What is infant constipation?

Constipation is a condition where stools become firmer and harder. Your baby will be troubled or in pain when they need to empty their bowels, and the bowels will not be emptied as often or as easily as usual.

A breastfed baby will very rarely get constipation because breast milk is more easily digested. They also have several helpful types of bacteria in their large intestine that are capable of breaking down some of the otherwise indigestible proteins in milk. As a result, their stools are softer, making bowel movements easier. Breastfed babies also have higher levels of a hormone called motiline that increases the movement of the bowels.

It is equally normal for a young breastfed baby to have a bowel movement several times a day or as little as once a week. In rare cases, there can be up to three weeks between bowel movements. If the baby is entirely breastfed and doesn’t appear to be troubled by the lack of bowel motions there is probably no problem.

Bottle fed babies frequently suffer from constipation because formula milk is harder for a baby to digest.

A formula fed baby should empty their bowels at least daily.

A baby who receives only formula milk will typically have fewer bowel movements than a breastfed child. Their stools will be thicker and have a different, more greenish colour. A formula fed infant should have a bowel motion daily or at the very least every two days.

A baby who is constipated often shows signs of colic because the large amount of stool in the intestines makes the intestines larger causing pain. In some cases, the child may not want to eat and may even retch a little.

Seek help if:

  • If your baby isn’t gaining weight or shows any other unusual symptoms, seek the advice of a doctor.
  • If there has been no bowel motion for more than 24 hours and there is severe, unusual pain
  • There is difficulty passing the stool and the stool is grey or white in colour
  • The skin or eyes are yellow
  • There is alternating constipation and diarrhoea that continues despite self help treatment
  • The stools are very dark in colour, almost black. (This does not include the passing of maconium, the stools of the first days of life)
  • You are concerned for any other reason

What causes it?

  • Starting solids: the frequency of bowel movements and the consistency and appearance of stools will depend on the food your baby eats. The stools will begin to look a bit more like ordinary stools in consistency and smell. The pattern in bowel movements will also change. Your infant may have movements several times a day or as infrequently as once every two to three days. At this point, some babies may get slightly constipated. This is because the intestines have to get used to the new composition of the nutrients.
  • Dehydration.
  • Iron sulphate is a form of iron often used to supplement formula and some iron enriched foods such as farax. Constipation can be a side affect of eating these foods in sensitive children. See baby food recipes for homemade alternatives to these foods.
  • In some cases, constipation can be a symptom of a more serious underlying disease.

The vicious cycle of constipation

It will hurt your baby to pass the large hard stools that have gathered in the intestine. Cracks around the anus may appear; these may start to bleed and cause more pain.

To avoid the pain, your baby may start holding back stools, which makes the food stay longer in the large intestine.

As a result, your baby’s body will absorb more water from the stools and make the stools even harder. This can cause your baby to remain constipated.

What can you do?

  • Massage your baby’s tummy: Start at the belly button and then massage outwards in circles in a clockwise direction following your baby’s colon.
  • Place your baby so he or she is lying on their back. Hold their legs and turn them gently in a quick cycling motion. This will make the stomach muscles move and, in turn, put gentle pressure on the intestines to make them move.
  • If your baby is on formula, you should follow the instructions on the package carefully. Making the mixture too thick by putting in more than the recommended amount of powder can lead to constipation and other medical problems.
  • You can give your baby some extra water or extra breast feeds when solids are started if constipation appears to be a problem. Start with 15ml of cooled boiled water between and after feeds, add more if the temperature is hot. Increase the amount appropriately as the baby gets older.
  • Introduce solids cautiously. See Nutrition in the first year.
  • Supplement with probiotics- If breastfeeding, the mother can take an acidophilus and bifidobacterium supplement twice daily. If the baby is formula fed, add a 1/4 of a teaspoon of an infant probiotic (such as neocare or one prescribed by your naturopath) to a bottle twice a day.
  • Remove all iron sulphate containing foods from your baby’s diet.
  • Daily abdominal massage and reflexology sessions.

