Constipation in babies and young children is often temporary and of little concern. It can usually be solved by slightly modifying the baby’s diet and increasing the water volume of his or her meals to moisten the stool and facilitate transit. However, in rare cases, certain symptoms can be alarming, requiring an examination by a professional.

Symptoms of constipation in babies

Babies and toddlers are not yet able to articulate their problems. It is then our responsibility to detect them. But, that is not always easy. Above all, it is important to remember that each child, as well as each adult, has its own rhythm of digestion and that one cannot therefore jump to a hasty conclusion by comparing the transit of a baby to that of another baby.

The important element to take into account is the way the baby is fed: whether he or she is bottle-fed or breastfed. Or whether he or she has already started a varied diet.

Infants before 6 months old rarely experience constipation, especially if they are breastfed. Furthermore, some babies growl, squirm, and cry with each bowel movement without necessarily being constipated.

A clear indication is hard, dry stool. Insidiously, however, a rather slimy consistency can also be an indication of constipation: if the hard stool stays in the intestine for too long, it can become softer by fermentation.

It’s also important to keep in mind that in babies and toddlers who eat normally, long-lasting and frequently recurring constipation may indicate gluten or lactose intolerance. Hirschsprung’s disease, a congenital disorder of the nerves in the intestinal wall, can also be the cause.

Breastfed babies

Although exclusively breastfed babies usually have several bowel movements per day during the first few weeks (up to 8), it is quite common for them to have only one bowel movement every 3 – 4 days, or even every 10-15 days. This is completely normal and should not worry the parents. This change in the pace of transit can be sudden and happen overnight.

Bottle-fed babies

Bottle-fed babies generally tend to have between one and three firm stools per day, although others only have a bowel movement every three to four days. This is not abnormal, unless the stool is very compact and very dry. Constipation occurs when the muscles in the lower intestine contract and block the stool, which then remains in the intestine becoming hard and dry.

Babies with a diverse diet

Once the child begins to have a varied diet, often after 6 months, episodes of constipation are not uncommon. They manifest themselves through these symptoms:

• Irritability, abdominal pain and stomach discomfort
• Large stool production and painful bowel movement
• A bloated, swollen, hard and painful belly
• Abdominal pain that lasts after a bowel movement
• Blood-streaked stools, usually due to anal damage caused by passing hard stools
• Stools similar to small hard balls

Causes of constipation in babies

The majority of constipation in children are said to be “functional”: this means that they are not linked to a specific pathology. Most of the time, they are only temporary and due to simple dietary factors:

• Poorly prepared bottles: the quantity of water is not sufficient in relation to the quantity of powdered formula
• Change of diet as during food diversification for example
• Insufficient water intake, especially in summer when the risk of dehydration is high (after six months)
• Food too low in fiber – when the baby has a varied diet
• Constipation can also be a child’s way of expressing stress often triggered by a change in environment (entering a nursery, for example).

When to go see a doctor

Although it is of great concern to parents, constipation is common in babies and is not considered a pathology. In the vast majority of cases, it is sufficient to monitor the evolution of the child’s transit as the slowdown in transit is often only temporary.

However, if symptoms persist, it is important to have your child examined by your doctor or your baby’s pediatrician to rule out any possible medical conditions. Even more so if your child:

• Suffers from constipation that has lasted for more than a week
• Has bloody stools
• Has a very bad stomach ache
• Throws up
• Has anal fissures

If the stool is not evacuated sufficiently, there is also a risk of intestinal obstruction. The symptoms of the latter are usually quite characteristic: sudden sharp abdominal pain, pallor, vomiting, sometimes traces of blood in the stool. If in doubt, consult a doctor without further delay.

How to prevent or relieve infant constipation

When constipation occurs, especially in a bottle-fed baby, it may be due to a poor adaptation to the powdered milk or the mineral water used. Parents are advised to use waters that are “suitable for preparing foods for infants”. In case of constipation, it recommended to use water richer in minerals for just a few days.

If constipation occurs in a baby over 6 months old, who has already started a solid diet, it is advisable to favor mashed green vegetables or plum or prune compotes to relieve the constipation. A diet low in fiber or very rich in dairy products can sometimes be the cause.

It is also important to make sure that the child is comfortable (if he or she is old enough to use the toilet, his or her feet should be resting on a stool, for example). Lubricant can be used early on to help pass hard stools.

With the right diet, your baby’s bowel movements should return to normal within a few days. Here are the rules of conduct to follow:

• If the baby doesn’t have a big appetite, split the meals into several smaller portions.
• If the baby already has a varied diet, increase the amount of fiber.
• Make sure your baby drinks enough water (if more than 6 months old) throughout the day. For the preparation of milk bottles, as for water consumed in isolation, opt for plain water rich in magnesium.
• Eliminate chocolate in all its forms.
• Give your child a few spoons of prune juice during the day.
• Add a few teaspoons of vegetable broth, apple juice or freshly squeezed orange juice to the baby’s bottle.
• Limit foods that promote constipation such as rice, bananas, carrots, and quince.

In addition, whatever the age of your child, abdominal massage can help speed up transit and relieve it. To do this, bring her legs up to her stomach by making small movements. You can also, several times a day, gently massage your baby’s belly, around his navel, in a clockwise direction. This can stimulate his bowels and help lower stools.

Self-medication, however, should be avoided: suppositories with a laxative effect should only be administered on the advice of your doctor or the pediatrician who follows your child. Do not be tempted to use an aggressive method such as an enema or the introduction of a rectal thermometer on your own to stimulate the natural expulsion reflex, as this may cause lesions and your child’s increase pain.