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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)

HH-I-14 ©Copyright 1984, Revised 2022, Nationwide Children’s Hospital

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Constipation in children under one year old

Usually, parents of babies are worried about the exact opposite problem - too frequent stools. Therefore, not everyone immediately understands what to do if a baby under one year old has constipation.

Gastroenterologist, hepatologist at GMS Clinic Sergey Vyalov gave an interview to the Internet portal parents.ru and spoke about constipation in children under one year old.

Introduction

Constipation, also known as diarrhea, stool retention, discolia, caprostasis, difficulty in emptying the bowel is not a universal condition with unambiguous characteristics. Each person, including a child, has his own indicators of the norm and deviations from it, associated with age, intestinal microflora, diet, state of mind and hormonal background, concomitant diseases. Yet there are a few common points of reference.

What is constipation?

Specialists diagnose constipation if the baby does "big" things:

• regularly and without problems, but passing dry and hard stools;
• with difficulty - the child has to push, the feces do not come out on the first try;
• less than 5 times per day.

In the first six months of life, constipation is a rather rare occurrence, rather, on the contrary, in the period from 0 to 6 months, 6-10 bowel movements per day are considered the norm. Breastfed babies have more frequent bowel movements, while artificial babies have less.

Up to 6 months constipation is rare

Usually, parents of babies in the first months of life are alarmed by the condition opposite to constipation - too frequent bowel movements. But in a baby, regardless of whether he eats breast milk or formula, the intestines should work exactly like this - in a mode that is considered diarrhea for older children and adults.

There should be no other option, at least until the introduction of complementary foods at 4-6 months. After all, the baby receives mostly liquid food, the waste products of which have the same consistency and leave the intestines without encountering any obstacles on the way - the baby has not yet learned to control the sphincter that restrains the release of feces.

The baby's intestines have just begun to "get acquainted" with microorganisms that come from mother's milk, from her skin (the baby licks the nipple), from the environment. Far from all new "partners" are accepted: there are rejected ones, those who have not taken root, and so on. Checking and rejection are accompanied by loose, unstable stools.

Too frequent bowel cleansing does not need correction and treatment if the child is gaining weight and developing properly. Normal appetite and sleep, gas, absence of fever and other signs of illness indicate that parents have nothing to worry about. If the mother of a baby, tired of changing diapers 10 times in one day, wants to change the situation and asks the doctor to prescribe fixing medicines for the baby, then, unwittingly, she will doom her baby to chronic constipation.

Not according to the rules

And yet, in the first 6 months, constipation in infants is not excluded. It can be called:

• microflora transmitted from the mother;
• insufficient fluid volume;
• stress.

Let's say a woman has too many methane-producing bacteria in her stomach and intestines that cause constipation. They grow rather slowly, ferment, releasing carbon dioxide, which contributes to flatulence and bloating. With this deviation, the woman lives, adapted and learned to solve the problem with the intestines in one way or another. Noticing the same thing in a child, she decides that the baby has inherited her features and "saves" him with the same means, making a mistake. Babies should not be given laxatives, especially those containing senna. The baby's body gets used to such drugs too quickly and without them it can no longer cleanse the intestines.

Constipation in a baby up to 6 months is also provoked by a lack of fluid and hormonal fluctuations. At 6 months, the baby should receive a lot of moisture - about 140 ml per kilogram of weight per day. A breastfed child gains this rate from mother's milk and does not need additional sources of liquid (but only if there is no predisposition to constipation). Little artificers are soldered from the moment they switch to a mixture.

If a woman is tense or nervous, then her level of the stress hormone cortisol rises. Through breast milk, saliva or sweat, the substance enters the baby's body and also provokes constipation.

Even if the mother does not breastfeed the baby, the constipating microorganisms sooner or later get to the gastrointestinal system of the crumbs and make negative changes in it.

Constipation after introduction of complementary foods

The kid is growing, improving his skills, and it's time to introduce him to new foods. These circumstances, on the one hand, help to establish peristalsis, and on the other hand, increase the risk of constipation.

