Constipation

Constipation is a common problem in children. As with other common problems, the parents get flooded with advices and information from well meaning friends and family that it gets difficult to differentiate what is right from what is not.



Is my child constipated?

Constipation is not determined by the number of bowel movements alone. The number of bowel movements a child has, varies with the age of the child and also from child to child. One may pass stools twice a week, another twice a day and both may be completely normal. So when do you say that your child is constipated?

Your baby is said to be constipated :

In the first month , firm stool less than once a day.

If the baby passes well formed/ hard stool and the baby wriggles, cries or is in obvious discomfort.(Many babies have some grunting and drawing up of legs during bowel movement which is quite normal)

If the child passes painful hard pebble like stool.

If the surface of the stool is streaked with blood.

If the child has tummy pain/ discomfort.



My baby is breastfed, can she still get constipated?

Breastfed babies are rarely constipated, although she may have a bowel motion only once a week or 10 days. This is because breast milk is almost completely digested , promotes growth of good bacteria in the gut and acts as a natural laxative. However a breastfed baby can still get constipated if they are not getting enough milk or for other medical reasons (discussed below).

Formula fed baby in the other hand can get constipated as formula is difficult to digest. Normally they pass stool less frequently (once a day or so) than breastfed babies (who pass bowel motion as frequent as 5 to 6 times a day), their stool is smelly and pasty when compared to the soft, less offensive and seedy stool of breast fed babies.



Why is my baby constipated?

A little understanding of formation of stool can give you a clear picture of why constipation occurs. Normally food is digested as it travels along the intestine, nutrients are absorbed and the roughage reaches the colon. A normal stool is the result of having enough water left in the roughage, the urge to defaecate felt when the bowel is distended with stool, the muscles of intestine and abdomen cooperating for straining. Constipation can occur if any of the above is compromised.

Causes of constipation :

Constipation is sometimes set off when they are switched from breast milk to formula or to cow's milk.

If the baby gets inadequate breast milk.

When the child is not getting enough water/ fluids in his diet.

When the child is not getting enough fibre (whole grains, vegetables and fruits).

Sometimes related to psychological problems/ behavioural issues.

During minor illness when the child gets dehydrated.

Anal fissure- A constipated child passes hard , pellet like stools which while passed tears the child's delicate rectal and anal mucosa, causing fresh bleeding and much pain. This pain causes the baby to hold faeces in fear of pain, causing the stool to get harder and starts a vicious cycle.

If the constipation is severe and resistant, your doctor may want to rule out other rare medical reasons like Hirschsprung's disease, thyroid levels, calcium levels and neurological problems.





What am I supposed to do when my child gets constipated?

1. If baby is breastfed continue to breastfeed as often as possible.

2. If baby is bottle feed, discuss with your doctor about changing over to the kind of formula that may be easy to digest .Try smaller and more frequent feeds.

3. Formula fed babies can be offered sips of water.

4. Delay introduction of solids, particularly rice or banana.

5. A warm bath may sometimes help the baby to pass stool.

6. For older babies, avoid constipating foods like rice, banana, cooked carrot and switch over to fibre rich foods like barley and oat. Add pureed prune, peach, peas or apricots to loosen the bowel.

7. For older kids, diet modification is the most important step. Make the kid drink enough water. Avoid undiluted juice or fizzy drink. Introduce plenty of fibre rich food- wholemeal bread, beans, lentil, peas, vegetables preferably with skin, dried or fresh fruits, nuts and seeds. Remember that even a high fibre diet require water for their intestinal sweeping.

8. Get your kid to exercise and move about. Babies can be helped by bicycling their legs or gently massaging their abdomen.

9. Discuss with your doctor regarding use of laxatives or suppositories. They can help by easing the passage of stool and thereby helping the child to tide over the fear of having to pass a painful, hard stool.

10. If severe, your child may need an enema.



What can I do to prevent my kid get repeatedly constipated?

A proper diet with enough water and fibre is often helpful. Avoid aggressive toilet training. Encourage your child to have bowel movements at a set time everyday, preferably in the morning. Explain your child that he should not ignore his urge and must go whenever he wants to, no matter where he is or what he is doing. Make it a stress free routine. Use star charts. Don't let the child get ashamed about his constipation. If constipation persists, consult your doctor.





My baby is getting iron fortified formula, can this be a reason for his constipation?

Contrary to popular opinion, iron fortified formula is not related to constipation. Nevertheless it is important to prevent iron deficiency anaemia.