What Is Constipation in Infants?

What Is Constipation in Infants?

In its simplest definition, constipation in infants is the passage of infrequent, hard stools that require straining. If it has lasted less than four weeks, it is defined as acute; if it has lasted longer, it is defined as chronic constipation. Constipation is a common digestive system disorder in children of all ages. It is not uncommon in infants, and 17%–40% of all children with constipation problems are infants under 1 year of age. Constipation may be due to an organic cause or may be functional, without any underlying organic cause. 90%–95% of all constipation cases in children are of the functional type.

Organic constipation usually resists treatment; if the underlying organic cause is corrected, treatment for constipation will be more successful. Some of the organic causes of constipation, which account for approximately 5%–10% of constipation cases, are: certain congenital intestinal anomalies, neurological diseases such as cerebral palsy and spinal cord diseases, Hirschsprung disease, endocrine diseases such as hypothyroidism, hypoparathyroidism and diabetes, certain metabolic diseases, celiac disease, certain kidney diseases, hypercalcemia, anomalies affecting the anus and rectum, disorders of the neuromuscular network of the intestines, and certain medications. The months in which functional constipation is most frequently seen in infants are the period of transition to complementary foods.

What Are the Symptoms of Constipation in Infants?

Symptoms of constipation are not only related to how often the infant has bowel movements each day. What the infant feels during defecation is also important. At the same time, the appearance of the stool is also used as a diagnostic criterion for constipation. Symptoms of constipation in infants are as follows:

Dry, lumpy stool in the diaper

Painful defecation with straining

Passing larger stools than normal

Abdominal hardness and distension

Restlessness

Liquid stool stains in the diaper

Fewer than three bowel movements per week

Large amount of stool in the last part of the large intestine (rectum)

How Does Constipation Occur in Infants?

Constipation has many possible causes. Constipation in infants may result from several changes. Particularly during the period when complementary feeding is started, constipation may develop due to digestive problems when infants begin eating a new food. Other causes of constipation in infants include:

Switching to a formula that is difficult to digest after breast milk, or consuming processed foods,

Insufficient fluid intake in the period after complementary foods are introduced,

Insufficient breast milk in breastfed infants,

Insufficient intake of high-fiber foods in older infants who have started complementary feeding,

A reflection of parental anxiety

Cow's milk intolerance or other food intolerances,

Due to the iron medication being used

How Is Constipation in Infants Diagnosed?

Constipation, which may adversely affect the infant's health and development, requires consultation with a specialist physician. For the diagnosis of constipation in infants, the doctor asks parents questions about bowel habits and symptoms. These questions are generally aimed at determining whether defecation is painful and how often the child normally has bowel movements. After a detailed personal and family history, a careful physical examination is performed to rule out possible organic causes. The ‘alarm signs and findings’ that raise suspicion of organic constipation based on history and physical examination are: onset of constipation very early (before 1 month of age), first stool after birth (meconium) not passed within 48 hours, family history of Hirschsprung disease, blood in the stool without an anal fissure, growth retardation, bilious vomiting, severe abdominal distension, perianal fistula, abnormal position of the anus, decreased muscle tone, and a tuft of hair or a dimple at the lower end of the spine.

If organic causes have been ruled out as a result of these evaluations, a diagnosis of functional constipation can be made, and treatment is started. In patients who do not respond adequately to appropriate treatment dose and duration, even without alarm signs and findings, the doctor may order various tests. Depending on the infant's age and the doctor's decision, these may include thyroid function tests, calcium, sodium and potassium levels, celiac disease tests, and food allergy tests. In advanced stages, imaging studies may be used.

How Is Constipation in Infants Treated?

To treat constipation, the underlying cause must first be identified. Then a treatment plan targeting the problem is prepared. In organic constipation, the primary cause is identified and treated if a treatment exists, and laxative therapy is additionally given. In functional constipation, which is a much more common cause, treatment has two main components: non-drug and drug-based approaches. In non-drug treatment, the infant's feeding regimen is adjusted to correct the problem. The practices that can be applied to improve constipation in infants are as follows

If complementary feeding has started, the infant's fluid and water intake is increased

Pureed pears, plums, apricots, etc. are added to the diet

Vegetables and grains in the diet are increased to boost fiber intake

If the infant is formula-fed, another formula recommended by your doctor may be tried.

