This cannot be said that if a baby is constipated , then this is normal, but this is a common and natural reaction to an incorrectly selected diet or other reasons. Therefore, it is important for parents to monitor their baby’s stool so as not to miss the beginning of the problem. Thus, the absence of bowel movements in a newborn for 24 hours is already a reason to talk about disturbances in the functioning of the digestive system.
But it is even more important not to forget that the body of a small child is different from an adult. As he grows up, his internal organs continue the formation that began in the womb. All systems are under active development, including the gastrointestinal tract. This means that the physiological processes in the baby’s body are not the same as in adults, so they cannot be interfered with by dangerous medications and supplements.
But what to do if your baby is constipated? Definitely treat, only correctly, taking into account the age of the child and the state of his digestive system. It is especially necessary to diagnose stool disorders in infants in order to exclude various diseases of the intestines or other organs and systems of the body. After all, constipation can be a symptom of serious pathologies.
What is constipation and what is its cause?
According to the definition, constipation is not only a bowel movement that is less frequent than individual physiological age norms, but also a change in the shape and nature of stool. This criterion is extremely important in making a diagnosis. In addition, according to the main international document, which is used by pediatricians and gastroenterologists around the world when talking about functional disorders of the gastrointestinal tract in children (Rome IV criteria, 2016), symptoms must persist for at least 1 month.
There are two large groups of causes of constipation: organic (5%) and functional (95%). Organic causes include congenital malformations of the gastrointestinal tract, neuromuscular diseases (central paralysis, neurofibromatosis, etc.), systemic diseases (diabetes mellitus, Down syndrome, connective tissue diseases, etc.), taking medications (for example, iron supplements, hypervitaminosis D) and others (celiac disease, allergy to cow's milk protein, etc.). In most cases, constipation in infants and children in the first years of life, both with artificial and breastfeeding, is functional in nature and is associated with a violation of the innervation of the gastrointestinal tract.
But according to the American Academy of Pediatrics, the norm is considered to be bowel movements for children in the first 7 days of life at least 4 times a week, from 4 months to 4 years - at least 2 times a week.
Lack of regular bowel movements and pain during bowel movements bring great discomfort to the child. And in this regard, it is important not to confuse functional constipation during artificial feeding in an infant with infantile dyschezia. Infantile dyschezia is a condition characteristic of children under 9 months of age, which is accompanied by episodes of restlessness, straining, and crying before passing gas or stool. The baby is still learning to control his muscles, so in order to coordinate the work of the muscles of the abdominal wall (tighten them to “push out” feces) and the anus (relax it), you need to make a lot of effort. But it is important that the stool is soft. When a child suffers from constipation, the stool is dense and hard.
Features of constipation in a newborn
First, you need to remember what age of the baby we are talking about. Children under 1 year of age are infants. Experts also divide infancy into two stages:
- newborns (first 4 weeks);
- infants (from 4 weeks to one year).
When we talk about constipation in a newborn or infant, we mean precisely in infancy - up to 1 year.
Secondly, at each stage of development of the baby’s digestive system, it has its own characteristics, which should be taken into account when diagnosing “constipation in an infant.” Among them are:
- The first days after birth. During this period, dark, odorless stools, which are based on intestinal epithelial cells and products of digestion of amniotic fluid, are considered normal. It usually appears 8 hours after birth and is called meconium. Then the child will have stool approximately 1-3 times a day. Its acceptable colors are yellow-brown or greenish.
- Up to two months. During this period, there is no strict norm for baby stool. When breastfeeding, it will be liquid, and the process of defecation can accompany each feeding or occur 2 times a day.
- From 2 to 6 months. It is at this time that the frequency of bowel movements in the child begins to decrease. As a result, by the end of this period, the frequency of bowel movements is 1-2 times a day, and if the baby’s body quickly absorbs milk and has a good metabolism, then bowel movements can be even less frequent - up to 1 time in 2-3 days. At first glance, such indicators indicate constipation in the baby, but if the child is actively gaining weight, eats well and does not show signs of other problems with bowel movements, then everything is normal.
