Constipation

Functional constipation is prevalent in 15% of infants1.

Causes

The exact cause is not fully understood. Hypotheses include:

  • Dietary and fluid intake (especially dehydration), dietary changes, psychological, pain, fever & medicines3.
  • It is often the result of repeated attempts of voluntary withholding of faeces by a child who tries to avoid unpleasant defecation because of fears associated with evacuation2,4

ROME IV criteria for the diagnosis of constipation3

Must include one month at least two of the following in infants and children up to 4 years of age:

  • Two or fewer defaecations per week
  • History of excessive stool retention
  • History of painful or hard bowel movements
  • Presence of a large faecal mass in the rectum
  • History of large diameter stools

In toilet-trained children, the following additional criteria may be used:

  • At least one episode/week of incontinence after the acquisition of toileting skills
  • History of large-diameter stools that may obstruct the toilet.

NICE guidance on constipation3

The NICE Clinical Guidelines recognise the role nutrition plays in the management of FGIDs in infants and recommend conservative and nutritional approaches ahead of medical interventions3.

The guidance states that laxatives and diet modifications may help:
1. Try polyethylene glycol 3350 (for example Movicol Paediatric Plain) plus electrolytes. Use a stimulant laxative if this does not work
2. Dietary modifications may then be considered to ensure adequate fluid intake; however, this is assumed to come from breastmilk

Very little guidance is given specifically for bottle-fed infants under 6 months of age with functional constipation

Practical management

  • Massage the infant’s tummy in a clockwise direction, making firm but gentle circular motions from the belly button outwards.
  • Put the infant lying on their back. Gently move their legs backwards and forwards – in a ‘bicycle’ motion.
  • Give the infant a warm bath to relax the bowel.
  • Give additional cooled, previously boiled water.

If education and diet are unsuccessful, other nutritional or medical options may be considered. Please click here if you would like to read more on Aptamil Comfort

References:

  1. Vandenplas Y et al., J Pediatr Gastroenterol Nutr 2015
  2. Benninga MA. et al., Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology 2016; 150:1443-1455.
  3. NICE. Constipation in children and young people. 2010.
  4. Tabbers MM. et al., Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014;58:265-281.