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Kids health issues – Constipation in babies and toddlers (6 months+)

Most of us are aware that a healthy diet, adequate fluid intake, an active lifestyle and correct toilet habits can reduce the chances of constipation. Infants on solids can be particularly vulnerable to this condition, and many parents are surprised by the sudden pellet-like appearance of their bub’s poo when they start on solids. In young children, toilet training can also be followed by bouts of constipation.

What is constipation?

Constipation is when one experiences difficulty in passing faeces. Often it is associated with hard, dry stools and can be accompanied by discomfort or pain. Yes, it’s upsetting for everyone concerned.

Part of our fluid intake each day comes from the fluid in food. However, if there is a lack of fluid intake (or a drop-in fluid levels) in the body, the intestinal canal can ‘wring’ out even more fluid than usual, leaving dry, compacted faecal matter.

Poo should be formed, soft and easily passed. Keep in mind that we all ‘beat to the tune of our own drum’ and children are no different. Some children poo once every two or so days, others every day, some two to three times a day – whatever is usual for your child should be your benchmark. So it is important to be aware of any changes. A little one who poos daily and then suddenly doesn’t go for days may well be constipated.

But also remember that constipation is signalled by more than just frequency. Other signs of constipation include:

• Hard dry stools
• Poo that resembles pellets
• Difficulty in passing a poo (this may be associated with or without tummy ache and pain)
• Tummy aches and pains
• Holding onto a poo for fear of pain

In young children, persistent constipation can cause runny poo to leak into their underpants; this is termed ‘soiling’.

What causes constipation in babies and children?

Constipation can be caused by a few things; even weaning and early potty training can be a reason. The common causes of constipation include:

• A lack of fluid intake or loss of fluid
• Some formulas may be more constipating than others
• Incorrect formula-to-water ratio
• Dietary issues such as a lack of fibre or excessive intake of foods (such as refined foods) or fluids (such as milk); these can displace foods rich in fibre
• Putting off going to the toilet, as can happen in newly toilet-trained tots or due to the busy schedule of a young child, or not wanting to use certain facilities such as the school toilets
• Inactivity
• Some supplements such as iron
• Some medications

How do you prevent constipation?

Of course, prevention is always better than the cure.

Constipation in baby

Breastfed babies tend to suffer from constipation far less than those consuming formula. If you sense that your baby (who is not yet on solids) is experiencing constipation without an apparent reason, consult your GP or child health nurse as soon as possible.

Of course, hotter weather can be an issue. If you are wondering about offering baby (who is not yet on solids) some water, check with your child health nurse first.

For bubs on formula check for the following:

• The ratio of formula to water. Ensure that the scoop is not tightly packed. Measure the water first. You can always call the manufacturer’s hotline to check on this.
• That the formula is right for your bub; some don’t suit all babies. Research suggests that formulas with probiotics can soften stools and also that the protein composition of a formula can affect constipation.

For babies who are four months and above on solids, consider the following:

• Babies’ kidneys are not yet fully developed and therefore they are not as adept as adults at handling the waste products from the digestion and metabolism of food. Infants’ kidneys use more water to remove waste products from the body. Some bubs do just fine with an extra breastfeed; others may need to start water.
• Take care with legumes and fibre cereal. Excessive lentils, peas and fibre cereals can interfere with fluid, which is why they tend not to be offered in the early stages of solids.

Other tips:

Infant massage, when done correctly, may help and a warm bath could be just the thing to relax your bub.

What and when should infants drink?

It is difficult to offer a definitive guide on how much a bub will drink; it can depend on whether they are breast or formula-fed, how often they feed, what types of solids they consume, the temperature, and more. Regularly offering your little one water is the best way forward; it’s also worth remembering that little ones don’t have a great thirst reflex until after 12 months of age, some even later.

• As solids are increasing in volume in the diet, it becomes more important to monitor the amount of water a child is drinking, particularly in the case where milk feeds are being replaced by solid food.
• Water is the best option, particularly over juices and cordials.
• Ensure that drink bottles and cups are placed in easy-to-see and reachable positions and check the levels throughout the day.

For more on why juice is not recommended in infancy or early childhood, see our tip sheet on juices.

What about prune juice?

Offering baby a fruit juice to help with constipation is not advisable and can be more of a hindrance. Any changes experienced as a consequence of juice tend to be counter-productive to nutrition. Likewise, the addition of sugar or similar is not ideal for baby.

Bottle or cup?

Sipper cups can be introduced around the time of solids. Use clean water and encourage bub to drink a little water around eating times. Just a few sips can make a big difference. Even if baby takes a while to adjust to the taste of water, gently persist; without making a fuss it will eventually click.

Reducing the risk of constipation in children

A similar picture presents with regard to children. We can look at the following areas:

Diet

• Encourage a diet rich in fruit and vegetables (as well as containing fibre they keep the bowel healthy)
• Ensure your child is eating plenty of wholegrain foods such as breads, cereals, rice, nuts and seeds.*

Fluids

• Children who have adequate diets but suffer from constipation commonly do not drink enough fluid (water). Ensure water is always accessible and remind children to drink (the thirst reflex takes time to develop). About 400-800mls of fluid a day is the average for most young children as they do get some fluid from food.
• Avoid the excessive use of milk and other calorie-dense fluids as they can displace food and fibre.

Other

• Encourage physical activity, which can help the small muscles in the intestines to move food.
• Acidophilus powder (for example, a baby bifida) has been shown to help bowel functioning and soften stools.

Fibre facts

Not all fibre is the same; some will increase the passage of stools through the intestines whereby others tend to slow it. Figure 1 highlights the known effects of different fibre and their sources.

Figure 1 Types, sources and actions of dietary fibre

Updates on fibre

Not all starch is digested and absorbed. Some starch, termed resistant starch (RS), passes undigested through the small intestine to the large intestine where it can be fermented by bacteria in our intestines. RS has known benefits such as glucose and insulin control and colon health. Foods that contain RS include: grains (excluding rice) and foods made from whole grains such as wholemeal bread and wholegrain cereals, bananas, potatoes and legumes.

What to do if your child has constipation?

Mild constipation will generally resolve itself by one or more of the above suggestions. If, however, the problem persists, seek medical advice about clearing the accumulating stools and further prevention.

IF YOU ARE UNSURE OR SYMPTOMS PERSIST SEEYOUR MEDICAL PROFESSIONAL

Children should always be supervised when given nuts and seeds due to risk of choking.

This information is adapted from Leanne Cooper from Sneakys baby and child nutrition. Leanne is a qualified nutritionist and mother of two very active boys.