Infant Constipation: Causes, Solutions, and Dietary Tips

Infant constipation

Hello, Doctor Huang.
My daughter just turned seven months old today.
Since she was five months old, she has had a severe aversion to milk.
Following the doctor's advice, we switched her formula (S-2x), and starting from the third day after the switch, my daughter began to experience constipation.
She actually has bowel movements almost every day, but her stools are very hard and round; sometimes she passes two or three large pieces, and other times she only passes one piece and refuses to go further.
Later, due to the severe constipation, I switched her back to her original formula (Anxier), and the situation improved somewhat.
At six months, I switched her to a larger infant formula (Anxier), but a week later, the same issue occurred again.
After two days, she even had blood in her stool.
In the past few days, my daughter cries almost every time she has a bowel movement because she struggles to pass it.
Now that she is seven months old, she has had blood in her stool for the past few days.
In the last two weeks, I have switched her to fresh milk in hopes of improving her constipation, but it hasn't helped.
I have also given her plenty of fruits like watermelon, cantaloupe, and wax apples, as well as vegetable purees, but she is still constipated.
Therefore, I would like to ask the doctor if I should give my seven-month-old baby fresh milk? Is it a problem with the formula? She really dislikes drinking water and cries every time I try to give her some.
I have also tried adding some sports drinks, but she refuses those as well.
Is it a problem if she drinks too little water? Given her constipation, should I avoid giving her watermelon since it is diuretic? What should I do? I am very worried that if this constipation continues, she might develop hemorrhoids before she turns one.
Is that a possibility? I hope the doctor can reply to me soon.
Thank you very much! A worried mother.

Jinchih, 30~39 year old female. Ask Date: 2001/05/02

Dr. Huang Zheming reply Pediatrics

From four to six months of age, babies enter a phase known as the "milk refusal period." During this time, in addition to milk, it is important to introduce complementary foods to help them gradually adapt to solid foods, which will provide additional nutrition and promote intestinal motility for easier bowel movements.
After three months, the diet should primarily consist of liquids, such as purees or liquid foods (like rice cereal or wheat flour).
After six months, they can start consuming porridge, noodles, and other semi-solid foods.
It is crucial not to rush or complicate the process, as this may lead to excessive burden and digestive issues.
Simple complementary foods include:
1.
Fruits such as apples, pears, oranges, tangerines, papayas, bananas, or fruit juices and purees.
No seasonings, preservatives, or honey should be added (honey can contain botulinum spores, which are not suitable for infants under one year old).
2.
Vegetables like spinach and carrots should be boiled with water and then strained to be fed with a spoon (or potatoes and carrots).
3.
Grains: rice cereal, wheat flour, broth, and porridge can provide a sense of fullness and can replace some milk feedings, serving as a side to milk or replacing one to two milk feedings.
Possible causes of constipation include:
1.
Pathological factors: megacolon, abnormal anal opening, hypothyroidism, or other intestinal obstructions.
2.
Functional constipation: (which accounts for 98% of constipation) due to overly refined foods with low fiber content.
*It is important to maintain a regular eating schedule, drink plenty of water, and develop good habits (regularly encourage the baby to have bowel movements, as babies cannot control their anal sphincter until they are eighteen months old).
It is best not to rely on medications for long-term solutions to constipation, as this may lead to small bowel changes and affect the absorption of vitamins A and D.
It is advisable to consult a pediatric specialist at a major teaching hospital for detailed guidance.
Thank you!

Reply Date: 2001/05/02

More Info

Dear Concerned Mother,
Thank you for reaching out with your concerns regarding your daughter's constipation issues. It's understandable to feel anxious when your child is experiencing discomfort, especially when it comes to something as critical as bowel movements. Let's break down the situation and explore potential causes, solutions, and dietary tips that may help alleviate your daughter's constipation.

Understanding Constipation in Infants
Constipation in infants can be defined as infrequent bowel movements or difficulty passing stools. In your daughter's case, it seems that the stools are hard and painful to pass, which is causing her distress. There are several factors that could contribute to constipation in infants, particularly at her age of seven months.

1. Dietary Changes: You mentioned that your daughter has been switched between different formulas and has recently been introduced to solid foods. Changes in diet can significantly impact bowel habits. Formula-fed infants are more prone to constipation compared to breastfed infants, especially if the formula is not well-suited to their digestive system.

2. Fluid Intake: Adequate hydration is crucial for preventing constipation. Since your daughter is reluctant to drink water, this could be a contributing factor. Infants require fluids to help soften their stools, and insufficient fluid intake can lead to harder stools.

3. Fiber Intake: While you are providing fruits and vegetables, it’s essential to ensure that these foods are high in fiber. Foods like prunes, pears, and peas are particularly effective in promoting regular bowel movements. However, be cautious with certain fruits like watermelon, as they can have a diuretic effect and may not contribute significantly to fiber intake.

Recommendations
1. Reassess Formula: Since you have noticed a correlation between changing formulas and the onset of constipation, it may be beneficial to consult with your pediatrician about finding a formula that is gentler on her digestive system. Some formulas are specifically designed to help with constipation.

2. Introduce Water Gradually: While your daughter may resist drinking water, it is important to encourage her to drink small amounts throughout the day. You can try offering water in a fun cup or using a straw to make it more appealing. Additionally, consider offering diluted fruit juices (like prune juice) as they can help with constipation.

3. Increase Fiber-Rich Foods: Continue to offer a variety of fruits and vegetables, focusing on those that are high in fiber. You can also introduce whole grains like oatmeal or whole grain cereals, which can help promote regularity.

4. Monitor for Allergies or Intolerances: If you suspect that certain foods or formulas are causing issues, keep a food diary to track what she eats and her bowel movements. This can help identify any potential allergens or intolerances.

5. Gentle Abdominal Massage: Sometimes, gentle abdominal massage can help stimulate bowel movements. You can try massaging her tummy in a clockwise direction to encourage digestion.

6. Consult a Pediatrician: Given that your daughter has experienced bleeding during bowel movements, it is crucial to consult with a pediatrician as soon as possible. They can assess her condition, rule out any underlying issues, and provide specific recommendations tailored to her needs.

Conclusion
It is understandable to worry about the long-term effects of constipation, such as the potential for hemorrhoids. However, with appropriate dietary adjustments and medical guidance, many infants can overcome these challenges. Remember, every child is different, and what works for one may not work for another. Your pediatrician will be your best resource in navigating this situation.

I hope this information helps you feel more empowered to address your daughter's constipation issues. Please do not hesitate to reach out to your healthcare provider for further assistance.

Best wishes for your daughter’s health and well-being!
Sincerely,
Doctor Q&A Teams

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