Managing constipation in infants

Dr. Rotimi Adesanya

My daughter is three weeks old and she did not have a bowel movement for five days. She was miserable! I called my paediatrician and she told me this was normal for breastfed babies when they were going through a growth spurt.

“She proceeded to tell me that if my baby seemed distraught by it, I should give her half of an infant glycerin suppository. Within 10 minutes of giving the suppository to her, she filled up the diaper with faeces and has been happy since.” — A concerned mother.

I have also seen several mothers of neonates and infants with the same complaint of their babies’ inability to move bowel for up to 10 days. The babies are without any abnormality and they will start moving their bowels after rectal examination.

This is partly due to the stimulation of the nerves innervating the rectum and they will not need any medication; while very few (about two per cent) may have an underlying medical condition and may need to be sent for further tests such as X-ray and ultrasound scan of the abdomen.

It is advisable for mothers of newborns with constipation to contact their doctors for advice and not assume all is right.

Constipation in infants less than one year of age is common, but it can be a source of concern for parents. Sometimes, the baby is not really constipated, but must be given time to set his own schedule for having a bowel movement.

Infant constipation is the passage of hard, dry bowel movements — not necessarily the absence of daily bowel movements. Infant constipation may begin when a baby transitions from breast milk to formula or begins eating solid foods.

In rare cases, constipation may be caused by a lack of nerves or by structural problems in the lower large intestine.

Signs and symptoms

•An infant who is constipated usually strains more than other babies to have a bowel movement.

•The stool may be formed and hard like small pebbles, or it may be soft and mushy. Stool may even be wide and large.

•Sometimes, solid stool stays inside and liquid stool (like diarrhoea) may pass out around it.

•Other signs of constipation are infrequent stools that are difficult to pass.

•The child’s abdomen can become swollen with gas, and painful cramps can result from constipation.

•The child may be restless and cranky.

Investigations

•Digital rectal examination: In this procedure, a doctor or other health care provider inserts a gloved finger into the rectum to feel for anything unusual or abnormal.

•Abdominal X-ray: This is a diagnostic test to evaluate the amount of stool in the large intestine.

•Abdominal scan may be helpful in some cases.

Treatment

•You may give fruit juices (prune, pear, cherry, orange or apple). If the stool becomes too loose, just give less juice to your baby.

•If the baby is eating rice cereal, it may help to switch to oatmeal or barley cereal. Rice cereal can cause constipation in some children.

•To ease the passage of hard stools, consider applying a small amount of water-based lubricant to your baby’s anus.

•It might help to place an infant glycerin suppository into your baby’s anus. Glycerin suppositories are available without a prescription. They are only meant for occasional use when dietary changes are not effective.

•If your baby is old enough to eat strained foods, you may give him fruits and vegetables.

•A warm bath at least once a day can help relax his rectum. This can make it easier for him to have a bowel movement.

•Proper toilet training/bowel habits for older infants: Have your child sit on the potty at least twice a day for at least 10 minutes, preferably shortly after a meal.

The treatment listed above is applicable to infants above three months only. Those that are less will need a doctor’s review.

In conclusion, most of the time, constipation is a temporary situation. However, some children may have diseases of the intestine, such as Hirschsprung’s disease. All cases should be referred to a competent medical practitioner.

culled from Punch