From constipation to diarrhoea: what to do!? Part 1

Constipation Part1 PinterestYou know that you are a mother when you are excited and relieved by the fact that your little one has a regular bowel movement and get distressed when nothing has happened for a few days in “that department”….

A few months ago we had a discussion on colic, where mommies and caregivers shared their concerns and advice with one another. Another matter that was frequently mentioned during these discussions and for which advice were shared, was tricks on how to treat constipation. I think why this came up while discussing colic was simply because often a constipated baby presents with similar symptoms as a colicky baby does. However, if one can pin-point which symptom is most severe, one would be able to use a more specific solution to manage the condition at hand, often addressing the other symptoms then too.

Constipation is a common problem within the first years of life, and can cause many parents and caregivers to seek frequent medical advice, contributing to already high medical expenses. More often than not, constipation is over diagnosed and it is therefore important that you can make a clear differentiation between normal and abnormal defecation patterns of infants/toddlers. More importantly, this can help to avoid unnecessary medical tests, treatments and pharmaceuticals.

So, let’s have a look at what constipation is, what causes it and how it can be prevented and treated/managed. For a more indepth discussion on diarrhoea, please read Part 2 of this article.

What is infant constipation?

The definition proposed by Biggs et al. (2006) for infant constipation is: “difficult or rare defecation lasting for at least 2 weeks” and it has been well accepted and recommended by experts in the healthcare industry. Symptoms such as distension of the colon, pain, irritability and crying may also contribute to the symptoms of constipation and may sometimes even be confused with infantile colic. When these symptoms persist, it is highly recommended that you seek advice from your health care professional without delay.

What are the possible causes of constipation?

Toilet training, stressful events, illness, unavailability of toilet facilities, fear of pain are all known causes of constipation. Feeding plays a key role in the stool patterns of infants, especially infants younger than 4 months. Healthy breastfed babies may defecate as frequently as 7 times per day, or as infrequently as once a week (with normal stool consistency). On the other hand, it is seen as ‘normal’ for an infant who is under the age of 1 year and formula fed to defecate at least once in 3 days. Firm or harder stools are also often seen when breast milk is switched to infant formula or with the introduction of solid foods. Monitoring these changes in the frequency, size and consistency of stools can help you to determine whether your infant/toddler may be suffering or starting to suffer from constipation.

It is important to know that constipation can also be caused by an underlying cow’s milk protein allergy or organic disease, although this is very rare, it is vital that a thorough medical history and physical examination are performed when constipation is diagnosed. Most of the infants/toddlers today suffer from “functional constipation” (no organic cause/problem), which can be effectively treated with dietary changes and lifestyle modifications. Remember that pharmaceuticals are short-term treatments whereas a dietary intervention may provide a long-term solution.

My infant has “functional constipation” how do I manage it, what is safe?

The first step in managing this condition is to educate and reassure yourself, and keep in mind that functional constipation is one of the most common manifestations in infants. As already mentioned, once the diagnosis has been made guidelines suggest dietary modifications as the very first step in treating the problem. Let’s look at what the advice is for breastfed and formula fed babies.

Whilst Breastfeeding: Remember, if an infant is exclusively breastfed and presenting with constipation, keep breastfeeding and seek medical advice. If the infant is breastfed and starting with solid foods, ensure that the correct amounts and types of food are introduced at the correct age. Every infant is unique and stool consistency may change, but a change in stool consistency and frequency does not necessarily mean “constipation”.