By six months, the baby is already trying to control defecation, because he realized that after it there are unpleasant sensations - itching, burning and other discomfort in the areas where the feces get. In order not to experience discomfort, the child tries to restrain the urge. At first, he does not succeed, because the rectum has already learned how to work - reflexively contract and push out waste. And after a couple of months, everything works out, the baby wins and enters the path leading to chronic constipation. To get the baby out of this vicious circle, the mother must minimize the duration of the baby's skin contact with feces and expand the baby's diet by mastering complementary foods.

Proteins, fats and carbohydrates that are part of the products are absorbed in the small intestine, and do not reach the large intestine, where feces are formed. What can not be said about fiber. While the baby is drinking breast milk or formula, this component of the dishes is not familiar to him. Even if a nursing woman herself consumes a lot of plant foods, the baby does not get anything. Fiber, as already noted, is not absorbed in the intestines, does not enter the bloodstream, which means that it is not in breast milk. For the first time, a baby gets fiber with complementary foods by trying its first 25 grams of mashed potatoes from zucchini, carrots and other vegetables. Plant fibers literally attract all waste to themselves, as a result, fecal masses are formed, which help the intestines to master the correct peristalsis. There are a lot of muscles in this section of the gastrointestinal tract, in the intestines, they must learn to consistently contract - tighten and relax in order to squeeze waste out.

The next new product should be introduced one month after the previous one. The novelty is likely to cause more frequent and loose stools at first. If it does not have a green color and does not foam, there is no need to run to the doctor and ask to prescribe fixatives. Be patient, after a while the innovation will be mastered and will bear fruit. Instead of liquid and shapeless yellow-white feces, you will see brown feces that have formed.

Special constipation

There are other causes of constipation in babies. Unfortunately, they are much more difficult to deal with, since these are developmental pathologies, diseases, and injuries.

Acute constipation. It develops for anatomical reasons, for example, due to obstruction of the large intestine, or during intussusception - the introduction of one part of the intestine into another, which causes blockage of the lumen. Against the background of complete well-being, the baby suddenly becomes restless, cries, refuses to eat. The attack ends as unexpectedly as it began, but after 3-5 minutes it repeats and intensifies: one or two times vomiting appears with an admixture of green bile. If the stool passes, then blood impurities are visible in it. After 5–6 hours, the stool stops, and bloody discharge comes out of the rectum. At the same time, the baby's stomach is soft. The temperature is usually normal. The child may even lose consciousness. With such symptoms, you need to call an ambulance.

Hirschsprung disease. It is based on a violation of the innervation of the large intestine - the central nervous system cannot control this section of the gastrointestinal tract. As a result, processed food accumulates in the intestines. The picture of the disease is quite diverse. If only the short part of the intestine is affected, then constipation forms gradually, and it is possible to do without surgical intervention for quite a long time. When a longer segment is affected, the absence of stool is fraught with a serious condition and immediate surgical intervention is required.

infectious attack. If in the first months of life the baby suffered an intestinal infection, the nerve cells in the large intestine may die, which will lead to a delay in the act of defecation, accumulation of feces and the development of constipation. With dysentery, the so-called toxic megacolon is possible (a sharp expansion of the colon). The child develops impaired consciousness and repeated vomiting. The abdomen increases sharply due to a greatly enlarged intestine. The complication requires emergency surgical care.

Problems with the CNS. Injuries during childbirth and the syndrome of infantile cerebral palsy also affect the functioning of the gastrointestinal tract, as they are associated with various complications, such as impaired swallowing, regurgitation, and vomiting.

Vasculitis. Vascular inflammation extends to the nerve plexuses and sensitive cells located in the intestinal wall.

Disorders in the work of the endocrine system. With hypothyroidism (lack of thyroid function), the movement of contents through the intestines slows down. With dysfunction of the parathyroid glands, constipation occurs due to a violation of mineral metabolism, with diabetes mellitus it becomes the result of damage to the nerve plexuses of the intestine or dehydration of the child's body.

