My Child is Constipated

It is interesting how important children’s bowel movements are for their parents. I have had many mothers tell me that part of their definition of a “good day” is that the infant has passed a good stool. But what if this does not work so well?

In order to discuss regularity of bowel action we need to look at different age groups.

At birth a baby is supposed to pass the first stool within 24 hours of life. These stools are black and are called meconium. They are exceptionally sticky and it helps to put some barrier ointment like vaseline or petroleum jelly onto the buttocks prior to passing the first stool to make wiping it off very easy. If your baby has not passed stool in the first 24 hours ask a heath professional for opinion, as there can be an underlying problem.

After about 2 days this stool changes and becomes yellowish-green for a short while before turning yellow in breastfed infants. In formula fed infants the stools may remain green or brownish and usually have a strong odor. The stools are anything from watery-loose to soft and in formula fed infants even pasty. Little pieces in the stool likened to mustard seeds are normal for both breast- and formula fed infants. Often at this point infants pass stools with every feed. This is termed the gastrocolic reflex, where intake of food signals to the lower intestine the need to make space by defecation.

After a few weeks the infant has established a bowel routine that can include anything from passing stools seven times a day up to only once per week. As long as the infant is not uncomfortable, unwell, very bloated, vomiting or passing hard stools this is completely normal. Fussing while passing stools, turning red in the face, making grunting sounds and pushing hard are no signs of constipation as long as the stools are not hard. Increasing frequency particularly when suddenly watery or loose and with foul smelling stools might be diarrhoea (see blog “danger signs in infants and children” from 15 November 2016).

In older children constipation is usually a dietary problem. Most children with constipation eat starchy fruit and vegetables (e.g. banana, apple, pear, orange root vegetables like potato, sweet potato, pumpkin, butternut, etc.) Starch gets split up in the intestines to sugar which then gets absorbed and takes the water with it out of the intestines. The remaining content becomes hard and dry. The same applies to sugary drinks and cooldrinks. The sugar in the fluid gets absorbed as well and leads to absorption of water from the stool. Dietary change to a more fibre laden diet and with drinking sufficient amounts of water will commonly keep the stools soft and resolve constipation. Vegetables with fibre are green and leafy and in general everything that gives wind (e.g. cabbages, peas, beans, lentils, onions, etc.). Fruit that have plenty of fibre usually have big stones (e.g. prunes, plums, apricots, peaches, nectarines, avocado, mango, etc.) Sometimes additional assistance with emptying the bowel is necessary and your doctor will prescribe certain medications. These should be used in general for as short time as possible. If the hard stools remain despite adding fiber to the diet, it might be worthwhile to ask a health professional for help, particularly if this has been an ongoing issue.

One more thing: If you note with the constipation that your child has specks of blood on top of the stool have your health practitioner review your child for a small cut on the anus called a fissure. Passing stools is painful in case of a fissure and constipation worsens as the children try to hold their poo for as long as possible in order to avoid the pain.

In short:
Stooling patterns vary according to the age of the child and just not passing stool for a while does not on its own qualify as constipation. If constipation is present and remains an issue consult your healthcare provider to investigate the cause and give input on resolving the issue.