Constipation in babies under one year of age: what could be the reason?

Author, editor and medical expert - Klimovich Elina Valerievna.

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Last updated date: 11/16/2021

Average reading time: 17 minutes

Constipation (from the Latin constipatio - accumulation, accumulation) can occur in a child at any age1, 3. It is associated with a slowdown in the movement of feces through the intestines3, 4. This is one of the most common “children’s” problems4, but many parents do not recognize it or They believe that a child at 3 or 4 years old will “go away on its own”, without medical help. Some parents do not consult a doctor on time3, 5 because they cannot understand whether the baby goes to the toilet often enough, whether the density and volume of feces is normal1, 3, 5.

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Diseases and risk factors

Constipation in children can be caused by a number of diseases that directly or indirectly affect the digestive process.

Hirschsprung's disease

This disease is characterized by a congenital defect in the nerve endings of the colon. These nerve endings are necessary to regulate the contractile function of the intestines, due to which feces are transported. Due to the lack of nerve endings, the intestinal walls do not contract, thereby causing stagnation and accumulation of contents.

Celiac disease

Celiac disease, or celiac disease, is a chronic digestive and immune disorder that damages the small intestine. The disease occurs due to eating foods containing gluten. Gluten is a protein found primarily in flour products such as pasta, cookies, and bread.

This disease occurs due to genetic characteristics of a person, which lead to the inability of the intestines to absorb gluten and disrupt the process of formation of feces.

Spina bifida

A congenital spinal malformation, a type of neural tube defect, often combined with defects in the development of the spinal cord. The defect is an incomplete closure of the neural tube in an incompletely formed spinal cord, which leads to paralysis of the lower extremities, bowel and bladder dysfunction.

Hypothyroidism

Hypothyroidism or underactive thyroid gland. The thyroid gland is an organ that produces a large number of hormones that control the functioning of the body. If the gland does not produce enough hormones, a person experiences a number of symptoms, which include constipation.

Constipation can also be caused by other diseases that affect the digestion process in one way or another. These include various tumors pressing on the intestines, injuries to the brain and spinal cord, and diabetes.

A number of medications can also cause indigestion:

• Anticonvulsants;
• Preparations containing aluminum and calcium - antacids;
• A number of painkillers;
• Some antidepressants;
• Antispasmodics.

Preventive measures

The diet should contain a lot of vegetables, fruits, cereals and wholemeal flour; you can add wheat and oat bran as sources of fiber. It is better to cook vegetable soups. The child should drink a normal amount of liquid - fruit drinks, compotes, clean water, juices.

One of the most important conditions for normal bowel function is constant moderate physical activity. Any kind of sports or even just regular walks will be very useful.

You need to teach your child how to sit on the toilet correctly. Your feet are on the floor, your knees are bent, you can even raise your knees a little by placing a small bench under your feet, your torso is tilted forward. There is no need to push; on the contrary, you need to relax so that the intestines themselves perform the act of defecation.

Sources:

1. P.L. Shcherbakov, L.N. Tsvetkova, V.V. Kashnikov. Chronic constipation in children // Issues of modern pediatrics, 2005, vol. 4, no. 4, pp. 54-62.
2. HE. Komarova, A.I. Khavkin. Constipation in young children: causes and features of dietary correction // Issues of modern pediatrics, 2014, No. 13 (1), p. 114-118.
3. M.I. Dubrovskaya, P.V. Parshina. Current issues in the development of constipation in children, approaches to therapy // Issues of modern pediatrics, 2012, vol. 11, no. 11, pp. 76-82.

Vostrikova Ekaterina Borisovna Clinic

Author of the article

Vostrikova Ekaterina Borisovna

Specialty: gastroenterologist

Experience: 13 years

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

Signs of the disease

Source: t.tomsickova / Depositphotos
Clinical manifestations of constipation are varied. They become most pronounced with prolonged constipation and are:

• Bowel movements less than 2 times a week;
• The stool comes out heavily, its substance is dry, hard, consisting of many pieces;
• Defecation is accompanied by pain;
• The child may feel that some of the contents have not come out;
• Abdominal pain and bloating;
• Traces of liquid stool on underwear.

You should immediately seek medical help if you have the following symptoms:

• Bleeding from the anus;
• Blood in the stool;
• Weight loss;
• Vomit.

If older children can talk about a problem with the intestines, then parents may not even be aware of the problem of a very young child.

