Constipation in infants under the age of one – everything you need to know

How often should a baby pass stool?

The answer to this question depends on the baby’s diet.

Babies who are breastfed have a wide range of normal stool frequencies—anywhere from several bowel movements per day to just once a week can be considered normal. However, most breastfed babies have at least one bowel movement daily.

Babies who are not breastfed typically have fewer bowel movements. For non-breastfed babies, having only one bowel movement per week is considered constipation.

As babies grow older during their first year, the number of bowel movements per day generally decreases, regardless of how they are fed. The consistency of the stool also becomes thicker and firmer.

So how is constipation defined in babies?

Constipation in babies isn’t defined solely by the frequency of bowel movements. More importantly, it depends on the consistency of the stool and how easily the baby passes it.

During their first year, many babies strain and cry while passing stool. This is not always a sign of constipation—it may simply reflect normal gastrointestinal development. However, if a baby is straining and passing hard, round stools, even at a very young age, this is considered constipation and should be addressed.

What are the common causes of constipation in infants under the age of one?

In most cases, constipation in infants isn’t due to structural abnormalities of the gastrointestinal tract. Rather, it’s a functional issue—meaning there’s no problem with the nerves or muscles, but a temporary interruption in how things work.

Some babies have difficulty coordinating their muscles to pass stool. If this process becomes painful, they may start avoiding defecation, worsening the problem.

One potential cause is cow’s milk protein sensitivity. In such cases, after medical evaluation, the baby’s formula may be changed, or the breastfeeding mother may need to adjust her diet. It’s essential to consult a pediatrician before making formula changes to avoid unnecessary stress and confusion. Although cow’s milk protein allergy is not very common—and constipation is not a common symptom—the European Society for Pediatric Gastroenterology recommends eliminating cow’s milk temporarily in babies with treatment-resistant constipation.

What are some rare causes of constipation in infants under the age of one?

There are rare but important causes of constipation that require medical investigation and treatment.

If constipation appears very early in life or from birth, doctors will look into congenital gastrointestinal issues. One such condition is Hirschsprung’s disease, which affects the innervation of the bowel. Other possible causes include thyroid dysfunction and, in some cases, cystic fibrosis.

It’s worth noting, however, that these serious conditions account for only a small percentage of cases. Most babies with constipation do not require extensive investigations.

What kind of investigations will the doctor perform to assess constipation in infants under the age of 1?

Evaluation begins with a thorough medical history—including pregnancy and birth details—and a physical examination focused on the spine, abdomen, and anus.

In a small number of cases, additional tests may be required, such as:
– Bloodwork (thyroid function tests, and sometimes celiac screening depending on the baby’s age)
– A sweat test to rule out cystic fibrosis
– Anorectal manometry, which evaluates rectal reflexes and sphincter function. If Hirschsprung’s disease is suspected, the child will be referred for surgical assessment.

How is constipation managed in babies?

Constipation management in babies is more complex than in older children due to limited treatment options. The treatment approach depends on the cause and the baby’s age.

Here are common management strategies:

1. Massage – Gentle abdominal massage and leg flexion can increase intra-abdominal pressure and help the baby pass stool.

2. Nutritional management – For babies who have started eating solids, small amounts of tomato juice, prune juice, or blended fruits may help.

3. Pharmacological treatment – This should only be given under medical supervision:

a. Oral treatments:
Paraffin oil – Softens stools to ease passage. It must not be used in babies with respiratory conditions, as aspiration into the lungs can be dangerous.
Lactulose – An undigested sugar that retains water in the bowel and softens stools. It’s safe and widely used.
Polyethylene glycol (PEG) – A non-absorbable substance that retains fluid in the intestines. It’s supported by medical literature for use in infants but should only be used if the baby is well-hydrated.

b. Rectal treatments – Suppositories can be effective in emptying the bowel quickly, but should not be used as the sole treatment method. They can be helpful when used alongside other strategies.

What about stimulation of the rectum in order to help a baby who is experiencing constipation?

Some parents use rectal stimulation, such as inserting a thermometer, to help their baby pass stool. However, this practice is not recommended, except in rare cases. It may prevent the baby from learning to defecate naturally and carries a risk of injury.

What should you know and remember in the long run for babies with constipation?

Constipation in infants is common and usually resolves over time. That said, it requires attention and care. Proper management can relieve discomfort and help prevent the development of chronic constipation and related complications.

In summary: Constipation in infants is a common issue that often resolves on its own. In most cases, it doesn’t require extensive testing or treatment. However, close monitoring and timely intervention—when necessary—can make a significant difference. In rare cases requiring further evaluation, it’s essential to consult a pediatric gastroenterologist for specialized care.