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 Netcare Park Lane Hospital.
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 them, and if their normally soft stools resemble clay pebbles. Other signs are if they strain, or the stomach grows hard and sensitive to the touch, or they stop eating.
Possible causes
Constipation is rare for an exclusively breastfed baby, but can be triggered by a change in your diet. If baby is bottle fed, a change in formula may affect them, as different brands can have different protein. “Baby may even have an allergy to milk protein in their formula, or if breastfed, in your diet,” says Dr Muyanga.
Dehydration can also cause constipation – if baby doesn't get enough liquid, their system will absorb what it can from whatever they eat and drink and from the waste in their 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 that. If baby is too young, lie them on their back and gently pedal their legs in the air.
2. “Massage can help too – try rubbing baby's tummy gently a centimetre or two below the naval,” suggests Dr Muyanga.
3. A little prune, pear or apple juice mixed with breast milk or formula may do the trick.
4. If baby is on solids, cut back on possible constipation culprits – rice, bananas and cooked carrots. Offer baby 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 help, or your baby is not eating and is losing weight, or has blood in their stools, or if baby is younger than four months and not had a bowel movement in 24 hours when they usually do, 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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