Important: symptoms of constipation in an infant:

• Problems with sleep, the child often wakes up and cries.
• When changing the diaper and washing the baby, he behaves restlessly, fidgets, and begins to cry. This is associated with pain during bowel movements.
• The baby poops less frequently than usual and his or her stools are hard or pellet-like.

Chronic constipation is characterized by skin changes. It becomes pale, acquires an earthy tint, and loses elasticity. Becomes dry and flaky. There is a coated tongue and bad breath.

When you can't do without medical help...

Unfortunately, not in all cases you can cope with constipation on your own. If defecation disorders are accompanied by severe pain in the tummy, the baby refuses to eat, his stomach is very swollen, and blood is found in the stool, immediately go to the doctor . He may prescribe laxatives, which are still best not to get carried away with (as well as enemas). If the cause of constipation is dysbacteriosis, then the pediatrician will prescribe drugs to restore the microflora (for example, Biocomplexes Normoflorins). After examining the child, the doctor may refer you to other specialists, for example, an endocrinologist or urologist. The causes of constipation often have an emotional and psychological component (perhaps something scared the baby, he was stressed). In this case, you will need the help of a neurologist.

Mother's diet

Source: Alexander Dummer: Pexels
Breastfeeding mothers often wonder how their diet affects the quality of their breast milk and how choosing foods for it can affect the baby's digestive system. However, most women do not need to restrict their diet while breastfeeding and should aim for a nutritious and varied diet.

In some cases, infants may seem to avoid feeding after the mother has taken certain foods. In this case, a woman can simply eliminate this food from her diet and return to it after stopping breastfeeding.

Important: Special recommendations include avoiding caffeine while breastfeeding. Caffeine is easily transmitted to the baby through milk. It reduces the amount of iron in milk, which can lead to iron deficiency anemia. It is recommended that a nursing mother consume no more than 400 milligrams of caffeine per day. The most caffeine is found in coffee and chocolate, and the least in tea.

A healthy diet while breastfeeding is essentially the same as a nutritious diet without breastfeeding. The main difference is that breastfeeding people need 450 to 500 extra calories per day. But if you want to lose weight after pregnancy, you can do without them, having first discussed this with your doctor.

A healthy diet for a pregnant woman includes:

• Fruits, especially rich in potassium and vitamin A (melon, banana, apricot, mango, oranges). Helps reduce the risk of constipation in both the child and the mother;
• Vegetables containing vitamin A and potassium (spinach, carrots, tomatoes, red peppers);
• Grain products, especially brown rice and whole grain bread;
• Protein-containing foods such as beans, peas, nuts, meat, fish, mussels.

Important: A nursing mother needs to drink a lot of water, especially in the first weeks after birth. Lack of fluid negatively affects milk production. A sufficient amount of water ensures the efficient functioning of the digestive system, helps food to be absorbed, which means breast milk will be well-balanced in nutrients. The higher the conditional quality of milk, the lower the likelihood of constipation in a child, since balanced milk improves peristalsis and fecal removal.

How to help a child?

Firstly , review your diet and frequency of meals
.

Breast milk contains oligosaccharides (more than 130 types) that promote the formation of regular stool. The mother's diet also affects the baby's stool. Strong tea, blueberries, and starchy foods slow down intestinal motor function. It is better to exclude them.

Age norms

A breastfed newborn baby can have bowel movements as many times as he is fed. If a child has stool 1-2 times a day or less during the first 3 months of life, you should consult a doctor. For bottle-fed children under one year of age, constipation is considered to be the absence of independent bowel movements during the day.

A common cause of constipation in breastfed infants is disturbances in feeding and nutrient absorption.

If there is quantitative underfeeding or good absorption of the mother's breast milk, the volume of feces in the child is not sufficient to arouse the urge to defecate. In such cases, retention of stool for 2-3 days is not considered true constipation.

Important: Constipation in infants who are breastfed and complementary foods is caused by a lack of foods containing plant fiber. Excess fat in food aggravates constipation and promotes even greater hardening of stool.

In addition to reducing the frequency of bowel movements with constipation, children may experience a decrease in appetite and abdominal pain. With chronic constipation, the volume of stool increases.

What is constipation?

Functional constipation is one of the most common problems in pediatrics. They most often occur at the age of 2-4 years, when the child is potty trained. However, both at an earlier and at an older age, bowel dysfunction worries approximately 15-25% of children.

