Constipation in babies

Mild gastrointestinal disturbances are common in the first 6 months of life as an infant adapts to digesting a range of nutrients.3 It is estimated that up to 55% of babies will experience symptoms such as mild constipation, colic and wind in the first 6 months of life.3

There is a wide variance in bowel movement frequency among infants – some pass stools several times a day, others only a few times a week. Constipation is defined as a decrease in the frequency of bowel movements characterised by the passing of hardened stools which may be large and associated with straining and pain. Soiling of the clothes may result from overflow from the overloaded bowel.4

As well as infrequent, or irregular, bowel movements, a baby with constipation may also display the following signs and symptoms:

  • Loss of appetite
  • Lack of energy
  • Being irritable, angry, or unhappy
  • Foul-smelling wind and stools
  • Abdominal pain and discomfort

Causes
Constipation in babies and children is quite common, although the incidence is lower in exclusively breastfed babies.

Advice for parents

Parents of babies with constipation may find the following NICE advice helpful.

For babies who have not yet been weaned

  • For babies who are bottle-fed, try giving a little cooled boiled water – the amount is calculated based on the baby’s weight and usually given following feeds; do not dilute the formula feeds and continue with their normal feeding schedule
  • Try gently moving the baby’s legs in a bicycling motion; careful massage of the stomach may also help to stimulate the bowels

For babies who are eating solids

  • Babies should be given plenty of cooled boiled water or diluted fruit juice
  • A diet rich in fruit and vegetables can help (the best fruits are apples, apricot, grapes, peaches, pears, plums, prunes, raspberries and strawberries)
  • If no improvement is seen with the suggested dietary changes, parents should seek advice from their GP, who may prescribe a laxative (usually an osmotic), followed, if necessary, by a stimulant laxative. Bulk-forming laxatives are not suitable for babies5



The dietary recommendations for the treatment of constipation in infants and children published by ESPGHAN in 2014 differ slightly from the NICE guidance. They recommend a normal fibre and a normal fluid intake for children with constipation.6

SMA® Comfort Easy to Digest Infant Milk contains 100% partially hydrolysed whey protein and is suitable from birth. It is designed for babies experiencing tummy troubles.

References
  1. Department of Health. Infant feeding recommendation. May 2003 Available here.
  2. Best Practice for Infant Feeding in Ireland. Food Safety Authority of Ireland, 2012.
  3. Iacono G et al. Dig Liver Dis 2005; 37: 432–438.
  4. National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summary (CKS): Constipation in children. September 2010. Available here.
  5. National Institute for Health and Care Excellence (NICE). Clinical Guideline. Constipation in children and young people: Diagnosis and management of idiopathic childhood constipation in primary and secondary care (CG99). May 2010.
  6. Tabbers MM et al. JPGN 2014; 58: 258–274.
  7. NHS Choices. Colic. 2014. Available here.
  8. National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summary (CKS): Colic - infantile. November 2014. Available here.
  9. Vandenplas Y et al. Nutrition 2013; 29: 184–194.
  10. Billeaud C et al. Eur J Clin Nutr 1990; 44: 577–583.
  11. Infante D et al. World J Gastroenterol 2011; 17: 2104–2108.
  12. Carnielli VP et al. J Pediatr Gastroenterol Nutr 1996; 23: 553–560.
  13. Yao M et al. JPGN 2014; 59: 440–448.
  14. Limanovitz I et al. The effects of infant formula beta-palmitate structural position on bone speed of sound, anthropometrics and infantile colic: a double blind, randomized control trial. ESPGHAN 2011.
  15. Hyman PE et al. Gastroenterology 2006; 130: 1519–1526.
  16. Ramirez-Mayans J. J Int Pediatr 2003; 18: 78–83.
  17. Vandenplas Y et al. J Pediatr Gastroenterol Nutr 2009; 49: 498–547.
  18. National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summary: GORD in children. March 2015. Available here.
  19. Moukarzel A et al. J Clin Gastroenterol 2007; 41: 823–829.
  20. Xinias I et al. Curr Ther Res Clin Exp 2003; 64: 270–278.
  21. Heyman MB, Committee on Nutrition. Pediatrics 2006; 118: 1279–1286.
  22. Saneian H et al. Iran J Pediatr 2012; 22: 82–86.
  23. Huang Y, Xu JH. Chin J Contemp Pediatr 2009; 11: 532–536.
  24. Moya M et al. Acta Paediatr 1999; 88: 1211–1215.

*Ingredients of all formulas were confirmed by telephoning company carelines dedicated to answering queries about their products (March 2015)

IMPORTANT NOTICE: Breast milk is best for babies and breastfeeding should continue for as long as possible. Good maternal nutrition is important for the preparation and maintenance of breastfeeding. Introducing partial bottle-feeding may have a negative effect on breastfeeding and reversing a decision not to breastfeed is difficult. Caregivers should always seek the advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist on the need for and proper method of use of infant milks and on all matters of infant feeding. Social and financial implications should be considered when selecting a method of infant feeding. Infant milk should always be prepared and used as directed. Inappropriate foods or feeding methods, or improper use of infant formula, may present a health hazard.