In infants, mild constipation may be a sign of inadequate insufficient water intake. This is the case, for example, when the breastfeeding mother does not drink enough, when artificial milk is insufficiently diluted or when a hot climate tends to dehydrate the child. Constipation can also be caused by an excess of flour or thickeners in the bottle, an error in diluting formula milk, or an excess of constipating foods too many constipating foods (chocolate, quince, banana, rice, starchy foods, etc.) in the diet of the breastfeeding mother.
Understanding an infant’s digestive system
An infant’s digestive system is still developing, making it considerably different from that of an adult. This distinction is essential to understanding why infants are more likely to suffer from constipation.
Development of the digestive system
At birth, a baby’s digestive system is not yet fully developed. This immaturity means that their bodies process food differently. Their stomach has a smaller capacity, and their intestinal tract is shorter, which can affect the frequency and consistency of bowel movements.
Limited stomach capacity
An infant’s stomach capacity is limited. This means they can only consume a small amount of food at a time. Breast milk or infant formula is digested fairly quickly, which may require frequent feedings. This rapid digestion can sometimes lead to more frequent bowel movements, but can also lead to constipation if there are not enough fluids.
Intestinal transit in infants
The intestinal transit of infants is different from that of adults or older children. Their digestive system is faster, but their ability to move stools may be less efficient due to weak abdominal muscles. This can contribute to constipation, especially if the diet is not adequate in terms of fibre or hydration.
Absorption and the intestinal microbiome
Nutrient absorption in infants is also an important consideration. Their intestines are in the process of developing and adapting to absorb the various nutrients they need to grow. In addition, the intestinal microbiome, i.e. all the micro-organisms present in the intestine, is still being formed. This microbiome plays a crucial role in digestion and can be affected by factors such as the type of delivery (caesarean section or natural route) and breastfeeding.
Breastfeeding and the digestive system
Breastfeeding has a significant impact on an infant’s digestive system. Breast milk is designed to be easily digestible and contains enzymes and hormones that help to regulate intestinal transit. Breastfed babies may have more frequent bowel movements, which is normal, but they may also be prone to constipation if their fluid intake is inadequate.
Genetic factors in infant constipation
Constipation in infants can be influenced not only by diet, hydration and physical activity, but also by genetic factors. A family history of digestive problems can be an important indicator in the assessment of constipation in a child.
Family heritage and digestion
The tendency to develop digestive disorders, including constipation, can sometimes be inherited. If close family members have suffered from chronic constipation, the infant may be more likely to experience similar problems. This may be due to hereditary traits that affect the functioning of the digestive system, such as the speed of intestinal transit or the sensitivity of the intestine.
Genetic disorders affecting constipation
In some cases, specific genetic disorders can cause constipation in infants. For example, Hirschsprung’s disease is a disorder in which nerves are absent from certain parts of the intestine, leading to difficulties in stool movement. Other conditions, such as cystic fibrosis, can also affect the digestive system and cause constipation.
Identifying early signs
It is crucial to look out for early signs of constipation, especially if there is a family history of digestive disorders. Signs may include hard or infrequent stools, pain during bowel movements, or a swollen tummy. Constipation in infants may be more than just discomfort; it may indicate a more serious underlying problem.
The importance of a medical assessment
If you suspect that your child’s constipation is linked to genetic factors, it is important to consult a paediatrician. A medical assessment can help determine whether the constipation is due to a genetic condition and guide you towards the appropriate treatment. In some cases, specialised care or regular monitoring may be required.
Management and therapeutic approach
Management of constipation linked to genetic factors may involve a combination of medical treatments and lifestyle modifications. This may include the use of special laxatives, dietary changes, and sometimes surgery in more severe cases. A personalised approach, taking into account the child’s family history and overall health, is essential to effectively treat constipation.
What is constipation in infants?
In infancy, constipation is mainly functional, but great vigilance is required in this age group to spot signs suggestive of organic disease. We know that the frequency of bowel movements in breastfed infants can be more variable than in non-breastfed infants(some breastfed newborns may have a bowel movement with every feed or only one every seven to ten days).
Mineral oil is contraindicated in infants because their swallowing is uncoordinated and they run the risk of aspiration and subsequent pneumonitis. It may be a good idea to increase fluid intake and reduce excess cow’s milk to relieve constipation in older infants. Lactulose and glycerine suppositories can be used.