- From 6 months to 1 year. The digestive system begins to change significantly due to gradual complementary feeding. Now the child begins to form stool that is darker in color and may even have an unpleasant, putrid odor. It's all about the products: if they are not suitable for the baby and cause reactions in his digestive system, then you urgently need to stop giving them and consult a doctor for advice. It turns out that if complementary feeding was started incorrectly, expect problems with bowel movements. At this age, these are the most common causes of constipation in infants.
But in general, the general symptoms of constipation in a baby are the same:
- poor appetite, accompanied by frequent irritability and crying. Capricious behavior indicates health problems, because the baby cannot yet talk about them on his own. If you additionally experience poor weight gain, you should make an appointment with your doctor or pediatric proctologist;
- irritation on the anus. Redness and other signs of irritation of the skin of the anus may indicate constipation, rectal fissures and other related diseases;
- dry and dense feces. Normal stool in a child under one year of age has a liquid or soft consistency, but not hard. Dry stool is most often caused by changes in diet, namely the consumption of solid foods.
Note!
As you can see, it is impossible to say for sure whether a child has problems with bowel movements. In one case, emptying once every 3 days is considered the norm, and in the other, the situation once a day already indicates problems. That is why only a doctor can diagnose constipation in a baby. What to do, how to prevent this problem and what a small child can do - all these questions will be answered by a qualified pediatrician. Even if you are mistaken and the baby is not constipated, the specialist will be able to reassure you and perhaps identify other disorders in the development of the baby.
Why does a baby get constipated when bottle-fed?
Unlike breast milk, the formula molecule takes longer to break down and digest - this is one of the factors that affects the frequency of bowel movements. In addition, if a baby in the first month of life has stool less than twice a week, analyze whether he is receiving enough formula, because underfeeding is also often the cause of constipation in a newborn with artificial feeding.
Quite often, parents experience constipation when switching to artificial feeding too quickly or too early. The baby's intestines, accustomed to breast milk, need time to adapt to the new type of nutrition. And very often at this moment, parents, worried that stool retention is caused by the fact that “the formula is not suitable,” rush to transfer their baby to a new one. This can lead to a vicious circle when another mixture introduced into the diet too quickly (in less than three days) will only aggravate the symptoms.
It should also be taken into account that changes in the frequency and nature of stools can be influenced by conditions such as allergy to cow's milk protein and lactase deficiency. Therefore, a thorough analysis of the situation together with the pediatrician will rule out or confirm the assumption that constipation in a bottle-fed baby is associated precisely with these reasons.
And, of course, constipation during artificial feeding in an infant can occur during the introduction of complementary foods. The child begins to receive food that is completely new to him, the digestion of which requires different enzymes and more time, so the stool becomes rarer and has a completely different consistency.
What to do if your newborn is constipated
Firstly, do not try to cure the child yourself. Young mothers and fathers do not have the same knowledge as qualified doctors, so they cannot provide the baby with the help that he really needs.
Secondly, do not rely on advertisements and advice from pharmacists, because neither the advertisers nor the salesperson at the pharmacy are doctors and have not seen your child’s test results. Their recommendations are based solely on consumer demand, and therefore have nothing to do with real medicinal properties.
Thirdly, when choosing treatment for constipation in infants, rely on the doctor’s recommendations. He may prescribe the following treatment options for you:
- balanced diet. Proper nutrition for a baby is the most important part of its normal development. If the child receives the required amount of nutrients, his stool will normalize. It is especially important to monitor the diet of a mother who is breastfeeding: the consumption of fatty foods, tea, coffee and foods that lead to difficulty in intestinal patency and increased gas formation will be prohibited.
The fact is that if for older children it is necessary to normalize their diet and food intake, then a breastfed child is completely dependent on the mother’s nutrition. If she does not monitor her diet, then it is not surprising that the baby has problems with bowel movements.
- massotherapy . Small children cannot yet perform gymnastic exercises, so parents should massage them to stimulate intestinal function. To do this, you need to make circular movements along the stomach in a clockwise direction. This will normalize the functioning of the gastrointestinal tract and help improve intestinal motility, as a result, feces will move better through it.
- medicines. There are medications that can be used to treat constipation in infants. These include cleansing enemas, suppositories, enzymes and other medications. But none of these drugs should be used at will without consulting a doctor. Only he must prescribe the necessary treatment, especially medication.