In order to understand whether it is constipation or not, special diagnostic criteria have been developed. To make a diagnosis, there must be at least 2 symptoms observed within 1 month:

• 2 or fewer bowel movements per week;
• episodes of excessive accumulation of feces in the intestines;
• episodes of painful or difficult bowel movements;
• episodes of large diameter stool;
• the presence of large fecal masses in the intestine of a child trained in toilet skills.

Additionally, the following symptoms may be observed:

• at least 1 episode per week of fecal incontinence in a toilet-trained child;
• episodes of large-diameter stool, which can cause blockage in the toilet drain.

Diagnostic criteria for diseases and conditions associated with constipation of functional origin, in accordance with the Rome IV criteria (2016)

That is, you need to understand that constipation is not only retention of stool, but also difficult, painful passage of feces with incomplete bowel movements (when the child holds back bowel movements) (even if he goes to the toilet every day).

Causes and types

Source: freepik - ru.freepik.com
Constipation in a child can be one of the manifestations of diseases not directly related to the pathology of the gastrointestinal tract (such as rickets, hypothyroidism). However, in the vast majority of cases, constipation is caused by problems with the intestines themselves.

During digestion, the intestinal walls contract in waves, pushing the contents towards the outlet - this phenomenon is called peristalsis or intestinal motility. There are two main options for intestinal motility disorders:

If the child’s stool is very rare, accompanied by bloating, and the volume of feces during bowel movements is large (as in an adult), we can assume that this is the so-called atonic constipation. Constipation associated with insufficient contractile activity of the intestines is called atonic. In this case, the child may not have the urge to defecate for a long time.

Compulsory measures (long-term potty training) usually only aggravate the situation and reinforce the child’s negative attitude towards what is happening.

Thick stools consisting of hard, smooth pellets (the so-called “sheep feces”), abdominal pain, and sometimes pain during defecation usually indicate spastic constipation. Spastic constipation in children occurs due to spasms (increased contractile activity) of the intestines.

In some cases, stool is released in the form of a ribbon or a thin stream. In such a situation, the child should be consulted with a surgeon to exclude organic pathology of the rectum (narrowing, neoplasm).

Diagnostics

A pediatrician examines children who retain stool. If necessary, a pediatric gastroenterologist is involved in consultation. The specialist collects a detailed medical history and identifies predisposing factors, dietary changes, and concomitant diseases. To verify the cause of constipation, an instrumental examination of the gastrointestinal tract and laboratory methods are prescribed. The most informative:

• Finger examination
  . Assessing the condition of the rectal ampulla is the first thing to do when a child is constipated. During the examination, fecal stones, large neoplasms, and places of greatest pain are determined. Before the examination, the abdomen is palpated to detect bloating, spasms, and an increase in the size of the sigmoid colon.
• Ultrasonography
  . Ultrasound of the abdominal cavity is a simple non-invasive diagnostic method that shows signs of inflammatory processes, abnormalities in the structure of the digestive tract, and suspicious neoplasms. Additionally, using an ultrasound sensor, a targeted ultrasound of the liver and pancreas is performed.
• Radiography
  . A survey X-ray of the abdominal cavity is quite informative and allows one to detect dilation of intestinal loops and signs of intestinal obstruction. To check the condition of the colon, barium irrigography is prescribed, which is performed after an enema. Sometimes radiography of barium passage through the gastrointestinal tract is used.
• Coprogram
  . Microscopic examination of stool includes determination of undigested food particles, fatty acids, red blood cells and white blood cells. Bacteriological culture of stool is required to exclude dysbacteriosis. The stool is examined for helminth eggs and the presence of protozoal infections.
• Laboratory indicators
  . If a child has persistent constipation, a biochemical blood test and liver tests are performed to rule out concomitant hepatobiliary disorders. If endocrine diseases are suspected, the hormonal profile is examined. Sometimes a highly specialized toxicology blood test is indicated.
• Additional methods
  . To exclude organic pathology and intestinal tumors, sigmoidoscopy or colonoscopy is recommended. To diagnose Hirschsprung's disease and UC, a biopsy of the intestinal wall is taken during the study. If there are signs of nervous system disorders, you need to consult a neurologist, EEG and EchoEG.

