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 (See our free downloadable resource: The Poop Chart) 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.
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.
“Remember to monitor stool size, frequency and consistency when suspecting constipation. Don’t be shy to “play with the poo”!”
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:
- If constipation occurs while exclusively breastfeeding, seek medical advice.
- Remember to monitor stool size, frequency and consistency when suspecting constipation. Don’t be shy to “play with the poo”!
- 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.
- Do not introduce solid foods before the recommended age of 4½-6 months and refrain from unhealthy/refined foods, unless under specific circumstances.
- A daily addition of probiotics to formula can make the world of difference.
- Always ensure that you mix the formula correctly and give your baby enough water.
The following Q&A takes delves deeper into the smelly but serious topic of diarrhoea.
Q. When can we say a baby or child has diarrhoea?
A baby or child is reported to have diarrhoea when there is a decrease in the consistency of the stools (stools are looser or liquid), as well as an increase in the frequency of stools passed (typically more than three episodes in 24 hours).
Acute diarrhoea typically lasts less than seven days and not more than 14 days and most babies and children also vomit during a diarrhoea spurt (Guarino et al., 2014).
Q. What causes diarrhoea?
Diarrhoea can be caused by:
- infections including bacteria and viruses (infectious diarrhoea);
- an increased osmolarity in the gut, which is as a result from too sugary or too salty foods which in return draws water to the stools (osmotic diarrhoea);
- a sensitivity to a food such as a lactose intolerance could also cause diarrhoea.
Diarrhoea can rapidly lead to dehydration and should be treated quickly to avoid more serious health problems.
Q. How can I treat diarrhoea?
The first risk of diarrhoea is dehydration. In case of severe diarrhoea, an oral rehydration solution should be given to a baby for a few hours, especially if the weight loss is more than 5% of the weight of the infant before the diarrhoea started. While oral rehydration or solutions with fluids (containing glucose, Na+, K+, Cl–) is preferred, oral electrolyte solutions such as Rehydrate are readily available.
After the baby is rehydrated, refeeding is needed to stimulate their recovery – after which the baby’s normal feeding should be continued with special care to avoid a relapse. If the baby is being breastfed, it is advised to continue to do so. However, for formula-fed babies, there are options that can be used to treat diarrhoea.
For example, soy milks are known to be lactose free, but are not specifically designed for feeding during diarrhoea, but rather for primary lactose intolerance and long-term feeding. The same applies to the various Lactose Free (LF) formulas on the market.
For the treatment of diarrhoea, a single week of lactose-free feeds should be sufficient, after which the usual formula should be used again. These above-mentioned formulas do not have an adapted mineral, electrolyte and carbohydrate profile to assist with rehydration and their taste has not been improved or modified to assist with overcoming a loss of appetite.
While analysing all of the formulas on the shelf, Novalac AD stood out as one for the dietary management of diarrhoea.
This formula is not only lactose-free to prevent any secondary intolerances if your baby has diarrhoea, but it also contains higher concentrations of relevant electrolytes (such as sodium, potassium and chloride) to allow for rapid rehydration as well as an optimal energy intake to help with weight recovery.
Please remember that you should always consult your doctor, clinic sister or pharmacist for medical advice when your baby appears to be suffering from diarrhoea.
Q. What else can be done?
If you prefer making use of pharmacological options, consider the following:
- Absorbants such as Smecta, which acts like a clay coat for the entire mucosal lining and absorbs toxins, bacteria and viruses. However, such products cannot be given within one hour before or after any additional medications, as it will absorb that too.
- Kaolin/Pectin combination combines an adsorbent and protectant and acts by absorbing excess fluid and reducing intestinal movement. Examples of such products include Gastropect or Pectrolyte, but these products are not safe to on newborns.
Q. What must I do if my baby has diarrhoea?
Parents must be particularly vigilant in cases of diarrhoea and take these essential measures:
- Regularly monitor your baby’s weight and appearance.
- Check the temperature of your baby twice a day.
- Watch out for vomiting occurrences.
- Give your baby as much water as possible.
- Consult the doctor urgently if diarrhoea continues.
To prevent diarrhoea from recurring, good personal hygiene is highly important. Ensure that feeding bottles and teats are sterilised and wash your hands thoroughly before preparing food for your infant. If formula feeding, discard unused formula immediately after a feed to reduce the risk of contamination.
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 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.