Constipation in babies and toddlers
Constipation in a child can cause discomfort and anxiety for both the child and the parent. Here’s some practical advice
Most children will suffer from constipation at some point between the ages of about 7 months and 8 years. The reasons are many so it’s important to try to identify the specific cause of your child’s constipation before treatment is sought. The goal is to seek a long-term solution and not just treat the symptom (constipation), as this will probably mean you’ll miss the underlying cause – and for some it could be a serious disease or condition.
What is constipation? Normal stooling patterns for infants and toddlers change as they get older. Newborn babies have about four bowel movements a day; this falls to around one to two a day by the time they’re 2. From 4 years onwards you can expect one bowel movement a day. However, because not all children fall within the average, doctors define constipation as a difficulty or delay in having a bowel movement for two or more weeks. Recognising constipation is tricky for parents of small babies. A baby having a normal bowel movement may grunt, cry and kick his legs before passing even a soft stool. This is because babies don’t have the benefit of gravity, and they’re learning which muscles to use to make a bowel movement. So it’s important to keep an eye on the consistency of your baby’s stools, as well as the frequency, before concluding that your baby has constipation.
What causes constipation? Incorrect diet is the biggest cause of constipation in young children, but there are other non-diet-related causes including the use of certain medications and calcium or iron supplements, especially in adults. If your child is not taking a supplement that contains calcium, make sure he’s not drinking a lot of cow’s milk, which is very high in calcium. A child older than a year does not need more than 500ml of cow’s milk per day. As for iron intake, eating excessive amounts of iron-fortified baby cereals (most of the products on the supermarket shelves are iron-fortified) can also contribute to constipation.
BABIES UNDER 1 YEAR In babies under the age of 1, constipation is uncommon. Occasional constipation can be helped by exercising your baby’s legs (“bicycle riding”) with every nappy change. If you are worried, speak to your doctor. In babies that are exclusively breastfed, infrequent bowel movements are normal (one stool every three to seven days). When a baby does have a bowel movement, there is no need to worry if the stool is soft. Only when the stool is hard, or difficult to pass, will it be considered constipation.
What to do If your baby is on infant formula, make sure the milk is made up according to the instructions. Adding too little water makes the formula too concentrated, which can lead to constipation. Under the age of 6 months, give your baby a little bit of extra water between formula feeds. After 6 months, offer a variety of diluted fruit juices such as prune, apple and pear juice. Be sure not to give more than one serving of 125ml per day. Once your baby is on solids, stewed prunes can also be given.
TODDLERS OVER 1 YEAR It is fairly common for toddlers to have constipation now and again, and it’s rarely anything to be concerned about. Often, increasing fibre and fluid intake will solve the problem. However, if constipation persists after dietary and behaviour modification, a paediatrician needs to be consulted.
What to do Normal bowel function is promoted by eating well-balanced, regularly scheduled meals that involve eating lots of fresh fruit and drinking enough fluids. Regular physical activity and a toilet routine also helps. Next: Get practical advice on diet, physical activity and toilet routines...
1. Increase fibre intake Fibre is essential for healthy bowel movements. In the gastrointestinal tract, fibre attracts water, creating soft, bulky stools that stimulate bowel contractions to push the contents along. The DRI (Dietary Reference Intake) for the fibre intake of a 1- to 3-year-old child is 19g per day. Read the nutritional tables on food labels to identify high-fibre foods. A product is seen as a good source of fibre if it contains 3g or more per serving. Choose foods made with wholegrains such as wholegrain bread, and high-fibre breakfast cereal such as bran flakes, muesli, wholewheat ProNutro and other multigrain cereals (use cold milk, not hot). Try to include a variety of vegetables and fruits into your child’s diet. “Mealies, either on the cob or frozen kernels, work well as they help to sweep the colon clean,” says Dianne Ivison, registered dietitian in Cape Town. Stewed prunes are a natural laxative. Make your own or find them in the baby food section of supermarkets. Choose snacks that are rich in fibre, such as wholegrain crackers, digestive biscuits, fresh and dried fruits (apricots, peaches, pears, raisins, figs, prunes and dates), raw vegetables and fruit bars. Try to get your child to eat peas, beans and lentils; these are some of the richest sources of fibre. When you start adding fibre to the diet, start slowly and gradually increase the amount so your baby’s body can get used to it.
2. Give enough fluids When you increase fibre intake, you must also always increase fluid intake – they work together. Children should drink at least one litre of fluids every day. Water is obviously best, but diluted fruit juice and rooibos tea are also good options. A small glass of apple juice a day can help to keep constipation at bay. “Having a cup of warm liquid in the morning, with or after breakfast, can help with constipation,” says Dianne. “If a child is prone to constipation, avoid follow-on formulas for children over 1 year of age. Rather allow moderate amounts of full-cream cow’s milk.”
3. More dietary tips Dianne recommends that children who are prone to constipation should avoid refined starches and fast foods as these are difficult to digest. Red meat, especially biltong and “droë wors”, can worsen constipation. There are many home remedies that may be passed on to you, like adding brown sugar or oil to bottles or cereal. Although they will not be harmful, it’s better in the long term to adopt healthy habits that promote healthy bowel function.
Physical activity Encourage your child to be active. Regular exercise helps to stimulate normal bowel function and does wonders for constipation.
1. Explain how exercise works If a child knows what causes constipation, he may feel more open to dietary changes. Draw a picture: toddlers can be shown what their intestines look like and how stool needs to move along like cars or a train. Illustrate how water helps to soften the stool, and how holding it in can cause it to become hard and painful to pass.
2. Create a toilet routine Set aside relaxed times for a bathroom visit. Due to the effect of the gastrocolic reflex (the peristalsis that the colon undergoes after a meal in its attempt to clear the bowels), the highest probability of a successful bowel movement is right after a meal and, for most children, right after breakfast. So it may help to make a bathroom visit part of the daily routine, at a set time after a meal. Have your child sit on the toilet for at least 10 minutes. It is often easier if his feet are on the floor or on a footstool. Don’t make a big fuss but try to make it fun and relaxing. Keep some toys and books nearby so your child has something to do while he sits on the potty. Give praise and a reward for a bowel movement. Teach your child to go immediately when nature calls. If ignored (as can easily happen when children are busy with exciting activities), the urge will pass and the stools will become dry and difficult to pass. In rare cases where a child has psychological issues around going to the toilet, a visit to a child psychologist may be worth it. Before they have dealt with their issues, they won’t be able to overcome the constipation.
How is constipation treated medically? The treatment depends on the child’s age and the severity of the problem. Medications that may be prescribed are a stool softener, a mild laxative, or a suppository. Never use constipation medications without discussing it with your doctor first. Improper use can be harmful to children! Avoid all preparations containing castor oil and cascara. Mineral oil, stimulant laxatives and enemas should also not be used. It is important to take prescription medications correctly. Follow the doctor’s instructions accurately. One of the biggest mistakes parents make in treating their child’s constipation is stopping the medication once the child begins having soft stools. If stopped too early, your child is likely to relapse and become constipated again. Although it’s not seen as a medical treatment, massaging the abdomen can help to ease some discomfort in children with constipation. But make sure you know how before you try it.