How to tell if your baby is constipated
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.
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Constipation in babies - causes, signs and treatments
Constipation in babies - causes, signs and treatments | Pregnancy Birth and Baby beginning of content5-minute read
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What is constipation?
Constipation is when your baby’s poo is hard and dry, making it difficult for them to poo. Sometimes, doing a hard poo can be painful. It’s common for babies to have constipation when they are changing from formula or breast milk to solid foods.
What is normal?
All babies are unique, and this includes how often they poo. There is a very wide range of ‘normal’. Some babies poo after every feed. Others will only poo once every few days. When it comes to how often they poo, once in 7 days, or 7 times in one day are both fine, so long as your baby is happy and well. But while the number of poos is not critical, if your baby seems to have pain when trying to poo or has a very hard, dry poo, you can speak with their doctor or child health nurse for advice.
Why is my baby constipated?
One of the main causes of constipation in babies is a change in diet. A change in diet may include:
- changing from being formula-fed
- changing from being breastfed
- exposure to new foods and flavours
- not drinking enough liquids (breastmilk, formula or water)
It is more common for bottle (infant formula) fed babies to have constipation than breast-fed babies.
If your baby has started eating solid food, a lack of fibre in their diet may also potentially cause of constipation. Some babies simply have a natural tendency towards constipation, even when they have a good diet and drink enough fluids. This doesn’t mean they are unhealthy or unwell.
Baby poo guide
Learn more about your baby's poo.
In extreme cases, rare illnesses can cause constipation such as:
- problems with nerve endings in the bowel
- problems relating to the spinal cord
- thyroid deficiency
- other metabolic disorders
All babies are checked for these conditions, so this is usually not something you need to be concerned about. But if you are worried about your baby or are notice that pooing is painful for them, seek medical advice.
How to recognise the signs of constipation
The main signs of constipation are hard, dry poos. The following are other signs of constipation:
- Your baby may show signs of straining when trying to pass a poo.
- Your baby may be unsettled, may seem fussy or irritated.
- Your baby may be eating less or feeding less well than usual.
- A tear or crack might appear in the skin around the anus, which may at times bleed.
In some cases, if your child is constipated, they may look bloated or their stomach may appear larger than usual. It can be possible to feel their poo (hard, solid lumps) while pressing softly on their stomach.
How to treat constipation at home
Try these tips to help babies who have difficulty passing poos:
- If your baby has infant formula, always measure the water first before adding the formula powder — this helps ensure that the ratio of water-to-formula is correct.
- If your baby is old enough to drink water, offer extra drinks (boiled and cooled first).
- Gently rub their stomach to help stimulate the bowel — your baby might also feel better with gentle massage to help manage the pain of constipation.
- A warm bath can help calm and settle your baby and relieve discomfort.
If your baby is older than 6 months, add some extra fruit and vegetables to their diet to boost their fibre intake.
If your child is older than 9 months, adding stewed prunes or apricots to their meal may help. They can have up to 3 tablespoons, 3 times a week. Cereal that has bran may also help mild constipation. Older babies can try prune juice diluted with water (half prune juice and half water). Start slowly, with 10 millilitres. Increase as needed until they can do a soft poo.
Does my child need to see a doctor?
Constipation is common. Often it will pass without intervention, or with the help of the strategies listed above. If you are worried that your baby has constipation, is uncomfortable or is in pain, their doctor can assess them and recommend baby-safe strategies. There are medical treatments for constipation that your doctor may consider, based on your baby’s circumstances.
If your baby was previously treated for constipation but still struggles to poo, it is important to go back to your doctor for a review. There are several treatments they can try.
Speak to a maternal child health nurse
Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.
Sources:
The Royal Children’s Hospital Melbourne (Kids Health Information 2020 - Constipation), Queensland Health (Constipation in children), Perth Children’s Hospital (Constipation in children)Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: September 2021
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Constipation in children. Prevention. Diet therapy
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Sabitova Vasily Ilyasovna Gastroenterologist
06/21/2019
Constipation is widespread among both adults and children (5-30% depending on the diagnostic criteria). Symptoms become chronic in more than 30% of patients, not only cause discomfort and pain to the child himself, but also disrupt the quality of life of his family. nine0003
CONSTIPATION - a condition manifested by an increase in the intervals between bowel movements (compared to the individual norm) or systematically slow, difficult and / or insufficient bowel movements. Constipation also includes stools with “gruel”, but after defecation was absent for up to 3 days.
