Constipation is a common problem in infants and children.
As a pediatric dietitian, I see this problem frequently and the cause is seldom because of lack of fiber or fluid.
Children in general do not require a lot of fiber. Their intestines are shorter, thus, shorter transit time. And we don’t want food to go through the intestine too quickly. Otherwise, the body would not have enough time to digest and absorb nutrients during the precious growth period.
Fluid intake or hydration is seldom an issue either. Most infant’s main diet is either breastmilk or formula, so hydration is not an issue. Same for toddlers, who usually consume 16-32oz whole milk along with couple ounces of diluted juice.
However, too much milk can be constipating for some children.
Let’s first define constipation
Constipation is usually defined as having infrequent bowel movements that are hard and painful. However, in children, it is less related to the frequency of pooping. But more the consistency of the poop.
Infants that strain or groan when they poop are not constipated if their stool is soft, even if they only have a bowel movement every two or three days. It is also important to remember that many breastfed infants only have a bowel movement once every week or two.
Parents frequently describe the poop of their constipated kids as “rabbit’s turds”, “hard pellets”, “pebbles”, “hard rock”, “golf ball”, etc.
What Causes Constipation?
Remember, constipation is not a condition itself. It is a sign or symptom that something else is wrong, such as an underlying medical condition, such as Hirschsprung’s disease, cystic fibrosis, Celiac disease, spinal bifida, hypothyroidism, food allergy, etc.
Constipation is also often found in children with special needs, such as spina bifida, Down syndrome, mental retardation and cerebral palsy, and it can be a side effect of many medications and hypotonia.
Children with developmental disorders that involve hypotonia or low muscle tone tend to have constipation. And this is due to weak musculature of the child. Hypotonia does not only affect skeletal muscles, but is affects smooth muscles in the inters tines as well.
Cow’s milk protein allergy is a common cause of constipation in infant and young children. Other signs to rule out that constipation is the result of cow’s milk allergy is projectile vomiting and bright red blood in stool.
There are many reason why an infant poops only once a week. Some breastfed children poop once a week. And there poop is normal yellow seedy poop and growing well. Then, I would say, that’s their normal.
If, on the other hand, an exclusively breastfed infant is pooping only once a week with normal yellow seeding stool, but not gaining weight or failure to thrive. Then, I would suspect inadequate intake from breastmilk.
Either the child is not latching properly or mom’s milk supply is being compromised.
Further investigation is needed.
Constipation is frustrating for both the child and the parents.
In pediatrics, we always say that children control their parents with 3 things: eat, sleep and poop. These are the three things that drive parents nut the most.
Treating Constipation in Infants and Children
Constipation, if not treated, can lead to a vicious cycle of constipation, not want to eat, then become more constipated, then not want to eat even more. Eventually vomiting, poor growth, and abdominal distention may result.
Like I said, I see constipated children frequently in my practice. I also see many children with constipation on medication, such as miralax. Almost every constipated child I see is on miralax, an osmotic laxative.
Now that you have better understanding of the cause of constipation, we’re going to talk about the treatment.
Constipation Treatment in Infants and Children
The treatment focuses on the cause of constipation. We’re not talking about giving a medication to “manage” the constipation. We’re going to “cure” constipation or make it disappear for good.
Medication should be save for the very severe case of constipation involving obstruction and causing other problems. Warning signs that may indicate a more serious condition causing your child to be constipated include poor appetite, vomiting, weight loss, poor weight gain, fever, abdominal distention or having a poor appetite.
It is important to note that infants that are exclusively breastfed rarely become constipated. Infrequent bowel movements do not mean constipation if your infant’s stools are soft when he finally passes one. And, most importantly, your infant is growing nicely on the growth chart.
I’ve heard parents adding Karo syrup or other light or dark corn syrups to their infant’s bottles of formula. I have never have any parents tried this. It just does not sound right. So I would not recommend Kara syrup or whatever other syrup in infants.
Infants’ digestive system is very delicate, you don’t want to put random things in it.
If you have an exclusively breastfed infant with hard pellet stools, projectile vomiting or blood in stool. I would suggest mom to first remove all dairy (cow’s milk, cheese, yogurt, etc) from her diet. If that doesn’t solve the problem, then remove soy products too.
If the infant is formula-fed with hard pellet stool, projectile vomiting or blood in stool. Change to either soy, or better yet, a semi-elemental formula, such as Alimentum or Nutramigen. If these do not work, and symptoms persist, then try elemental formula, such as Neonate Infant or Elecare Infant.
WIC will provide these formula with a physician prescription with a diagnosis of milk protein allergy.
Projectile vomiting in infants can also be the result of gastric reflux, tracheomalcia or pyloric stenosis.
But with blood in stool, cow’s milk allergy sits highly on the list.
In cases where it’s just simple constipation, there is no projectile vomiting or blood in stool, I usually suggest parents to give couple 2-3 ounces of diluted juice (apple, pear, white grape or prune) a day. This usually resolve the constipation.
For older children, it may be the amount of dairy product they consume. The most common dietary culprit I see with constipation is dairy products, such as milk or cheese.
I personally do not think dairy products is necessary. And that human babies consuming cow’s milk is just not natural. But the dairy industry has so much power over the dietary guidelines that dairy occupies one whole food group of its own instead of being part of the protein group.
RELATED ARTICLE: Non-dairy Calcium Food Sources that Will Surprise You.
What if your child is constipated because he/she is intentionally hold their poop?
Having infrequent and large poop that are painful to pass is not fun. Did I mention painful too?
When this happens frequent enough, your child may start to associate pooping with pain, and he/she will try to hold his poop to avoid the pain.
This creates a viscous cycle, where bowel movements are painful, so he holds them in, causing his stools to be even larger and harder, which causes even more pain when it finally does pass.
To stop painful, large and hard poop is to not get constipated in the first place. If it is ruled out that milk allergy is to blame, then avoid dairy products at all cost. Otherwise, use miralax to help produce “soft-serve” consistency stool until child is comfort with pooping.
Also consider using a “squatty potty” to help stool comes out easily. This Youtube video perfectly explains how it works.