In infants , mild constipation may be a sign of insufficient water intake . This is the case, for example, when the nursing mother does not drink enough , the formula is insufficiently diluted or a hot climate tends to dehydrate the child. The constipation may also be due to excess flour or thickeners in the bottle, a dilution of error formula, or an excess of constipating foods (chocolate, quince, banana, rice, starches, etc.) feeding the nursing mother.
How to define constipation in infants?
During infancy, constipation is mostly functional , but great vigilance is needed in this age group to spot signs suggestive of organic disease . It is known that the frequency of bowel movements in infants who are breastfed may be more variable than those who are not ( some breastfed infants may have a bowel movement with every drink or only have one every seven to ten days ).
Mineral oil is contraindicated in infants because their swallowing is uncoordinated and they are at risk of aspiration and subsequent pneumonitis. It may be good to consume more fluids and reduce excess cow’s milk to relieve constipation in older infants. Lactulose and glycerin suppositories can be used .
Most (90%) newborns shed meconium within the first 24 hours of life. Before the age of 2, the number of evacuations will have decreased slightly to less than twice a day. After the age of 4, it is slightly less than once a day.
In general, the signs of pushing strain in a young infant are not synonymous with constipation. The infant only gradually develops the muscles involved in defecation.
What is functional constipation?
Functional constipation is a difficulty in passing stool for reasons other than organic causes.
Children are in fact prone to develop functional constipation during 3 periods :
- After the introduction of cereals and solid foods
- During potty training
- During the start of the school year
Each of these stages can turn defecation into an unpleasant experience.
What are the warning signs and their interpretation?
The following signs should alert :
- A delay in the emission of meconium (greater than 24 to 48 hours after birth).
- Hypotonia and poor sucking (suggesting infant botulism).
A fundamental finding in favor of an organic cause in the newborn is constipation appearing from birth; if normal stool has been passed, there is probably no significant constitutional defect.
The role of probiotics in infant constipation
The diagnosis of constipation in infants is relatively straightforward; it must include the presence for 1 month of at least 2 of the following :
- Two or less bowel movements per week
- History of excessive stool retention, painful or hard stools
- Large diameter stools and / or presence of a large fecal mass in the rectum.
During the first year of life, dietary support is almost impossible , except to change the type of formula in infants who are not breastfed. In a 2010 study, the authors concluded that administration of L reuteri (DSM 17938), a probiotic (live beneficial bacteria), to infants with chronic constipation had a positive effect on stool frequency, including the lack of improvement in their consistency.
Due to their safety profile, probiotics may be an attractive option in the treatment of functional constipation.
How to prevent constipation in infants?
- Make sure he drinks enough.
- If you are breast-feeding, drink plenty of fluids.
- In case of artificial breastfeeding, be sure to dilute the milk powder sufficiently and do not overuse flours and other thickeners.
- In the summer, give her regular bottles of water.
- Diet modifications include adding prune juice for infants, increasing fruits and vegetables and other sources of fiber in the diets of older infants and children, increasing water intake, and reducing the amount of constipating foods ( milk, cheese ).
Medical bibliographic sources and clinical trials :
- North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Evaluation and treatment of constipation in children; J Pediatr Gastroenterol Nutr 2006
- Baby and Child Constipation, Vidal, 2020
- Deborah M. Consolini, MD, Sidney Kimmel Medical College of Thomas Jefferson University, MSD, 2020
- Benninga MA, Nurko S, Faure C, et al. Childhood Functional Gastrointestinal Disorders: Neonate / Toddler. Gastroenterology 2016