A separate treatment group is traditional methods. Their effectiveness has not been confirmed by official medicine, but such drugs can be used in combination with other forms. So, the most popular are: decoctions of chamomile, cumin, dill, laxative juices from carrots, cucumbers, beets, cabbage, peach.
Summary
Constipation in a newborn can be both harmless (if it is transient) and dangerous (if it is functional or organic). Therefore, one should not go to extremes - ignore the problem or self-medicate the child. It is much more rational to contact a pediatrician or pediatric proctologist, who will identify the root cause of the problem and recommend effective treatment. It is the qualified assistance of an experienced doctor that is the key to the correct development of the baby.
The article “What to do if a newborn is constipated” was written by proctologists at the Medicna dopomoga clinic. All information about the causes and methods of treatment is for informational purposes only. Our doctors strongly do not recommend that parents make diagnoses on their own, much less give their child any medications. If you notice symptoms of constipation in your baby, contact a specialist immediately!
Treatment of constipation in infants with artificial feeding
First of all, treatment of constipation should begin with non-drug methods. In relation to children in the first year of life, this is the selection of a formula taking into account individual characteristics, calculation of the volume and mode of feeding. This issue should be discussed with your child's doctor in order to avoid the situation mentioned above (when constipation occurs when switching to artificial feeding and continues due to constant transfer from one formula to another). As a rule, pediatricians recommend formulas with a high content of pro- and prebiotics, fermented milk or medicinal, depending on the reason why constipation occurred in a newborn during artificial feeding.
For children already receiving complementary foods, it will be important to introduce more foods containing fiber (fruits, vegetables that have laxative properties, for example, apples, prunes, pumpkin; cereals), and consume additional fluids.
If there is no effect from non-drug treatment of constipation in a newborn and a baby of the first year of life with artificial feeding, pediatricians recommend therapy with laxatives. Preparations based on polyethylene glycol (macrogol) or lactulose are mainly used for treatment. These drugs are completely harmless and non-addictive. It is worth considering that the treatment of functional constipation takes quite a long time (at least a month), so you should be patient.
How to help your baby with constipation?
Factors contributing to constipation in children of the first year of life and ways to eliminate them.
Any difficulties with the baby's stool cause parents a lot of anxiety. And constipation is no exception. But it’s better not to panic, but to figure out what this problem is and how to help your child cope with it.
The normal frequency of stool in newborns and children in the first months of life while breastfed is from 1 to 7 times a day (that is, after each feeding), in rare cases more often. In children older than four months and up to two years, this amount is reduced to 1-3 times a day. At the same time, in children receiving formula milk, bowel movements, as a rule, occur less frequently than in breast-fed babies. Thus, bottle-fed children usually have stool 1-3 times a day. If everything happens with such frequency for your baby, then there is no need to worry.
Well, if a child goes to the toilet less than once every 3 days, and his feces are of a dense consistency and in the form of lumps, and other signs are present (large volume of feces, incomplete emptying, painful bowel movements), then we can already talk about the appearance of constipation at the baby's.
You should discuss your concerns about your baby's bowel frequency with your pediatrician. Constipation can be a symptom of serious medical conditions, such as food allergies, congenital abnormalities, and intestinal diseases.
Most often, the causes of constipation are the characteristics and nature of the diet. How to help your baby with constipation? One of the simplest and most effective methods of preventing and treating constipation is nutritional correction.
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Are you breastfeeding your baby? Don't be surprised, but your baby's stool is largely influenced by what you eat. Therefore, first of all, you will have to optimize your diet. It is necessary to maintain a drinking regime and limit foods high in animal fats (butter, fatty meats) and replace them with vegetable ones (olive and sunflower oil, nuts). Eat fermented milk products and foods high in dietary fiber (vegetables, fruits, dried fruits, cereals, wholemeal bread and others). They stimulate intestinal motility.
You also need to normalize the child’s diet to prevent underfeeding or overfeeding.
In addition, constipation in breastfed infants can be a manifestation of serious diseases, such as food allergies and lactase deficiency. Therefore, if constipation bothers your baby for a long time, be sure to contact your pediatrician - he will help determine the possible cause and give recommendations on dietary changes.
