, and establish a drinking regimen. nine0003
If this does not help, then you should definitely seek the advice of a pediatrician, and not treat constipation in infants on your own.

How and how to treat constipation in infants

Before treating constipation in infants, you should definitely consult a doctor, undergo the necessary examinations to exclude organic pathology.

So, how to treat constipation in infants? In most cases, constipation in infants is physiological, that is, due to the anatomical and physiological characteristics of the baby's digestive system, the nature of his feeding. nine0025 With this in mind, the treatment of constipation in infants is as follows:

Correction of the diet of a nursing woman and baby.

Correction of the baby's drinking regimen.

Prescription of probiotics.

Appointment of a course of massage and gymnastics, which improve intestinal motility.

In the absence of effect and as directed by a doctor, osmotic and volumetric laxatives, as well as emollients, may be prescribed. nine0003
What to do with constipation in a newborn?

Constipation in a newborn or infant is an extremely unpleasant problem for parents. And it is not always possible to quickly determine what is the cause of constipation in an infant. Most often, problems with bowel movements in babies are functional in nature and are directly related to the nutrition of the child.

Signs of constipation in a child of the first year of life

Infrequent dry and hard stools

Sleep disorder

Restless state

Pungent odor of feces and flatus

Causes of constipation in a newborn child

Causes of constipation in newborns and infants, as a rule, are not associated with a serious pathology of the internal organs or the central nervous system. The main cause of constipation in a baby is malnutrition, early transfer of a child to supplementary feeding with infant formula, frequent changes in products during artificial feeding.

When breastfeeding, the formation of constipation in children of the first year of life is affected by poor nutrition of the mother, for example, the use of large amounts of animal fats and a lack of fiber in the diet. One possible cause of constipation in newborns is dehydration. nine0003
What to do if a child has problems with stool

If a child under one year old has acute constipation and has anxiety, straining and arching, we actively massage the abdomen in a clockwise direction so that hand marks remain on the skin (but not bruises!) . We spread it on the stomach, do the exercise - legs to the head, children under one year old can massage the anus, if all this does not help - a children's candle with glycerin from the refrigerator.

If such situations are repeated often - a mandatory consultation with a pediatrician. nine0047
When introducing complementary foods to a baby with a tendency to constipation, first introduce fruits and vegetables into the diet.

If the child is older than a year and the process is chronic - evaluate nutrition - whether there are the necessary 5 servings of vegetables and fruits per day (portion - from the palm or fist of the baby). Estimate - how much water does the child drink per day? Is there enough physical activity during the day? What is the psychological climate in the family and the attitude - not to demand a chair from the child, not to swear and not to shout, not to discuss problems with other people in his presence, not to force him to sit on the potty, not to scold him for dirty panties when anointing. nine0047
It is better to choose laxatives based on macrogol or lactulose with the help of a doctor.

In parallel with laxatives, we conduct psychological work with the child at home and with a specialist - books about defecation, toilet games, etc.

In what case should you be very worried about constipation in a child? Namely:

if there is no meconium discharge in the first days of life; nine0047
retardation and constipation;

vomiting and tense abdomen;

blood in stool;

changes in hair growth and pigmentation of the sacrum and coccyx,

violation of the development of the sacrum;

changes in the anus - fistulas with discharge, hematomas, inflammation;

change in the muscular skeleton of the anterior abdominal wall - lack of muscles or insufficient development.

If a baby up to a year old is breastfed for several days (3-5 days, but not weeks!) Does not poop and does not worry - if he is cheerful and cheerful, eats well, does not spit up and does not stain the diaper, and farts well, in this no parental intervention required! The stool should be soft and not cause trouble during bowel movements. nine0003
In the treatment of constipation, toilet training is important - every day at the same time, preferably after eating and drinking - calmly and kindly go to the potty (if the toilet is, then there should be a support under the feet so that the knees are above the level of the priests) and try to poop. If there was no stool for several days, you can pre-put a glycerin suppository.

In the presence of painful defecation, fissures and blood, urgently show the child to a doctor (gastroenterologist or proctologist) and start treatment - local baths, suppositories and laxatives are applied. This is absolutely necessary in order to soften the stool and prevent the formation of persistent fear of defecation, which is then very difficult to remove.
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