Part One: From constipation to diarrhoea

You know that you’re a mother or parent when you get excited about poo! From relief that your baby has a regular bowel movement to distress about runny poo or no poo at all, you will find yourself quite obsessed with the contents of your baby’s nappy.

Constipation is a common problem in 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 important to make a clear differentiation between normal and abnormal defecation patterns of infants/toddlers to avoid unnecessary medical tests, treatments and pharmaceuticals.

What is infant constipation?

The definition proposed by Biggs et al. (2006) for infant constipation is: “difficult or rare defecation lasting for at least two 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 suggested that you seek advice from your healthcare professional without delay.

“Remember to monitor stool size, frequency and consistency when suspecting constipation. Don’t be shy to “play with the poo”!”

Possible causes of constipation

Toilet training, stressful events, illness, unavailability of toilet facilities and fear of pain are all known causes of constipation. Feeding plays a key role in the stool patterns of infants, especially infants younger than four months. Healthy breastfed babies may defecate as frequently as seven times per day, or as infrequently as once a week (with normal stool consistency). On the other hand, it is considered normal for a formula-fed infant under the age of one year to defecate at least once in three 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.

How to safely manage your infant’s functional constipation

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. 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:

  • While breastfeeding: If an infant is exclusively breastfed and presenting with constipation, continue to breastfeed 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.
  • While formula feeding: When an infant on formula is constipated 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 those that contain pre- or probiotics (S26 Gold Comfort/Gold, NAN, Novalac Premium, Infacare Gold) may offer an alternative to medical therapies.

However, literature regarding the efficacy of pre/probiotics or partially/extensively hydrolysed formulas could only provide evidence of some benefit on the relief of constipation and their data as the single/only intervention for functional constipation is very limited. We recently came across a specifically formulated infant formula for the dietary management of constipation: Novalac IT. We investigated the nutritional table on the label in more depth and noticed that this formula has higher concentrations of lactose and magnesium compared to a standard infant formula.

Research on these nutrients shows that both help to improve the frequency and consistency of the infant’s stools by improving the stool’s water content (hydration). Simply put, it helps to draw water to the stool, which in turn softens the stool and assists with constipation. We 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 solution than the long-term use of partially or extensively/hydrolysed formulas.

How to prevent functional constipation

Ensure that your baby is on a balanced and routine diet and avoid refined foods and foods/substances high in sucrose, preservatives and other chemical additives. It is also very important that your little one drinks enough safe, drinkable water.

A few last important facts:

  1. If constipation occurs while exclusively breastfeeding, seek medical advice.
  2. Remember to monitor stool size, frequency and consistency when suspecting constipation. Don’t be shy to “play with the poo”!
  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 mix the formula correctly and give your baby 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 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 the advice of a healthcare professional. Preparation and storage of any infant formula should be performed as directed on the tin in order not to pose any health hazards.