Treatment of constipation in children

Should I get an enema for constipation? It is not worth resorting to enemas often, since this suppresses the natural urge to defecate and disrupts the normal formation of the reflex. However, occasionally for constipation in children, you can use this remedy, following all the necessary recommendations. You can learn how to properly give an enema to a child from this video:

The volume of an enema for constipation in a newborn child up to 1 month is 30 ml, for a child 1-3 months - 30-40 ml (the smallest enema, not completely filled), for a child 3-6 months - 90 ml, 6-12 months - 120-180 ml. It is important to remember that the water in the enema should not be warm, but at room temperature (22-24 degrees). Toxic substances accumulated in the intestines quickly dissolve in warm water and are subsequently easily absorbed into the bloodstream.

If it seems that the intestines have not been completely cleansed, you should not rush: usually after the first portion, provoked by an enema, there is independent stool. Large-volume enemas should be performed by a doctor, as serious complications can occur.

What to do if your child is constipated?

• For any constipation in children, it is important that the child receives enough fluid - with water or clear, low-fat broth.
• For atonic constipation, massage of the anterior abdominal wall in a clockwise direction, laying on the stomach, and mild tactile irritation of the anus helps well.
• For spastic constipation, it is possible to use baby suppositories with glycerin. You should not introduce any foreign substances (soap, baby oil, etc.) into the rectum.

Treatment of constipation (especially chronic) in children is impossible without adherence to the regimen. It is advisable to teach your child to go and poop at the same time every day. To stimulate bowel movements, you can give your child a drink of cold water or fruit (for example, apple) juice in an age-appropriate dose. These activities must be carried out at the same time every day.

Calculation of fluid volume for healthy children

Children under 1 year of age

should drink at least 100 ml of water per day.

For healthy children weighing from 10 to 20 kg

Water demand is calculated using the formula:

100 ml (volume of water for children under 1 year) + 50 ml per kg for body weight over 10 kg.

For example, with a weight of 12 kg: 100 ml + 2 x 50 ml = 200 ml.

A child weighing 20 kg should drink water: 100 ml + 50 x 10 = 600 ml

For children weighing over 20 kg

The following formula for calculation is proposed:

600 ml (volume of water for a child weighing 20 kg) + 20 ml for each kg with a weight over 20 kg.

For children over 3-5 years old

you can use the calculation of the amount of water: 30ml / kg weight

Traditional methods of treatment

In addition to standard treatments, there are alternative ways to combat constipation.

Abdominal massage

In addition to relieving symptoms and treating constipation, abdominal massage has a strengthening effect on the abdominal muscles and relieves pain from infant colic.

Source: oksun70 / Depositphotos

The essence of the massage is light and gentle stroking of the child’s abdomen, smoothly transitioning to pinpoint pressure with the pad of the index finger from the navel to the periphery. The massage also ends with a smooth transition to stroking. The procedure is performed an hour before and after meals.

Treatment with medicinal plants

Many plants have a laxative effect and can be used as an auxiliary element in complex treatment. These plants include:

• anise;
• zhoster laxative;
• dandelion officinalis;
• horse sorrel;
• big plantain.

Plants are taken in the form of decoctions, infusions and teas. It is recommended to take breaks between courses of treatment for 2-3 weeks. This is necessary to avoid getting used to the fees and reducing their effectiveness.

It is not recommended to use medicinal laxatives without a doctor’s prescription: they can lead to increased gas formation and cause discomfort in the child.

Acupuncture

Acupuncture is an element of traditional Chinese medicine. The essence of the method is to insert thin needles into different parts of the body. To treat constipation, needles are inserted into the area of ​​the large intestine. This procedure helps to relax the intestinal walls and facilitate bowel movements.

Insufficient knowledge of the effectiveness of acupuncture prevents it from becoming a standard method in the treatment of constipation. The method may be accompanied by pain and bleeding.

Important: Acupuncture should only be performed by a qualified professional. And it is worth remembering that any trend from alternative medicine cannot replace real, evidence-based treatment.

Infant formula for constipation

An example of a formula that promotes regular soft stools is Nuutrilak Premium COMFORT.

Oligosaccharides are also added to infant formula. They also use gum for this. It is a natural source of polysaccharides (dietary fiber), which regulate intestinal motility. In addition, it has a beneficial effect on the colon microbiota and its diversity. All this contributes to regular soft stools in the child. An example of such a mixture would be Nutrilak Premium Antireflux.

In complementary feeding dishes, preference should be given to vegetables and vegetable purees. Dietary fiber and vegetable fiber should be present in the child’s menu.

Fruits and fruit purees are not main dishes. They can be used as a dessert or as an addition to porridge.