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Pharmamum’s Ultimate Guide: Constipation
I feel I have had my fair share of constipation issues to deal with as a parent. Both of my daughters caused me a lot of stress with their bowel habits but thanks to them and my knowledge as a pharmacist, I will be able to pass on what I have learned and provide you with good practical advice with how to treat and hopefully prevent constipation.
It’s amazing when your child is born, besides worrying about the most obvious feeding and sleeping issues, I’d say the next most common concern is about the child’s bowel habits? Is my child opening their bowels enough? Is my child constipated? Are you sure that is what a baby’s poo should look like? Is it too green? Too yellow? Too much? How much can one little baby poo? We seem to discuss our children’s poo quite often at mother’s group, as if we are discussing the weather.There is always one baby that opens their bowel at every nappy change and then one like my eldest daughter, would open her bowels once a week.
When your baby is born, your baby’s first bowel motion (meconium) is a black, thick, tarry looking excretion. Once the meconium is out, the bowel motions tend to become thinner, lighter and watery excretion.Your baby should have a bowel action within the first 24-48 hours after birth. If they don’t it is important that they be seen by a doctor. Depending on whether your child is breastfed or formula fed will determine the consistency, appearance and odour of the bowel motion. If breastfed, the bowel motion is more watery, light brown mustard colour, not much of a smell and easy to remove. Stools can be greenish in colour and that can be perfectly normal too. Formula fed babies have stools that can range in colour from yellow green and brown (depending on which formula they are on) , thicker, pastier, and a stronger smell. I had a combination of both. I breastfed my children, but needed to top up with formula, so I had a combination of bowel excretions. It does depend on your baby’s gut processing speed as to how often your baby’s bowel opens. Both of my children were very slow with their gut processing and this led to very infrequent bowel motions. I remember with my eldest daughter, once we got home from the hospital, her bowels would open every 1 or 2 days and then it began to slow down and would open every 3 to 4 days, and then between 2 and 4 months of age her bowels sometimes didn’t open for up to 10 days. To be honest I was freaking out by that stage, but every maternal nurse, doctor, paediatrician I asked, gave me the same answer. That answer was, ‘some’ babies poo 12 times a day and that is perfectly normal and some babies poo once every 12 days and that is perfectly normal.’ I had two babies that opened their bowels every 10-12 days and I learnt that that was perfectly normal. That put my mind at ease, but when they finally opened their bowels, they would go bright red in the face and look like they were really straining. However, the bowel motion was always soft. When babies are getting use to making a bowel motion they can often go red in the face, grunt or even cry and still produce a soft bowel motion. Long periods between stools in a baby who is generally well, putting on weight and thriving is not a cause to worry. As long as the baby’s tummy feels soft, they are not distressed or consistently crying, and the stool produced is soft. The important thing to understand is that even though a baby may only have a bowel action every 12 days, it is not considered ‘constipation.’ A baby/child is only considered to be constipated if their bowel motions are very hard and firm and described as passing ‘pebbles’.
It is very unusual for breastfed babies to be constipated unless there is a medical problem (eg. Milk protein allergy, hypothyroidism,coeliac disease). This is because breastmilk is easy to digest and there is a hormone in breast milk that stimulates bowel contractions. Formula fed babies can become constipated on formula for a few reasons:
- Formula preparation– each formula requires a different amount of water to make up the formula. It is important to always check, because if not enough water is added, that can lead to constipation and dehydration.
- Depending on the infant formula, the ingredients and the ratio of proteins ie. whey to casein, can all affect how your baby digests the formula. Most formulas are whey dominant which is easier to digest than a casein dominant formula. Casein dominant formulas are harder to digest and hence will move slower through the bowel, allowing more fluid to be reabsorbed, which can lead to constipation. As the casein is slower to digest than whey protein, it may keep baby’s tummy full for longer. Every baby is different and sometimes it really is trial and error as to which formula is right for your baby. As a mother you can tell if your child is comfortable on the formula. However, it can be very hard in the early days as sometimes it can be a multitude of factors ie colic, reflux etc. Constipation may be caused by a milk-protein allergy or intolerance. If your pediatrician/GP diagnoses your baby with a milk-protein allergy they will switch your baby’s formula to one that isn’t milk-based. I would always recommend consulting a doctor before switching formulas.