Gently moving the baby's legs in a bicycle motion while lying on their back helps make bowel movements easier.

A lukewarm bath helps relax the baby's muscles, thereby increasing bowel movements and making defecation easier.

If the infant is formula-fed, excessive dilution should not be done. Formula should be prepared with water according to the instructions on the formula, and extra water should be given between feedings.

When an adequate response to dietary measures is not achieved, drug therapy should also be started without delay. When constipation lasts longer, the response to treatment will decrease. In this case, the doctor may recommend a suppository for constipation. Glycerin suppositories are placed directly into the anus to facilitate defecation. However, use outside the doctor's instructions is not recommended. They may cause weight loss and diarrhea in infants. The doctor may also start a regular, long-term medication appropriate for the infant's age. However, using medication outside the doctor's instructions may harm the infant's health.

Frequently Asked Questions About Constipation in Infants

If there are alarm signs and findings along with constipation in infants, the infant must be evaluated for them without fail, the underlying organic cause must be identified, and the treatment process must be conducted accordingly. In functional constipation, prolonged constipation reduces treatment success and increases the likelihood of recurrence (relapse) when treatment is stopped. Therefore, treatment should be started before constipation becomes prolonged. In breastfed infants, the number of daily stools may vary. Under normal circumstances, bowel movements that occur 3–4 times a day may be as frequent as 9–10 times a day in small infants, or as infrequent as once every 8–10 days. In these infants, stool consistency is soft and there is no watery or hard stool. However, when infants receive insufficient breast milk, there is insufficient intake in terms of both the amount of nutrients and fluid content, and as a result constipation may develop. Constipation is rarely seen in an infant receiving adequate breast milk. When a baby is constipated and there is no other medical problem, breast milk is not discontinued. In some cases, constipation may occur as a sign of a food allergy to nutrients passed through breast milk. In infants, constipation relates more to how the stool looks than to how often bowel movements occur. If an infant passes hard, small, lumpy stools, this is a sign of constipation. Sometimes they may pass stools that are larger in amount and harder than normal. This is also an indicator of constipation. In infants, constipation usually appears when solid foods are started. The frequency of constipation is also higher in infants fed standard formula instead of breast milk. For formula-fed infants, formulas with a higher fiber content may be preferred. When complementary feeding is started, high-fiber foods should be added to the diet. Also, water should not be neglected between feedings. Gently moving the baby's legs, or bending the baby's legs at the knees and lifting them upward, helps the baby pass stool more easily. Gently massaging the baby's abdomen while lying on their back helps resolve constipation. Also, a warm shower helps relax the baby's pelvic muscles. The main cause of constipation in these infants is the transition to complementary foods. During this period, the infant may have difficulty digesting new foods. Therefore, softer foods with high fiber content should be added to the diet. Constipation may also occur due to insufficient fluid intake. Water should be given to the infant between feedings. To support fluid intake, apple, plum, apricot and pear purees, which are good for constipation, can also be added to the infant's diet. Hirschsprung disease is a congenital disorder seen in newborn infants. It is a condition that prevents the baby from passing stool. In this disease, nerve cells are usually absent in the left part of the large intestine, more rarely in the entire large intestine, and very rarely in the small intestine in addition to the large intestine. In the segments of intestine lacking nerve cells, the intestinal lumen (cavity) is severely narrowed, and stool material cannot be moved toward the anus. As a result, the baby cannot pass stool, but bowel movement can be achieved through physical intervention at the anus. In this disease, bowel movements are watery and forceful. The most dangerous conditions in Hirschsprung disease, apart from constipation, are "toxic megacolon," meaning extreme dilation of the large intestine, the development of severe infection in the body, or intestinal perforation. The only treatment for this disease is surgical removal of the non-functioning part of the intestine. Digestive problems in infants are harder to detect than in adults and may present with different symptoms. Therefore, these problems can be resolved with attentive parental supervision, correct choice of physician, and appropriate treatment.