Medical constipation. Before giving your child any drug prescribed by a doctor, carefully read the instructions. For example, anemia remedies containing iron can cause constipation. Observance of the rules of intake will help to avoid it - directly during meals, reducing doses of iron when introducing foods with a high iron content into the diet - buckwheat, apples, greens. Particular attention should be paid to constipation resulting from treatment with non-steroidal anti-inflammatory drugs, neuroleptics, sorbents and antibiotics, which cause intestinal dysbacteriosis.

Diseases and conditions accompanied by constipation are not so common in infants. Many pediatricians do not immediately remember them. Before getting to the truth, they prescribe a lot of unnecessary drugs, forgetting about effective bowel examinations, such as x-rays.

Source: parents.ru

Child constipation | Clinic Expert

Normal stool is a necessity not only for adults, but also for children. When can you say that a child has a regular bowel movement? Are there constipations with artificial feeding? We are discussing the topic of constipation in children with the gastroenterologist "Expert Clinic" Tula Saltymakova Yulia Anatolyevna.

Normal stool is a must not only for adults but also for children. When can you say that a child has a regular bowel movement? Are there constipations with artificial feeding?

We are discussing the topic of constipation in children with the gastroenterologist "Expert Clinic" Tula Saltymakova Yulia Anatolyevna.

- Yulia Anatolyevna, sometimes behind this or that problem it is not she who is hiding at all, but the anxiety of the mother, who "has big eyes from fear." How to understand that a child has constipation?

First of all, focus on how often the child goes to the toilet "in a big way". There is, for example, some controversy in the pediatric community about the frequency of stools in children under one year of age. Some say that if the baby goes to the toilet every two or three days, then this is the norm. I believe that this is not so, and the chair in this age range should be at least once a day, regardless of the type of feeding. If the chair is not daily, but, say, every other day, and this does not bother the child in any way, you still need to see a pediatrician and try to figure it out.

Normal stool frequency in a child
after two years - from 1 time per day
up to 1 time in 36 hours

- In turn, how to determine that there is normal bowel function in children? How many times a day should a child have a chair?

Up to two years, the frequency is the same, i. e. 1 per day. After 2 years and beyond (including adults) - 1 time per day or every other day, or rather - 1 time in 36 hours. At the same time, the consistency of the stool is also important: it should be soft, and the baby should not have any discomfort, much less fear of defecation. In other words, if everything is fine in time, but the first portion of feces is dry, the child is in pain, he worries or cries, hides, avoids sitting on the potty when he needs to have a bowel movement - this is definitely not normal and requires a mandatory visit to the doctor.

- At what age are children most vulnerable to constipation?

Up to one and a half years, as well as in adolescence.

- What causes constipation in children?

Up to 1.5-2 years, these are more feeding defects: thicker mixtures, their change, introduction of complementary foods, lack of water for the baby.

Constipation can also be an allergy to cow's milk, curds, yoghurts. In this case, the amount of consumed milk and products from it matters, i.e. constipation can develop with excessive consumption of them.

In adolescence, a tendency to constipation may develop due to hormonal changes in the body. It can also lead to them and deficiency in the body of iodine.

Read more about iodine and its lack in the body here

Constipation is possible with fever, lack of fluid intake, dry food.

Also, constipation can be a sign of diseases of the gallbladder, neoplasms in the intestines.

- Nutrition is an important factor for proper bowel function. How should I feed my baby in order to reduce the likelihood of constipation?

To avoid them, you need to diversify your diet. What can and should be eaten? These are, of course, cereals, but it is important to know which ones. For example, rice and semolina are foods that have a "fixing" effect and cause constipation. To cereals with a laxative effect include herculean and buckwheat. Porridge should be on the table every day.

The next element is vegetables, preferably boiled (so they are easier to digest, and the fiber in them creates the volume of feces necessary for normal bowel contraction). Fruit is also required.