Constipation can be related to functional or organic causes (abnormalities, inflammation). In children, 90-95% of constipation is functional. The peak incidence of functional constipation falls on 2-4 years, when they begin to accustom the child to the potty / toilet. nine0003
Main causes of functional constipation
- Pain
- Fever
- Dehydration
- Wrong diet of a nursing mother
- Insufficient drinking regime of a child with artificial feeding
- Insufficient drinking regimen of a breast-fed child with the introduction of complementary foods
- Early transition of the child to artificial feeding
- Fast transition of the baby from one mixture to another (less than 7 days)
- Irrational nutrition of the child (for a long time the child receives food with a large amount of proteins, fats and insufficient dietary fiber, abuse of drinks containing a large amount of astringents - tea, coffee, cocoa)
- Excessive use of baby hygiene products or the development of an allergic reaction of the skin of the perianal area
- Consequences of perinatal injuries of the nervous system
- Rickets, vitamin D deficiency
- Anemia
- Impaired thyroid function (deficiency - hypothyroidism)
- Food allergy, especially cow's milk protein allergy
- Forced potty training, period of adaptation to new conditions (nursery, kindergarten)
- Physical inactivity - a sedentary lifestyle
- Mental trauma or stress
- Systematic suppression of the urge to empty the bowels, associated, for example, with the beginning of attending a kindergarten, school, etc.
- Taking certain drugs
- Constipation in family members
Frequency of defecation in children of different ages
Age | Number of bowel movements per week nine0076 | Number of bowel movements per day |
0 – 3 months breastfeeding artificial feeding | 5 - 40 5 - 20 | 2.9 2.0 |
6 - 12 months | 5 - 28 | 1.8 | nine0081
1 - 3 years | 4-21 | 1.4 |
4 years and older | 3 - 14 | 1.0 |
In addition to the frequency of the chair, you should pay attention to its nature. For a more objective assessment, the “Bristol fecal shape scale” is convenient, since it is the shape of the feces, and not the frequency of the stool, that is more consistent with the time of intestinal transit. nine0003
Bristol stool chart
In accordance with this scale, 3 and 4 form of feces is regarded as normal, and 1 and 2 indicate delayed transit (constipation). Quite often, in practice, there are situations when a child has a bowel movement frequency within the normal range, but the stool is dense, fragmented, in a meager amount. These signs indicate incomplete emptying of the bowels and are considered as manifestations of constipation. nine0003
The consistency of the stool in newborns and infants should be mushy. From 6 months to 1.5 - 2 years, feces can be both formalized and mushy. From the age of two, the chair must be decorated.
Signs and symptoms of constipation
- abdominal pain, often bursting, aching, sometimes colicky
- bloating
- change in the shape and consistency of the stool nine0027 excessive flatulence
- unpleasant smell of flatus and stool
- may have pain during bowel movements
- straining during bowel movements
- there may be blood in the stool - on the surface of the feces or in the form of traces on a napkin (indicates an anal fissure)
If you do not eliminate constipation and do not establish bowel movements, then there is a risk of coprostasis (formation of fecal stones) and fecal intoxication:
- loss of appetite
- lack of energy
- general malaise
- depression, irritability
- nausea, vomiting
- skin symptoms - dryness, rash, peeling
- fecal incontinence, stool spotting
- urinary retention and incontinence due to pressure from a crowded bowel on the bladder nine0027 bleeding from fissures, hemorrhoids
The treatment of constipation involves the following goals:
1. Normalization of stool consistency (soft, painless stools)
2. Regularity of bowel movements (prevention of re-accumulation of feces)
The treatment of constipation is a sequential, complex, individual process and consists of several stages:
- child and parent education
- correction of nutrition and drinking regimen
- elimination of existing coprostasis with the help of medications
- maintenance therapy
It is necessary to exclude factors that provoke and contribute to constipation (normalization of motor and nutritional regimen, discontinuation of medications that can cause constipation, identification of a food allergen, exclusion or confirmation of neuromuscular disease, celiac disease, etc.). nine0003
Lifestyle normalization includes:
- development of a conditioned reflex
- active lifestyle
- gymnastics
- light abdominal massage training
- for small children - laying out on the stomach, bending the legs to the stomach.
Education is the first step in the treatment of functional constipation. It must be remembered that episodes of fecal smearing and encopresis (fecal incontinence) are not arbitrary and should not be blamed on the child, who may already be frightened and disoriented. In some cases, when the intra-family situation is difficult, the help of a family psychologist may be needed. nine0084
It is important to understand that the treatment of functional constipation can be lengthy, based on trust, partnership and requires patience. Modern laxatives that are legal in children will not make the intestines “lazy”, will not cause “addiction”, they enter the bloodstream in minimal amounts or are not absorbed at all and are safe for long-term use.
Correction of the behavior of a child with constipation is based on the development of a routine of visiting the toilet, in order to achieve regular defecation. Defecation should be every time at the same time. The urge to defecate is based on the gastrocecal reflex, which manifests itself in the morning 1 hour after eating. A child with constipation needs to spend 3-10 minutes in the toilet (depending on age). It is necessary to plant the child on a potty or offer to visit the toilet after each meal. nine0003
A prerequisite for effective defecation is to provide a good support for the legs (a low bench on which the child can put his feet), which helps to increase intra-abdominal pressure.
If the defecation is not successful, the child should never be punished and vice versa. The daily frequency of bowel movements can be noted in a diary, which can be analyzed at a scheduled visit to the doctor.
