By Dr Rahul Nagpal
Constipation is uncommon in infancy, particularly in breastfed babies, but it does happen. Breastfed babies tend to have fewer incidents of constipation than formula-fed babies.
Six months after birth
During this time babies are exclusively fed breast milk and the advice is not to introduce any additional foods or fluids to the baby unless a doctor recommends it. After the first six months, parents or caregivers can introduce solid foods to the baby’s diet. A parent may notice changes in the baby’s bowel habits and the colour of their stools if they decide to switch to infant formula or when they introduce solid foods. The correct definition of constipation is when a baby experiences hard, dry, infrequent bowel movement that are difficult and painful. Breastfed babies rarely have these types of bowel movements.
The first few days of life
A newborn in the first few days after birth will pass dark, tarry stools called meconium, the substance he has stored since before birth. As the baby is introduced to breast milk, it clears the meconium out of the intestinal tract, so that within a few days, stools become softer and much lighter in colour. The stools are normally yellow, yellow-green or tan.
The first six weeks
A majority of babies, after the first few days, have two to five soft bowel movements every 24 hours, until they are about six weeks old. A baby this age may continue to have frequent bowel movements, sometimes even after every nursing. It is also normal for a breastfed baby older than six weeks to have only one bowel movement every few days. There are chances that some healthy babies will only have one bowel movement a week. When bowel movements are less frequent, they should be soft and easy to pass. If the baby is gaining weight and is happy, there should be no reason to be alarmed by infrequent bowel movements. It is also not necessary to give the baby a laxative, fruit juice, syrups or any other “helpers”. In fact, one should avoid attempts to force bowel movements, as it may have harmful consequences to the baby.
After solid foods
Once solid foods are introduced to a breastfed baby around six months, there will be many changes in his elimination patterns. The stools will have a stronger odour and different colour and consistency. It is normal to find bits of vegetables in the diaper, as even cooked vegetables are tougher to digest than many other foods.
While constipation is uncommon in breastfed babies, possible causes in such infants who are having other food also include:
1. A baby may develop harder stools and constipation after starting solid foods.
2. Not having enough liquids. Liquids help stool pass through the bowels smoothly.
3. Illness. Infections can cause a decrease in a baby’s appetite or lead to vomiting and diarrhoea, which may result in dehydration.
4. Medical conditions that affect the gastrointestinal (GI) tract, such as Hirschsprung disease, can cause constipation and other digestive symptoms.
5. Withholding stool. Babies may purposefully avoid passing hard or painful stools – a behaviour of some babies who have diaper rash may also withhold to avoid pain.
6. Stress. Exposure to new environments, travelling or weather changes may be stressful for a baby. Stress can affect their physical health and may result in a change in stool frequency and possibly constipation.
Parents should speak with a paediatrician if their baby:
· Appears distressed or in pain
· Has a hard, distended belly
· Passes bloody stools
· Has rectal bleeding
· Refuses to eat
· Has c fever
· Loses weight or is unable to gain weight
· Frequently struggles passing stools
(The writer is Director & HOD, Paediatrics & Neonatology, Fortis Flt Lt Rajan Dhall Hospital, Vasant Kunj, Delhi.)