Most newborns (90%) eliminate meconium within the first 24 hours of life. Before the age of 2, the number of evacuations will have decreased slightly to less than 2 per day. After the age of 4, it is slightly less than 1 per day.
In general, signs of straining in a young infant are not synonymous with constipation. Infants only gradually develop the muscles involved in defecation.
What is functional constipation?
Functional constipation is difficulty passing stools for reasons other than organic causes.
Children are prone to developing functional constipation during 3 periods:
- After the introduction of cereals and solid foods
- During toilet training
- During the first day of school
Each of these stages can turn defecation into an unpleasant experience.
What are the warning signs and how can they be interpreted?
The following signs should raise an alarm:
- A delay in the emission of meconium (more than 24 to 48 hours after birth).
- Hypotonia and poor sucking (suggesting infantile botulism).
A fundamental finding in favour of an organic cause in the newborn is constipation appearing from birth; if normal stools have been eliminated, there is probably no significant constitutional abnormality.
The role of probiotics in infant constipation
Diagnosis of constipation in infants is relatively straightforward; it should include the presence for 1 month of at least 2 of the following:
- Two or fewer bowel movements per week
- History of excessive stool retention, painful or hard stools
- Large diameter stools and/or presence of a large faecal mass in the rectum.
During the first year of life, dietary management is virtually impossible, apart from changing the type of formula in infants who are not breastfed. In a 2010 study, the authors concluded that the administration of L reuteri (DSM 17938), a probiotic (live beneficial bacteria), to infants with chronic constipation had a positive effect on stool frequency, even in the absence of any improvement in stool consistency.
Given their safety profile, probiotics may be an interesting option in the treatment of functional constipation.
How can constipation be prevented in infants?
- Make sure your baby drinks enough.
- If you are breast-feeding, drink plenty of fluids.
- If you’re formula-feeding, make sure you dilute the milk powder sufficiently and don’t overdo the flours and other thickeners.
- In summer, give your baby regular bottles of water.
- Dietary changes include adding prune juice for infants, increasing fruit and vegetables and other sources of fibre in the diet of older infants and children, increasing water intake and reducing the amount of constipating foods(milk, cheese).
FAQ
1. How often should an infant have a bowel movement? The frequency of bowel movements in infants varies considerably. Some infants may have a bowel movement after every feed, while others may only have a bowel movement every two or three days. As long as the stools are soft and there are no signs of discomfort or pain, this frequency is normally healthy.
2. Can changes in a breast-feeding mother’s diet affect her baby’s constipation? Yes, the mother’s diet can influence the composition of her breast milk and, as a result, can affect the infant’s digestion. Foods that cause gas or irritation in the mother can also have a similar effect on the baby. However, every baby reacts differently, so it is important to monitor your baby’s reactions to certain foods.
3. Are there any specific foods to avoid for babies prone to constipation? For infants starting to eat solid foods, it is advisable to avoid foods that can aggravate constipation, such as cereal rice, bananas and cooked carrots. Instead, opt for fibre-rich foods such as prune, pear or peach purée, which can help relieve constipation.
4. How can I tell if my baby is dehydrated? Signs of dehydration in an infant may include a dry mouth and lips, less crying with tears, increased sleepiness or irritability, and fewer wet nappies than usual. If you suspect dehydration, it is important to consult a doctor immediately.
5. When is it necessary to seek medical attention for an infant’s constipation? If constipation is accompanied by symptoms such as vomiting, fever, refusal to eat, blood in the stools, or if the baby appears to be in distress, it is crucial to consult a doctor. Similarly, if constipation is persistent and does not respond to dietary measures or lifestyle changes, medical assessment is necessary.
6. Can probiotics help manage constipation in infants? Probiotics, which are beneficial bacteria for the digestive system, can help improve digestion and relieve constipation in some infants. They can be particularly useful for restoring intestinal balance after the use of antibiotics. However, it is advisable to consult a paediatrician before starting any probiotic supplement.
Medical literature and clinical trials:
- North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Evaluation and treatment of constipation in children; J Pediatr Gastroenterol Nutr 2006
- Constipation in babies and children, Vidal, 2020
- Benninga MA, Nurko S, Faure C, et al. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology 2016
