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When the going gets tough… Constipation in babies

31 Jan

“I got something to tell you

I got something to say

I’m gonna put this dream in motion

Never let nothing stand in my way

When the going gets tough

The tough get going”

This Billy Ocean hit from the eighties has become somewhat of an anthem in my household. You see, the start of the new year also marked the start of a new era for Boy Wonder – eating solids. It was an exciting time for all involved. Mr Wonderful and I basked in the joy of another milestone reached. Our two labradors set up camp beneath the highchair waiting for precious morsels of food to rain down on them. And the squeals of delight Boy Wonder made after swallowing each mouthful of food left us in no doubt as to how he was feeling about solids.

A couple of weeks later, Boy Wonder’s squeals of delight were accompanied by bouts of grunting and panting. At the end of his evening meal he would gaze off into the distance, a look of sheer determination enveloping his cute little face. What is he trying to do? Why is his face turning various shades of red? Where did that bulging vein in the middle of his forehead come from? Wait a second – when was the last time I changed a soiled nappy? That’s when it hit me, my little man was constipated.

Constipation in babies is a topic I am often asked about at the pharmacy. According to Billy Ocean when the going gets tough, the tough get going. How exactly does one get going? As a parent or carer what can you do when the going gets tough?

Baby bowel movements

Understanding your baby’s bowel movements can be pretty hard (sorry, I had to go there). Generally speaking stools should be formed, soft and easily passed. When it comes to a baby’s bowel movements, there’s no “normal” number – only what is normal for your baby. Your baby may pass a stool after each feed, or wait a day or more between bowel movements. A baby’s individual pattern is determined by several factors including what they eat or drink, how active they are, and their metabolic rate. For example babies that are exclusively breastfed very rarely become constipated, although they may not poo for several days or up to two weeks.  If you pay close attention to your baby, you should be able to tune in to his or her unique bowel habits.

Since it can be hard (sorry, I did it again) to determine what is normal and what is abnormal, a scale can be used to classify the appearance of the stool. One such scale is the Bristol Stool Form Scale shown below.

      

Stools at the lumpy end of the scale are hard to pass and often require a lot of straining, while those at the loose or liquid end may be too easy to pass. The ideal stools are types 4 and 5, as they are most likely to pass easily and are least likely to leave you with an annoying feeling that you left something behind.

What is constipation?

Many babies strain and go red in the face whilst doing a normal, healthy poo. Note that on its own this is not a sign of constipation. Constipation is defined as a combination of:

  • Infrequent passing of stools
  • Excessive straining
  • Excessive stool hardness (see types 1 and 2 above)
  • Pain on passing stools

True constipation in babies is uncommon and should always be checked by a doctor or maternal and child health nurse.

What causes constipation in babies?

There are several constipation-causing culprits including:

  • Not enough breast milk: Exclusively breastfed babies are rarely constipated. Breast milk has the perfect balance of fat and protein, and produces stools that are almost always soft. In the rare cases that constipation does occur in an exclusively breastfed baby, it may be because the baby is not receiving enough milk.
  • Formula: Formula that is made up incorrectly or changes to formula (especially when swapping to follow-on formula or cow’s milk) may cause constipation.
  • Dehydration: Babies not receiving enough fluids become dehydrated. Their system responds by absorbing more fluid from their food and drink and from waste in the bowels, resulting in hard, dry stools that are difficult to pass.
  • Introduction of solids &/or inappropriate solids: Babies often become mildly constipated when they are introduced to solids. It is important to use the correct solid foods for the age of your baby.
  • Anal fissure: Sometimes a hard stool causes a little tear or crack in the skin around the anus. This is called an anal fissure and can be quite painful. Not wanting to be sore, the baby may ‘hold on’ causing the stool to become even harder and more painful to pass.
  • Medical condition or illness: Although uncommon, constipation in babies may be caused by an underlying medical condition.      That’s why it’s always a good idea to seek advice from a doctor, nurse or  other healthcare professional if your baby passes hard, painful stools, just to make sure.

Treating constipation in babies

Suggestions to treat constipation in babies include:

1. Get the formula right

If you feed your baby formula, check the formula tin to make sure each bottle is being made up correctly. Always measure the water first and then add the formula powder. Be sure to only ever use the scoop provided in the formula tin. You may also wish to speak to your doctor, nurse or pharmacist about switching brands.

2. Keep baby hydrated

In warm weather, formula-fed babies require extra fluid such as cooled, boiled water between feeds. Breastfed babies may require more frequent feeds.

3. Move it baby

If your baby can crawl, encourage them to do a few laps. If we’re not at the crawling stage yet, try some leg pumping. While lying on their back, gently move baby’s legs in a forward, circular motion like pedalling a bicycle.

4. Make the right food choices

Switching from rice cereal to barley or oat cereal, or adding pureed fruits or vegetables to cereal, once your baby is ready for them may assist with constipation. Cut down on constipating foods like rice, bananas and carrots, and consider introducing some pureed prunes, apricots or pears to loosen those stools. Ask your doctor, nurse or an accredited dietician if you are unsure about what foods to introduce when.

5. Have a bath

A nice, warm bath may help baby’s muscles to relax. Just be prepared for them to poo in the bath…

6. Healing hands

A gentle tummy massage may help move things along. Measure three finger-widths below the navel and apply gentle but firm pressure with your fingertips. Gently but firmly move your fingers in a clock-wise direction for about three minutes.

If the idea of touch appeals to you, you might consider an osteopathic treatment. Sometimes the nerves that supply the lower third of the bowel don’t function as well as they could due to lower back tightness. This causes a slowing down in gastric motility resulting in a sluggish bowel. Once any serious disease has been ruled out by a doctor, osteopathic treatment aimed at improving lower spinal and pelvic movement often improves bowel function. Babies often enjoy this hands on treatment and leave feeling relaxed and sometimes even asleep!

For those of you in Melbourne I highly recommend the experienced, baby-friendly folk at St Kilda Osteopathy.

7. Seek help

It is extremely important to talk to a healthcare professional about treatment options. Many over-the-counter treatments that make bowel movements more comfortable are available, but should never be used without the advice of your baby’s doctor, nurse or pharmacist.

There are also some things you should NOT do to treat constipation in babies:

  • Don’t give prune juice – it contains a natural bowel irritant and is not suitable for infants under nine months of age, even when diluted.
  • Don’t add any form of sugar, malt extract or rice cereal to formula – it will not help the constipation.
  • Don’t introduce solids before four to six months of age – it’s not recommended as a way to treat constipation.

Hopefully by following the above advice, constipation need not be a constant worry for you. By providing your baby with a healthy diet and enough fluids, your baby’s bowels should stay healthy. But at least you’ll know what to do when the going gets tough…

Where to get help

  • Your doctor, maternal and child health nurse, or pharmacist
  • The Maternal and Child Healthline: 13 22 29
  • Nurse-on-Call: 1300 606 024
  • The Royal Children’s Hospital: +613 9345 5522
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