It is important to note that constipation in children receiving natural feeding is never an indication for transferring the child to mixed or artificial feeding.
By analogy with breastfeeding, children receiving formula milk need to adjust their diet to solve the problem. Check the volume of the mixture received to eliminate both lack of nutrition and overfeeding. Also check if you are diluting the mixture correctly.
Often, constipation occurs when a mother, in order to feed her baby more nourishingly, makes the mixture thicker and adds less water than necessary. You can't do that. In addition, a more concentrated mixture provokes regurgitation.
For a bottle-fed baby with constipation, the formula needs to be selected individually. When choosing, pay attention to the fact that it contains components that contribute to comfortable digestion and regular bowel movements for the baby. These products include “comfort” class mixtures, which contain pre- and probiotics, partially digested protein, as well as a special fat composition.
The specially developed composition of the Similac Comfort mixture with 2′-FL oligosaccharides of breast milk to strengthen the immune system does not contain palm oil, therefore it helps to form soft stools similar to the stool of breastfed children, as well as reduce the incidence of constipation. The partially hydrolyzed whey protein in the mixture is easy to digest, and the low lactose content helps reduce gas formation. Pre- and probiotics help form healthy intestinal microflora in the baby.
The introduction of complementary feeding products and dishes into the diet of children suffering from constipation should be carried out in accordance with the recommended feeding schedule: no earlier than 4 and no later than 6 months of life.
The first to be introduced into their diet are foods rich in dietary fiber - vegetable puree (from zucchini, broccoli, cauliflower, etc.), and buckwheat, corn, oatmeal, and fruit puree (apple, plum) are used as grain complementary foods.
Regardless of the nature of feeding, children with constipation should be offered baby water in the amount of one feeding.
In consultation with your doctor, you can also discuss the possibility of using rectal suppositories and microenemas with glycerin.
Prepared on the basis of materials: 1. “Program for optimizing the feeding of children in the first year of life in the Russian Federation”, M.: Union of Pediatricians of Russia, 2022. 2. Nutrition of a healthy and sick child. A manual for doctors, ed. Tutelyana V.A., Konya I.Ya., Kaganova B.S. Moscow, 2013. - 264 p. 3. Clinical dietetics of childhood: a guide for doctors. Edited by Borovik T.E., Ladodo K.S. Moscow, 2015. - 720 p. 4. Khavkin A.I., Komarova O.N. Constipation in children of the first year of life in the structure of functional disorders of the gastrointestinal tract. Basic approaches to treatment. RMJ. 2015; 3: 152-157. 5. Zakharova I.N., Sugyan N.G., Moskvich I.K. Russian and international recommendations for the management of children with constipation. Issues of modern pediatrics. 2014; 13 (1): 74–83.
Treatments to be used with caution
As an emergency measure, you can resort to microenemas or cleansing enemas. However, these methods cannot be used on a regular basis, since they do not treat the cause, but they can become addictive: with their frequent use, children often begin to have bowel movements only after stimulation of the anus.
Previously, in the treatment of constipation, choleretic and enzyme preparations were often prescribed, and additional probiotics were recommended. To date, the lack of effect from their use has been proven.
Prevention of constipation in infants during artificial feeding
An important factor determining the frequency and density of stools is the child’s physical activity. The more the baby moves, the better the intestinal motility. As a preventive measure, place the baby on the tummy more often; from 4 months, “move” the baby to the floor so that he quickly masters motor skills, since doing this on the floor is both more interesting and safer.
Do gymnastics with your baby on a regular basis - this also helps prevent constipation in a bottle-fed baby. Perform the simplest exercises (bringing your legs to your tummy, spreading them at the hip joint), but every day. It will also be helpful to do a light tummy massage on a regular basis.
If it is necessary to transfer a child to another formula (for example, by age, when they switch from “one” to “two”), do this gradually, for at least 3–5 days, alternately changing one meal at a time to a new type of formula.
Most children over 4 years old have had problems with bowel movements since early childhood, but for some reason, full treatment was not carried out. Therefore, it is important to engage in prevention and solve problems as soon as they appear.