Cleaning out

The bowel needs to be cleaned out to start with then this needs to be followed up with preventative care. By simply increasing the amount of fiber in the baby’s diet, hard impacted stools will keep getting harder, larger and more difficult to move. If the suggestions below don’t help it is important to see your GP to rule out any potentially dangerous causes.

Step one Clear out the bowel

You can use a glycerin suppository to clear out hard stools. Gently insert in to the baby’s rectum and leave it there for a while. The glycerin coats and softens the stool allowing an easy and pain free exit.

Step two Massage to encourage movement through the large intestine

While waiting for the suppository to work an abdominal massage helps to stimulate the large intestine to keep the contents moving.

Step three Work from the inside

If your baby has started eating solids, it may help to keep things moving by giving stewed prunes to eat daily. Start with 2 prunes twice a day in 50 ml of water. If the baby doesn’t like the taste you can mix it with stewed apple. Give lots of extra breastfeeds if you are breastfeeding and give extra water if not. Follow dietary recommendations for introducing solids. Ensure you are giving your baby plenty of fiber and plenty of fluids.

Reflexology routine for constipation and diarrhea

See Using reflexology with your baby for guidelines

Use this reflexology foot chart to help you identify the areas talked about below.

Relax both feet with relaxation techniques and end with a thumb press on the solar plexus point in both feet.

Work each of the points suggested below:

  • Throat, oesophagus, thyroid and parathyroid areas
  • Mouth area
  • Pituitary, pineal, and hypothalamus
  • Spine with emphasis on the lower spine area
  • Stomach
  • Pancreas
  • Spleen
  • Sigmoid colon
  • Up the descending colon to the waist line and pelvic line (both feet)
  • Kidney
  • Liver
  • Gallbladder
  • Adrenals
  • Ileocecal valve
  • Up ascending colon and across the transverse colon

Do the relaxation techniques and thumb press on the solar plexus point in both feet

Aromatherapy

  • See Using aromatherapy for your baby for general guidelines and safe usage instructions.
  • You can use Mandarin, lavender, chamomile and grapefruit oils in a massage oil or in a bath
  • An abdominal massage with these oils can be very helpful
  • Start at the belly button and massage in a clock wise motion for one complete circle then move in a question mark like motion
  • Repeat this sequence until you or your baby have had enough
  • The question mark like motion starts at the belly button, moves in a half circle to the left then moves downwards to the groin. This follows the structure and the movement within the bowel.

Homoeopathic remedies

See Using homoeopathy for Infants for general guidelines and safety considerations.

Calc carb

  • The stool is hard at first then followed by diarrhea. It is large, pale and smells sour
  • The baby does not suffer from the constipation; in fact it may appear to feel better for it
  • The stool may be clay like or look like lumps of chalk
  • The diarrhea that follows the constipation contains undigested food, is sour smelling and very watery
  • This often accompanies teething

Causticum

  • The child will want to pass a bowel motion but will be unable to.
  • The stool will be soft even though the child has appeared to be constipated.
  • Will be worse in the evening

Hepar sulph

  • This child will appear Angry and irritable and will be over sensitive to everything
  • The child will get constipated when they get sick eg. A baby gets an ear infection and gets constipated at the same time
  • The stool will be soft although it is difficult to pass

Lycopodium

  • The baby will be restless and irritable
  • This is indicated for a baby who screams when they wake up and appears grumpy for some time after waking
  • The stools are hard and knotty

Nux vomica

  • This child will appear angry and impatient and quite stubborn
  • The constipation alternates with diarrhoea
  • Has a constant desire to pass a stool
  • You may notice a lot of straining
  • Only small amounts of stool will be passed at a time and it will be hard
  • The constipation may be caused by indulgence either by the breastfeeding mother or from too much food

Silica

  • The child will be sensitive to noise and may be ‘jumpy’ in general
  • The stool is large, knotty and hard and may come out a little way then slip back in
  • The cause of this constipation is weakness of the muscles in the bowels

Remedies should be discontinued as soon as symptoms improve or if symptoms worsen.