Whilst formula feeding: When an infant is constipated on an infant formula, and has not yet begun with solid foods, it is advisable to first change the formula. Formulas which are partially or extensively hydrolysed (Novalac HA, Novalac Allernova Smooth, Similac Allimentum, Similac Total Comfort, NAN HA, NAN Alfare) or contain pre- or pro-biotics (S26 Gold Comfort/Gold, NAN, Novalac Premium, Infacare Gold) may offer an alternative to medical therapies. However, literature regarding the efficacy of pre/pro-biotics or partially/extensively hydrolysed formulas could only provide evidence of some benefit on the relief of constipation and their data as single/only intervention for functional constipation is very limited. I recently came across a specifically formulated infant formula for the dietary management of constipation: Novalac IT. Since I was not familiar with the formula, I decided to investigate the label in more depth than I would usually do… From the nutritional tables, I noticed that this formula has higher concentrations of lactose and magnesium compared to a standard infant formula. But what did this mean? I did some research on these nutrients and found that both help to improve the frequency and consistency of the infant’s stools by improving the stools water content (hydration) – so basically it helps to draw water to the stools, which in turn softens the stools and assists with constipation. I also confirmed that this formula is safe to use as a single/only intervention over the long-term and can be used to manage symptoms of constipation before, during and after the introduction of solid foods (growing up phases). Looking at those expenses, it may also provide a more cost-effective and solution than the long-term use of partially or extensively/hydrolysed formulas.

What else can be done when my infant is constipated?

Glycerine suppositories or rectal stimulation can be used occasionally, especially if there is need for urgent/rapid relief, such as when there is a very hard stool in the rectum and baby is showing immense discomfort (that heartbreaking face and cry that make you want to sob!). This should not be used or done frequently. Rather consult your health care professional.

When infants have been introduced to solid foods – juices containing sorbitol such as prune, pear and apple juices, can decrease constipation, but the risk is that the infant may drink more fruit juice than formula, and therefore become malnourished. High sugar concentrations are also a concern. Again, it is always best to consult your health care professional (GP, Paediatrician, clinic sister etc.) if you are unsure.

Many mommies often use gripe water to try and assist their little ones who struggle with constipation as they believe it assists in digestion and stomach aches. However, for many years the safety and effectiveness of gripe water has been under question. I came across a recently published article Jain et al., (2015) who wanted to determine why mothers give gripe water to their babies and to find out what benefits or health risks it poses. Interestingly enough, what they found was that vomiting and constipation are seen in more children receiving gripe water than in those who did not. This is something to think about, since so many of my own friends and even I have used gripe water many a time to try and assist with baby’s tummy troubles. Turns out, that is the wrong thing to do.

Another “reactive” way to ease constiptation and help nudge “the little guy” out is to lie your baby on its back , hold its legs and move them in and out towards the tummy as well as around in circles. This sometimes does the trick. A mothers touch is very powerful and by rubbing your little ones tummy with a warm hand or by applying pressure, relief can be provided.

How to prevent “functional constipation” from occurring

You can ensure that your infant is following a balanced and routine diet by avoiding refined foods and foods/substances high in sucrose, preservatives and other chemical additives. It is also very important that you ensure that your little one drinks enough safe, drinkable water.

A few last important facts:

  1. If constipation occurs whilst exclusively breastfeeding, seek medical advice.
  2. Remember to “monitor” stool size, frequency and consistency when suspecting constipation.
  3. When functional constipation is diagnosed, a change in your infant’s formula or diet may be the only necessary change to obtain long-term results.
  4. Do not introduce solid foods before the recommended age of 4½-6 months and refrain from unhealthy/refined foods, unless under specific circumstances.
  5. A daily addition of probiotics to formula can make the world of difference.
  6. Always ensure that you are mixing your formula correctly and giving enough water.

 

Disclaimer: This post is based on personal experience and personal brand preference of the content author and has in no way been paid for or sponsored. BabyYumYum reserves the right to its opinions and fully supports the notion of promotion that breast is best in line with the World Health Organisation (WHO) infant feeding guidelines http://www.who.int/topics/infant_nutrition/en/ Breast milk is the best food for infants. Good maternal nutrition is essential to prepare and maintain breastfeeding. If breastfeeding is not applied, an infant formula may be used according to health professionals’ advice. Preparation and storage of any infant formula should be performed as directed on the tin in order not to pose any health hazards.

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