Infants and Constipation – Be in the Loop About Infant Poop

One of the more common reasons for visits to the emergency department is constipation and abdominal pain. Constipation concerns parents at all stages of their child’s development – infancy, toddler, school age and beyond. Because this is such a broad topic, I am going to focus on infants and constipation.

What defines constipation in an infant and what do we tell parents when they come to the emergency department?

By definition, infants have extremely variable pooping patterns. Regular bowel movements for a newborn or infant can be several times a day, once every two days or even once a week. Did you recently transition from breast milk to formula? A change from breast milk to formula often results in firmer stools with a change in pooping patterns.

The first thing to realize is that constipation can be organic or functional. Organic constipation is more concerning because it means that there may be a physical reason for constipation in your child – maybe an obstruction, a neurologic problem, cow’s milk allergy etc. Thankfully, over 90% of constipation in kids is functional and usually resolves itself over time.

In infants over one month, questions you want to ask are;
1. What is the consistency of the poop? Is it hard and pebble-like or soft and seedy? Soft poops imply that your baby is not constipated and may just poop every day.
2. Are there are small streaks of blood in the poop (this could be from a small tear in the skin from straining)
3. Has this been going on for 2 weeks or more?

If the answer to 2 or more of these questions is yes, then your infant may be constipated.

Things to worry about with constipation include vomiting, a distended belly, persistent crying. These symptoms could imply that there is an obstruction or blockage and your baby needs immediate medical attention.

If you or your doc suspects functional constipation in your infant, what treatments might they recommend?
1. If your infant is less than 3 months of age,many pediatricians will recommend using brown sugar. You add 1/2 teaspoon of brown sugar to 1 ounce of cooled boiled or sterile water. You can give this to your baby 2-3 times daily until the poops seem softer and less pebble like.
2. Sometimes your pediatrican might recommend a glycerine suppository. We recommend this almost as a last resort since we want babies to poop without having to use suppositories.
3. For infants that are older than 3 months, you can try diluted prune or pear juice. The juice should be diluted to 1/2 strenght in water and you can try 1 ounce daily. The American Academy of Pediatrics does not advocate giving infants juice on a routine basis. So, try this remedy until your baby has softer, possibly more frequent poops.
4. Belly massage – there is some anecdotal evidence that massaging your baby’s belly in a clockwise direction can help move things along. There are some clinical trials in adults proving that this is effective, and there is certainly no harm in trying-since babies love massage.
5. Laxatives or stool softeners – while laxatives are effective, they should be used only after the above home remedies have been tried without success and with the recommendation of your pediatrician.

And that’s the scoop on infant poop!