Normal Bowel Habit in a Newborn and Infant
The main symptom of infant constipation is not a low bowel movement frequency but a hard stool consistency.
Breastfed infants have stool of liquid or paste consistency from once after every feed to about once a week. Formula fed infants have stool of paste consistency once every one or two days. Infants on solid food have paste or formed stools, often containing parts of undigested food; bowel movement frequency depends on the type of the food.
Between the second and sixth week of life, frequency of bowel movements in infants often decreases because of improved absorption of nutrients in their intestines, thus leaving less residue to excrete, and decreased production of breast milk by their mothers. At this time babies also often start to strain before bowel movement and become increasingly irritated. From all this, parents often assume their babies are constipated, while they are really not.
Symptoms of Constipated Baby
An infant is likely constipated when he has all three symptoms listed below (1):
- Hard, dry or pebbly stool
- Straining and crying at defecating. Straining alone is not a symptom of constipation.
- No stools for 2-3 days in formula fed and no stools in a week for breastfed babies. Until the stool is soft, having only one bowel movement a week does not already mean a baby is constipated.
Additional symptoms may include poor appetite, not gaining weight and bleeding from the anus.
Some infants may strain and scream for up to 20 minutes before passing fairly normal stools; the problem is in uncoordinated defecating muscles and usually resolves in a few weeks. The condition is called infant dyschezia (Greek dys = abnormal; chezo = defecate) (1).
Causes of Constipation in Babies
Constipation in a breast-fed baby is most often caused by congenital disorders, like cystic fibrosis or Hirschsprung’s disease. A healthy breast-fed baby is rarely constipated.
Other rare causes of constipation in infants include diabetes insipidus, hypothyroidism and congenital anatomical defects of the rectum and anus.
Constipation in a formula fed baby may be caused by:
- Insufficient fluid
- Lack of fibers
- Change of formula, thickened, lactose-free, or casein containing formula
- Medications: paracetamol, ibuprofen, antibiotics, aluminium antacids
- Iron supplements. Iron in the formula does not likely cause constipation.
The following solid foods, especially if introduced early or in large amounts, can cause infant constipation:
- Dairy, white bread, pasta, white rice, bananas, green apples, carrots, corn, turnips and potatoes.
Remedies to Treat Infant Constipation
1. Water or Fruit Juice
Offer one ounce (30 milliliters) of water to a baby together with the formula 2-4 times a day. Breastfed babies will rarely need additional water.
To infants older than 3 months, 1 ounce of apple, pear or prune juice, diluted to 1/4 of strength can be offered twice a day until his stool become soft. Sorbitol from these juices attracts water into intestine thus stimulating its motion.
2. Fiber-Rich Foods
To infants who already started with solid food, fiber-rich pureed foods containing sorbitol, like apples, pears, prunes or apricots, can be offered.
NOTE: Citruses may irritate the infant’s bowel and skin around his mouth and anus, so they should be avoided until 1 year of age.
3. Karo Sugar or Syrup
Karo sugar should be used with a caution, since infant may get used to it and later reject any other food. Karo sugar has the same effect as sorbitol-rich foods.
A small amount of water-based lubricant applied to the baby’s anus can help to pass hard stool. Mineral oils, enemas and laxatives should not be used.
5. Massage and Exercises
The following can stimulate baby’s intestine and bring constipation relief:
- Give the baby a warm bath to relax, then oil your fingers and massage baby’s tummy in a clockwise direction. Continue only, if baby likes it.
- Allow your baby to crawl around or hold his legs and move them in a cycling manner.
6. When to Visit a Doctor?
Parents should take their baby to the doctor when baby can not get rid of constipation by above mentioned methods, when baby does not gain weight or bleeds from the anus.
- How to help a constipated baby (babycareadvice.com)
- Infant dyschezia (kumc.edu)