Once a baby starts solids, it can be a time where the bowel habits change dramatically. Going from a liquid diet (ie breast milk or formula) to introducing solids, your baby’s digestive system needs to ‘up its game’ by working out how to digest and breakdown food in the form of a solid. The body needs ‘to learn’ how to digest the food that is being introduced and there may be some initial problems’ in the form of constipation. You may start to notice that you see certain foods that have been partially digested and you can recognise them in your baby’s bowel motion. Babies can become constipated when starting solids because as the food is making its way through the intestines the body will absorb the nutrients and the water content. The longer it takes for certain foods to make its way out of the body, the more opportunity the body has to absorb the water content for the solid. My daughters both suffered with constipation when starting solids. What I learnt from treating their constipation and trying to avoid further bouts of constipation was:
- Keep offering water. Try and have a sippy cup always on hand offering sips of water in between normal breast/ formula feeds. I was recommended that once I made up the formula using the correct amount of water, to add an extra 10mL of water just to increase the fluid content. I would never recommend diluting formula any further as then it compromises the nutritional needs of your baby. It is preferred to offer sips of water in between feeds.
- Certain foods are binding and can increase the risk of constipation in babies and others may promote a loose bowel action. What I found over time was depending on the consistency of my childs bowel actions, determined what foods I would add or avoid in their diets to either try and make the stools firmer or looser. Finding a balance is important.
Binding foods:- Rice cereal (Rice is binding and all rice cereals are fortified with iron which can cause constipation), Bananas, the starchy vegetables (eg.potatoes and sweet potatoes), apples, white bread and rice. Too much dairy can also lead to constipation.
Foods that can speed up gut processing: stewed Prunes and apricots, Pears, Kiwi fruit, peaches, plums, diluted prune juice (small amounts), green fibrous vegetables (eg broccoli, beans, brussel sprouts, zucchini). Fibrous foods (eg wholemeal pasta, brown rice and fruits such as blueberries, grapes, raspberries and strawberries are all high in fibre.
I was never able to give my daughters rice cereal because of its constipating effect. I needed to make my own baby cereal by blending oats and millet and then cooking it and mixing it with pureed pears and prunes etc.
- As soon as you notice your baby is constipated, the quicker it is resolved the better. You don’t want to get to the point where the bowel motion is so hard, that an anal fissure occurs which is a little tear in the anus. Anal fissures are painful and you don’t want your baby associating a bowel action with pain as this will set up fear and anxiety when passing stools.
If your child is constipated and under the age of one, it is important to speak to your baby’s doctor immediately with any of the following symptoms:
- Constipation with a hard belly and vomiting
- Passing blood in bowel motions
- Tear or soreness around the anus
- Looking unwell
- Reduced number of wet nappies in a day
- Constipation with poor growth and development
Once you have seen the doctor and they have checked for any serious health problems, they may recommend the above remedies (eg increased water and diet) as well as some medication to soften the bowel motions or help encourage the stool to be excreted. What happens is a hard dry stool forms at the anus and once that has passed, the faecal matter that follows is loose. Hence, you may need to treat both orally and anally. The aim is to have your baby’s bowel empty and keep it empty by maintaining soft lubricated stools:
- Infant glycerol suppositories can be used once a day. They are very small rocket shape suppositories that you can insert into the anus. A bowel action can occur within 5-30 minutes. If that initial stool is really firm,passing it may cause your baby to be in pain. I would also recommend applying some vaseline on a clean finger around the anus to help stimulate the bowel to open.
- Coloxyl Drops contain a stool softener called poloxamer. The drops can be used in infants and can be added to bottle feeds or diluted fruit juice. They help soften the stools.
- Lactulose can be given orally to infants from one month old. Lactulose works by drawing in fluid into the abdomen to soften the bowel motions. It is very sweet and can be mixed in water, milk or dilute fruit juice.
Usually constipation will settle within 2 to 3 months of starting solids.
Any medication given orally can take 1 to 3 days to work, however once the bowel motions are loose and your baby can comfortably produce a bowel motion without straining, any association of pain with excreting a stool will soon disappear.
Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.