Constipation and Blood Streaks in Infants: A Guide for Parents

Bowel issues (constipation with blood streaks)

The baby is six weeks old and has been drinking water mixed with formula since birth.
After reaching one month, the baby had bowel movements about 3-4 times a day, with yellow, loose stools.
Suddenly, one morning, the baby had a slightly soft, log-shaped stool, and then did not have a bowel movement for over 24 hours.
The next day, the baby passed three small, pellet-like stools (urination has been normal), which were yellow and had a consistency similar to paper clay.
After that, the baby went another 24 hours without a bowel movement and then passed two larger pellet-like stools.
When seen by a doctor, it was noted that there was a slight fissure in the anus.
In addition to gastrointestinal medication, the doctor prescribed an ointment and a laxative powder.

After returning home, the baby took the first dose of medication (the amount ingested was likely very small, as it was mixed with formula and did not dissolve well due to the small bottle opening, which may have prevented adequate intake).
Shortly after, during a bath, I noticed the diaper had a small amount of yellow liquid mixed with a bit of red.
For the next feeding, I gave the baby formula mixed with the laxative powder (which seemed to dissolve better).
Two hours later, the baby had two large pellet-like stools (the largest about 3 cm, one of which had a dark coffee-colored portion).
Five hours later, the baby passed three small pellet-like stools (about 1 cm, all yellow).

Reflecting on the past few days, I am unsure if the issue is related to bottle sterilization, contamination from the cloth used to prepare the formula, incorrect measurements (either too much or too little formula), or if it is necessary to change the formula.
What should I pay more attention to? Currently, there are no issues with fever, vomiting, or abdominal distension, but I am very concerned since the baby is only six weeks old! Thank you, doctor!

E Ma, 30~39 year old female. Ask Date: 2020/05/04

Dr. Xiao Kaiwen reply Pediatrics

The issue of bottle sterilization or contamination from unclean cloths can generally lead to diarrhea.
If the stools are pellet-like, it indicates that the stools are somewhat dry and hard.
It may be worth trying a different formula.
Newborns have not yet developed strong abdominal muscles for bowel movements, so physical methods such as abdominal massage can be helpful.
Additionally, applying some petroleum jelly to a rectal thermometer and inserting it about 1 cm into the anus can stimulate bowel movements.
If the stools remain dry and hard for an extended period, it may be advisable to consult a pediatrician at a major hospital to determine if further examinations are necessary, such as an abdominal X-ray.

Reply Date: 2020/05/04

More Info

Constipation in infants, especially in a six-week-old baby, can be a concerning issue for parents. It's important to understand that infants' digestive systems are still developing, and variations in bowel movements can be common. However, when there are signs of discomfort, such as blood streaks in the stool or hard, pellet-like stools (often referred to as "sheep stools"), it is essential to address these concerns promptly.

Understanding Constipation in Infants
1. Normal Bowel Patterns: In the first few months of life, infants can have a wide range of normal bowel movement frequencies. Some may have several bowel movements a day, while others may go several days without one. Breastfed infants often have softer stools and may go longer between bowel movements compared to formula-fed infants.

2. Signs of Constipation: Constipation in infants can be indicated by:
- Hard, dry stools that are difficult to pass.

- Infrequent bowel movements (more than 24-48 hours without a stool).

- Straining or discomfort during bowel movements.

- Presence of blood streaks in the stool, which may indicate anal fissures or irritation.

3. Causes of Constipation: Several factors can contribute to constipation in infants:
- Dietary Factors: Changes in formula, inadequate fluid intake, or an imbalance in the amount of formula mixed can lead to constipation. If the formula is too concentrated, it can cause dehydration and hard stools.

- Dehydration: Infants may not be getting enough fluids, especially if they are primarily on formula and not receiving adequate water.

- Developmental Factors: As infants grow, their digestive systems mature, and they may experience temporary changes in bowel habits.

Addressing the Issue
1. Consulting a Pediatrician: Since your baby has experienced a significant change in bowel habits and has shown signs of discomfort, it is crucial to consult a pediatrician. They can assess the situation and determine if further investigation or treatment is necessary.

2. Dietary Adjustments: If your baby is formula-fed, ensure that you are mixing the formula according to the manufacturer's instructions. If you suspect that the formula may be contributing to constipation, discuss with your pediatrician the possibility of trying a different formula designed for sensitive stomachs or one that is easier to digest.

3. Hydration: While infants under six months typically do not need additional water, if your pediatrician recommends it, small amounts of water may be introduced to help with hydration.

4. Monitoring Bowel Movements: Keep a record of your baby's bowel movements, noting the frequency, consistency, and any changes in color. This information can be helpful for your pediatrician.

5. Signs of Improvement: After starting any new treatment or dietary change, monitor your baby for signs of improvement, such as softer stools and more regular bowel movements.

When to Seek Immediate Medical Attention
If your baby shows any of the following symptoms, seek immediate medical attention:
- Persistent vomiting or refusal to eat.

- Severe abdominal distension or pain.

- Blood in the stool that is more than just streaks.

- Signs of dehydration, such as dry mouth, lack of tears, or decreased urination.

Conclusion
Constipation in infants can be distressing for both the baby and the parents. Understanding the normal patterns of bowel movements, recognizing signs of constipation, and knowing when to seek medical advice are crucial steps in managing this condition. Always consult with a pediatrician for personalized advice and treatment options tailored to your baby's specific needs.

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