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infant constipation - general comments
breast fed infants
bottle fed infants
Constipation means infrequent, hard stools. It does not mean grunting or straining, although your baby may certainly exhibit these behaviors when having a bowel movement. So the first question to ask is, "Is my child really constipated?"
Next, consider why true constipation - excessively hard, dry stools - arises. The normal function of the colon is to remove water from the stool. Otherwise we would rapidly dehydrate and die. That is why severe diarrhea is dangerous - the stool is moving through the colon and being expelled from the body so fast, there is no time to properly reabsorb the stool water back into the bloodstream.
Conversely, if the fecal material remains in the colon too long, the water removal process may extract too much of the fecal water and leave the stool mass excessively dry and hard. It is just that simple.
So constipation arises when feces remain in the colon too long because:
Breast fed babies are essentially never truly constipated. This is because breast milk is such a low residue diet. Almost all of the milk is absorbed by the baby and used. The stools consist of a small amount of unabsorbed protein curds and a large amount of bowel secretions, chiefly mucus. And of course a lot of noisy gas. But these infrequent stools do not indicate constipation - just infrequent stools.
Later, when breast feeding infants start solids, they technically can become constipated, but it is unusual in my experience. It is not until the child is pretty much on solids and especially when weaned to whole cow milk that constipation is much of an issue. By then we are really discussing toddlers.
Breast fed infants do tend to save up after the first few months and poop less often. This worries some parents. Despite reassurances to the contrary, some folks just have to see a poop every day from their little darling to be happy and fulfilled. Go figure. They forget that stool can stay in the colon for a very, very long time and it will not hurt anything.
When the stool hoarding breast feeder does finally get ready to go, another problem comes to the fore: grunting and straining. When the baby's rectum forms in utero, it is in a state of permanent contraction for nigh onto nine months. The baby does not pass the meconium (fetal stool) in utero until perhaps right at the end of gestation right before, during or after delivery. Until the baby is several months old, and has passed and been stretched by quite a few bowel movements, the rectum and particularly the anus may be quite tight and resist easy dilation to allow the stool to pass. Because the baby has weak, flabby abdominal musculature (that is why his little tummy is so poochy), he must push against this tight anal spincter with his diaphragm. Just as Mom pushed during delivery, and with seemingly equal discomfort. Hence the grunting and red-faced straining.
The other major problem of both breast or bottle fed newborns which creates this sort of straining is dyschezia, or uncoordinated stooling.
The cure for the problem of a tight anus is pretty simple: a gentle rectal exam with a well-lubricated pinky finger by the doctor (which should be done on all babies with stooling troubles anyway to rule out a physical obstruction) will be both diagnostic and curative. If one such gentle dilation doesn't do the trick, I have Mom bring the baby back in a week and repeat the procedure. The anal spincter is stretched, and pretty soon, no more terrible straining.
Bottle fed infants are "a whole 'nother story." Infant formulas are not nearly as well digested as breast milk, and leave quite a bit more residue in the colon. (The exception to this rule in my mind is the new Similac® that really does seem to leave the stools about the same consistency as breast milk.) So true constipation in bottle fed infants is much more common; my feeling is that soy formulas are even worse than cow milk based formulas in this regard.
The young infant's colon is simply not designed for all the residue and stool bulk. The residue builds up, is dried too much, and becomes hard, pebbly stool. It is naturally difficult and uncomfortable for the baby to pass.
The addition of cereal to the diet only compounds whatever problems already exist. Cereal + milk = concrete. Cereal in the formula bottle seems to be especially bad, probably because parents don't realise just how much cereal the baby is getting.
Treatment of constipation mainly involves common sense diet modifications and sometimes medication:
Myths and misconceptions concerning infant constipation:
Copyright© 1996-2000 Jeffrey W. Hull