Diagnosis and treatment for Constipation in Children

Constipation is a very common problem for children. If early treatment is given, it can, in most cases prevent longer term problems.

Its 9.20am and I have already been faced with four poop nappies
It's 3:1, little man: missy… They are definitely in competition or keeping the nappy companies in business! But that's my babies and as I always say every baby is different and this is so evident when it comes to matters of the lovely poop kind! Having always been quite the private person I am surprised at my openness when it comes to poop since my littlies came along. Poop consistency, frequency and fragrance have become a source of regular conversation between my husband and me as well as my fellow mammies! This just goes to show you that poop can tell a lot about the health of your baby.
The following aims to inform you how constipation can affect infants and what to do if your little one is affected. Constipation due to underlying medical conditions will not be reviewed.
Constipation is always a difficult topic to discuss not least because it isn't the most pleasant but also because it means different things to different people. Some go a few times a day and some once a week. As long as the stool consistency is soft and easy to pass going once a week is not considered constipation. This might become a problem when one needs to strain and/ or the stool is hard and pellet like. Constipation is defined as a delay or difficulty in excretion present for two or more weeks and is a common paediatric problem.
Infants are by their definition unable to speak and therefore it up to us to identify when there might be a problem in the toilet department.
Some signs that will help you to recognise constipation are as follows: 
  • Hard, pellet like poop
  • Crying when trying to go
  • Less bowel movements than before i.e. every one to two days rather than maybe their usual three to four per day
  • He or she looks like they are in pain by arching their back, tightening of bum as well as crying
Straining in an infant is completely normal and not a sign of constipation as infants have weak stomach muscles and therefore need to strain. Straining is ok if your infant passes a soft stool within a few minutes.
There are some reasons why infants become constipated which might help in pre-empting episodes:
  • Change over from breast milk to formula milk. Breastfed infants typically have soft runny poops and sometimes go after each feed especially in the early days. The poop of formula fed infants is soft but not so runny and they might go 2-3 times per day. Soy and cow’s milk based formula can cause poop to be a little harder whereas hypoallergenic type formula milk can cause poop to be looser. First infant formulas are based on whey protein from cow’s milk and some infants can have an allergy to cow’s milk. Constipation is one of many symptoms that can be attributed to such an allergy. This can be diagnosed by your GP.
  • Change in formula type or brand. Some infants react to a change in brand or type of formula especially if the changeover is to a “comfort” or “stay down” type that has been thickened to aid in the treatment of reflux.
  • Weaning to solid food. Many infants suffer with constipation when weaning to solid food especially with cereal based foods.
  • Medication and/ or supplements. Some infants who require medications or supplements containing iron may suffer with constipation.
Being aware of these high risk times may help you to recognise constipation sooner and act speedily before it becomes a problem. Problems that may be encountered include withholding of the poop because of pain which may be caused by a small tear in the anal passage known as an anal fissure. Therefore early treatment of hard and/ or painful poop is essential to prevent your infant from withholding.
What to do if your infant becomes constipated or is showing signs..
  • For infants who are not yet weaned to solid food the first thing to do is to give extra water in between their usual feeds. Water should be freshly boiled and cooled. In infants over 4 months a squeeze of fresh orange juice can be added to the water if water alone fails. For formula fed infants the formula should be made up according to instructions given on the pack and not diluted down with extra water.
  • Massage of your infant’s tummy is very helpful. A warm bath followed by a nice relaxing massage in a clockwise direction on the tummy can do wonders to help stimulant your infant’s bowel. There are classes available to learn how to massage your infant properly and some are covered by health insurance so might be worth looking into. 
  • Laying your infant on their back and circling their legs in a cycling type motion can also be beneficial and like the massage can help to stimulate the bowel.
  • For infants who have been weaned to solid food increase high fibre foods such as fruits, vegetables and rice based cereals. Fruits such as apricots, pears, prunes, peaches and plums and vegetables such as sweet potatoes, beans, peas, broccoli and spinach are all high in fibre. Also increasing fluid intake is very important.
Laxatives suitable for infants are available over the counter at your pharmacy but it is important to consult with your pharmacist or GP before commencing any treatment.
It is important to try the above procedures first before thinking about using laxatives.
  • Lactulose solution (Duphalac®, Laxose®) -> 1 month- 1 year: 2.5ml twice daily; Lactulose can take 2-3 days to take effect and works to soften the poop by promoting water absorption by the poop therefore increasing fluid intake is important when treating with lactulose to avoid dehydration.
  • Glycerine suppositories are available in 1g strength suitable for infants. They work by triggering emptying of the bowels and provide rapid relief from constipation (usually within 15 minutes). It is important not to use another suppository if the first has not worked in this way. Contact your pharmacist or GP for advice.
It is important to contact your pharmacist or GP in the following circumstances:
  • Your infant is not eating or taking their usual breastfeed or formula feed.
  • There is blood in your infants nappy
  • Your infant loses weight
  • If your infant has repeated episodes of constipation 
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