Treatment of constipation should begin with lifestyle changes, which include dietary modification, drinking regimen and physical activity. nine0003
Calculation of fluid volume for healthy children
Children under the age of 1 year should drink at least 100 ml of water per day.
For healthy children weighing 10 to 20 kg the water requirement is calculated using the formula:
100 ml (volume of water for children under 1 year old) + 50 ml per kg for body weight over 10 kg.
For example, with a mass of 12 kg: 100 ml + 2 x 50 ml = 200 ml.
A child weighing 20 kg should drink water: 100 ml + 50 x 10 = 600 ml
For children weighing over 20 kg the following formula is suggested for calculation:
600 ml (volume of water for a child weighing 20 kg) + 20 ml for each kg over 20 kg.
For children over 3-5 years old you can use the calculation of the amount of water: 30ml / kg of weight
Principles of diet therapy for constipation:
- satisfaction of physical needs for nutrients and energy
- exclusion of excessive consumption of proteins and fats, which can inhibit intestinal motility
- enrichment of the diet with dietary fiber
- normalization of intestinal microflora with pro- and prebiotics
If the child is breastfed, then the mother's nutrition is corrected (restriction of products that promote gas formation). With artificial feeding, special mixtures are shown. For constipation associated with an allergy to cow's milk protein, therapeutic mixtures are prescribed if the child is bottle-fed. If the child is breastfed, cow's milk and products based on it are completely excluded from the mother's diet. nine0003
After the introduction of “thick” complementary foods, boiled water is necessary for all children, regardless of the type of feeding.
For older children, it is recommended to eat foods rich in vegetable fibers. It is not recommended to “smear food”, puree, “snacks”, “eating on the go”. Food should be crumbly, meat / poultry / fish - “piece”. A “bulk” breakfast is required to stimulate the “gastrocecal reflex”.
The main source of coarse-fiber vegetable fiber, containing a large amount of dietary fiber, is cereal bran, rye bread, as well as a number of vegetables and fruits. According to the principles of evidence-based medicine, a statistically significant increase in stool frequency and improvement in its consistency was demonstrated with the use of fiber compared with placebo. nine0003
Bran, as the main source of vegetable fiber, is recommended to be added to the second and third courses, after pouring boiling water over it and settling for 20 minutes. Bran can also be used in between meals, drinking plenty of fluids. For school-age children, the total amount of fluid when taking bran should be at least 1.5-2 liters per day, otherwise they mainly act as sorbents, absorbing fluid from the intestines, thereby increasing constipation. The dose is selected individually, it is recommended to start with 1 teaspoon 2-3 times a day, with a gradual increase to 40 g per day. When the effect is achieved, the dose is reduced and limited to one dose. nine0003
The American Academy of Pediatrics (2009) recommends a fiber intake of 0.5 g/kg/day (maximum 35 g/day) for all children. Fiber intake below the minimum recommended value has been shown to be a risk factor for chronic constipation in children.
However, long-term intake of a large amount of plant fibers due to fermentation by intestinal microflora is naturally accompanied by bloating and flatulence.
Children with constipation are shown to take cool liquids on an empty stomach (drinking and mineral water, juice, compotes, kvass), to enhance the laxative effect, it is possible to add honey, xylitol or sorbitol. It is very beneficial for bowel function to increase the intake of juices containing sorbitol/sorbitol, such as juice from plums, pears, apricots, peaches and apples, nine0003
With “sluggish” bowel function (hypomotor constipation), cool mineral water of medium and high mineralization is used, such as Essentuki 17, Batalinskaya, Arzni, Donat Magnesium, etc.; with spastic constipation (hypermotor constipation, stool form more often type 1) - warm and low mineralization (Essentuki 4). Calculation of mineral water - 3-5 ml / kg per day.
It is necessary to limit milk in its pure form and in dishes, as flatulence may occur with the appearance or intensification of abdominal pain. It is better to replace whole milk with sour-milk products - kefir, acidophilus, yogurt, yogurt, etc. nine0003
The diet of children with constipation includes dishes rich in vegetable fiber - salads from fresh vegetables, greens 2-3 times a day, baked apples, stewed vegetables, diluted vegetable and fruit juices with pulp. Food is cooked mostly unground, steamed or boiled in water.
It is preferable to take raw vegetables and fruits (in the absence of contraindications). Especially recommended are tomatoes, zucchini, pumpkin, carrots, beets, lettuce, cauliflower, apples. Dried fruits (prunes, dried apricots, figs) are given in soaked form and as part of cooked dishes. White cabbage, young green beans, green peas are allowed with good tolerance. Parsley, dill, celery are good to add to various dishes and salads. nine0003
If after reading the article you still have questions or you do not understand how to apply the recommendations in your particular case, we invite you and your child to be examined by a pediatric gastroenterologist at the DDC. For the convenience of parents, you can make an appointment with a pediatric gastroenterologist at the Children's Diagnostic Center on a weekday and on Saturdays.
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