Soups must be included in the daily diet, even if it is only a few spoons a day.

But bakery products should be limited: they do not provide the necessary volume of intestinal contents, and sweet ones also “interrupt” the appetite due to “fast” sugars. As a result, the child does not eat normal food, and the intestines have nothing to move.

Sweets, milk chocolate, glazed curds, curd masses, sweet yoghurts can also lead to constipation.

- Tell us more about psychological constipation. What causes them?

The cause of such constipation is the pain that the child suffered during the act of defecation. For example, this is possible if the feces were dense, dry. Moreover, even one such episode may be enough to form a fear of the act of defecation. Sometimes feces slightly injure the rectal mucosa, leading to the formation of an anal fissure. It does not heal immediately, and therefore the subsequent trip to the toilet may also be accompanied by pain.

When should I see a coloproctologist? Read more here

As a result, when the child feels another urge to defecate, he begins to worry, may cry, hide, pinch the buttocks, suppressing bowel movements. Moreover, this is possible even when the feces are already of a normal consistency, i.e. soft. Those. in this case, the act of defecation is prevented not by hard feces, but by the fear of the act of defecation itself. The child often manages to suppress it, which in the end only exacerbates constipation, since the liquid part of the stool is absorbed by the intestinal mucosa, and they thicken.

This is a serious problem. Sometimes it requires not only the help of a gastroenterologist, but also the intervention of a psychologist, a neurologist.

- Yulia Anatolyevna, what threatens constipation to the child's body? What could be the consequences?

There are several of them. Firstly, it is intoxication, i.e. the entry of toxins from the feces into the blood. In particular, it can be expressed in the form of a rash, peeling on the skin.

Anal fissures can also form as a result of trauma to the rectal mucosa from hard feces. In children under two years of age, the mucous membrane of the rectum itself may even fall out when straining.

Constipation leads to problems with the gallbladder. Possible deterioration of its contractility, the appearance of sediment in the bile.

Against the background of long-term, chronic constipation, the function of the overlying intestines, as well as the stomach, may suffer. This, for example, is described in adolescence. Therefore, belching, heartburn can be the result of prolonged constipation.

Possible formation of fecal conglomerates in the intestine.

Children's constipation is dangerous and the likelihood of developing such a serious surgical pathology as intussusception, intestinal obstruction.

- Are there over-the-counter medicines that can help children with constipation?

Yes. The safest, most affordable means for the treatment of childhood constipation are lactulose preparations, which are produced under different names. This is a synthetic carbohydrate. There are both foreign and domestic drugs. It must be remembered that in very young children, lactulose can significantly increase intestinal bloating.

- Some mothers use the old method of "helping" their baby to empty their bowels - a bar of soap. How safe is it?

This is harmful and dangerous. Soap is alkaline and irritates the rectal mucosa. Today, there are enough safe products on the pharmaceutical market (in particular, those that I spoke about earlier), and the use of soap is a completely unreasonable and harmful practice.

- You said that constipation can be not only a harmless symptom, but also a sign of serious illness. How can parents understand when they can help their child on their own, and when it is necessary to see a doctor?

If constipation occurred, which was quickly eliminated, for example, by optimizing nutrition, lactulose, then you do not need to sound the alarm right away. However, if it does not respond to treatment, the child is afraid of defecation, complains of pain in the abdomen before or after defecation, blood appears in the stool, then any of these signs is an unconditional reason for contacting a doctor.

- What diagnosis should a child undergo if he suffers from constipation?

General blood count, coprogram and stool analysis for dysbacteriosis are performed from laboratory tests. Of the instrumental - ultrasound of the abdominal cavity, distal intestines.

More about dysbiosis can be read here

Enver Aliyev

The editorial office recommends:

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For information:

Saltymakova Julia Anatolyevna

Graduate of the Pediatric Faculty of the Tver State Medical Academy in 2003.

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