Constipation (or sometimes just the threat of constipation!) is a common condition that can cause pain and discomfort to a child, as well as anxiety and concern for many parents.
Sometimes it can be difficult to tell if your child is constipated, since bowel habits vary among children. Today we’ll address constipation in infants, and save the older children for another day.
Generally we consider a baby to be constipated if his stools are hard. Watching for straining or even how many days pass between bowel movements can be deceiving. Many babies strain (and make all kinds of faces, and even turn red!) while they’re having a bowel movement — even when they are not constipated. Their immature abdominal muscles, and the fact that they’re often lying on their backs without gravity to assist them contributes to this. For some infants, skipping days between bowel movements can also be normal. Breastfed babies can, and often do, skip many days (even up to a week or more!) between bowel movements without being constipated. (In fact, it’s extremely uncommon for a breastfed baby to be constipated, and if she is, it’s usually not due to diet).
As long as the stool is soft, and not hard and small like pebbles, the baby is not constipated. Conversely, babies that have a bowel movement every day can still be constipated, if those stools are hard.
Sometimes when a baby is constipated you might see a small amount of blood with the stool. This happens when there’s a small tear of the anus as the hard stool passes. Babies who are constipated can be fussy and have abdominal pain. Sometimes there might be looser stool, even diarrhea, that “overflows” around the hard stool that might be stuck in the intestine.
Constipation does not cause fever.
There is often no identifiable cause for constipation, though a common time for it to occur is when solid foods are being introduced for the first time, around 4-6 months. Sometimes a change such as travel with new foods or schedules can contribute. There are also some less common medical causes for constipation, such as Hirschprung’s disease (an abnormality of nerves in the colon), hypothyroidism, and spinal cord abnormalities.
Once we’ve determined your baby is constipated, what can we do? In an infant who’s gone 2-3 days without a bowel movement (and is not breastfed), you can start by taking his temperature with a rectal thermometer. Sometimes this rectal stimulation will result in a bowel movement. Constipation is not due to the iron in fortified cereals (or formula, for that matter). The iron added to formula and cereals is a small, physiologic dose. Therefore, we do not recommend switching to low-iron formulas.
In this age group mixing pear, prune or cherry (100%) juice with water (in a 1:1 ratio) and starting with an ounce given once a day (by bottle or mixed with cereal) can help. Switching from rice cereal to oatmeal can be helpful, as well as decreasing bananas and applesauce and increasing high fiber foods such as pears, peaches, apricots and prunes.
If these dietary measures don’t help, or if your baby is under 4 months, give the office a call for advice. Less commonly, constipation can be caused by underlying medical issues like those mentioned above. Evaluation in the office is sometimes helpful or necessary, especially if your baby has been constipated since birth. There are safe medications to treat constipation when dietary measures are not effective, which we can discuss in the office as well. If those measures fail, we can call on our gastrointestinal specialists to help us out.
Hopefully this sheds some light on a common worry, and will at least get you started in the right direction if you think your baby might be constipated. As always, please don’t hesitate to call the office if you have any questions!
Dr. Amy Maddalena, a Kids Plus Doc since 2006.