Constipation is tricky to diagnose in a baby. Toilet habits can differ widely depending on their age, what they eat and drink, their level of activity and the speed of their digestive system. For some, a bowel movement may follow every feed, while other's can go a week with no action.
“As a general guide, babies up to four months old have a bowel movement three or four times a day, especially if breastfed, but that drops to about once a day by the time they move to solids, around six months,” says Dr Mpho Muyanga, a paediatrician at Life Brenthurst Hospital in Johannesburg.
The colour and consistency also changes with their diet. The most reliable signs of constipation are simply if your baby suddenly poops less often than what is normal for her, and if her normally soft stools resemble clay pebbles. Other signs are if she strains, or her stomach grows hard and sensitive to the touch, or she stops eating.
Constipation is rare for an exclusively breastfed baby, but can be triggered by a change in your diet. If she is bottle fed, a change in formula may affect her, as different brands can have different protein. “She may even have an allergy to milk protein in her formula, or if breastfed, in your diet,” says Dr Muyanga.
Dehydration can also cause constipation – if she doesn't get enough liquid, a baby's system will absorb what it can from whatever she eats and drinks and from the waste in her bowels, producing dry, hard stools that can tear the anus and cause bleeding.
“In rare instances, a medical condition may lie behind the problem, such as botulism (a rare but serious condition caused by toxins produced by Clostridium botulinum bacteria), food allergies or an underactive thyroid (hypothyroidism),” warns Dr Muyanga.
Top treatment tips
1. Exercise will often ease constipation. If your baby is crawling, encourage her. If she is too young, lie her on her back and gently pedal her legs in the air for her.
2. “Massage can help too – try rubbing her tummy gently a centimetre or two below her naval,” suggests Dr Muyanga.
3. A little prune, pear or apple juice mixed with breast milk or formula may do the trick.
4. If she is on solids, cut back on possible constipation culprits – rice, bananas and cooked carrots. Offer her foods with fibre, such as pears and broccoli, and a few spoonfuls of puréed prunes, pears or apricots.
5. Ask your doctor or Clicks pharmacist about over-the-counter 'stool softeners' such as glycerin suppositories. “But never give laxatives without the doctor's okay, even 'natural' ones such as senna or lactulose,” says Dr Muyanga.
6. If none of these measures helps, or your baby is not eating and is losing weight, or has blood in her stools, or if she is younger than four months and not had a bowel movement in 24 hours when she usually does, always call your doctor.
7. “Constipation associated with a big, bloated tummy and projectile vomiting could point towards obstruction, which is a surgical emergency,” says Dr Muyanga. Get help fast.
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