Constipation (in babies & children)

Okay, a different turn of topic for this weeks blog but a very common one.. constipation in children. 

I would get asked about this a couple times a week easily, so you see how common it is.

Constipation in babies is rare in breastfed babies.  There is very little residue from breast milk so very little poop.  Breastfed babies can poop anywhere from 10 times a day to once every 10 days and everything between those extremes is normal.  Even in hot weather breast fed babies are unlikely to get constipated as they have more frequent feeds and each feed gives them additional water.  

You talking about pooh again Nan???

Formula fed babies are more prone to constipation and there are a few things you can do to minimise this.  Firstly, don’t be too generous with the formula powder.  When scooping powder use a knife to scrape off the excess. Don’t use a heaped scoop, don’t flatten the scoop against the inside of the tin and don’t press the powder down into the scoop.  Any of these measures will get too much formula for the amount of water allocated and be more likely to constipate baby.  In hot weather I also encourage people to put a little additional water into the mix.. probably about 10% - if the tin calls for one scoop per 60mls if water then use 65mls or so.  

Constipation is a hard pooh - thick, solid stools or pebbles.  Babies may look like they’re in pain when passing a Pooh but this is not necessarily constipation and can be completely normal if they have a soft Pooh at the end of it.  Dyschezia is where the baby strains and cries before passing a stool - this in itself isn’t constipation - only if the Pooh is hard.  Dyschezia will usually settle by 6 months of age.

Constipation can become a problem when babies start solids which is why it’s best to start with fruit or vegetables, and go slowly, introducing one item at a time so you know exactly what is causing the baby problems.

If your baby does become constipated then you can use some stewed prunes (or apricots) or diluted prune juice.  Up to 3 tablespoons of stewed prunes (for the baby on solids) 3 times a week is the suggestion by Royal Children’s hospital in Sydney (and we have included a link for their kids health info sheet at the bottom of this blog).  I would always suggest you come and see a doctor if you think your child has constipation before starting on any of the above remedies.

Constipation continues to be common in older children and has many causes, most of which are functional (practical) rather than medical.  It is rare that a child has a medical cause for constipation - these are usually identified in the first week of life where an infant doesn’t pass meconium.

constipation…

affects 1 in 4 children!!

In older children the most common contributors to constipation are diet, too little water, or delayed urge.  This is when the child is too busy to go to the toilet and suppresses the urge.  This is s self fulfilling problem as the longer the child doesn’t go, the harder it is to go, the easier it is to suppress signals and the more the poop builds up.. The rectum in a child can stretch amazingly and hold a football sized amount of Pooh.  When it gets to this stage, the child often has incontinence, soiling and small amounts of diarrhoea rather than a proper bowel action.

Once the rectum is stretched like this it has to be emptied and then can require 4-6 months of bowel medication to keep it empty and allow it to return to normal size.  We aim for one nice soft pooh a day of toothpaste consistency.  There are many different medications that can be used so your child needs to see the doctor to work out a plan to get on top of things quickly and easily. 

Constipation of course is best prevented, and one of the easiest ways maybe to encourage your child to sit on the toilet after each meal.  This is where the star charts and rewards become useful (the RCH Info sheet has more details on this).  Make sure children have access to lots of water, and a diet with plenty of fresh fruit and vegetables is also good.

If you’re worried at any stage get a review by your doctor.

Constipation, along with diet, fluids and starting solids, are just some of the topics in our new “It takes a village” Antenatal and Postnatal Education Courses starting in 2019.  Talk to our staff if you’d like to know more.

i can poop anywhere, anytime…

just watch me!