Constipation is a really common reason children are referred to us in community based clinics, and if it goes on without treatment we end up seeing children in hospital with severe constipation. It is also very normal when weaning starts.
Why it happens
It typically happens as your baby's gut gets used to food after having had only milk. That adaptation can take quite a while.
So some change is expected rather than alarming. That is the first thing to say, because parents worry about this a great deal.
Changes that are normal
You may notice your baby going longer between visits to the toilet. You might also see changes in smell, changes in colour, undigested bits of food, and stools becoming thicker and firmer.
All of that is very normal to notice when solids are introduced.
Symptoms of actual constipation
We use the Bristol stool chart, and there is a version for children. Types 3 and 4 are around about what you would expect as normal.
The symptoms that indicate constipation are:
- Going less than three times a week.
- Stools that are really hard and lumpy, like rabbit droppings, which is type 1.
- Straining and discomfort.
- A distended or bloated tummy.
- Visible pain.
Why it is worth acting on
If constipation goes on without any treatment or intervention, it affects appetite, and that can lead to food refusal.
So it becomes a cycle. Uncomfortable baby eats less, eats less of the foods that would help, and the constipation persists. Breaking that early is much easier than breaking it later.
Fruits that act as natural laxatives
Certain fruits are genuinely useful here:
- Kiwi
- Pear
- Plum
- Apple
- Prunes
- Peaches
- Raspberries
These contain fibre and also sorbitol, which really helps to soften stools.
Serve them as finger foods or as a puree. They work well with plain yoghurt as a dessert, or with porridge or ready oats in the morning. You can also make little ice lollies with yoghurt.
Fibre, in balance
Alongside the fruits, offer some fibre. Weetabix for breakfast, cooked vegetables such as broccoli, and beans and lentils all help.
But this is a fine balance rather than a case of more being better. Filling a baby up on fibre rich foods reduces their appetite for other foods and risks displacing important nutrients. There are no fibre guidelines for the under twos precisely because it is so individual.
Fluid
Make sure your baby is having a good amount of water, with water at each meal.
In hot weather, breastfed babies may want more milk to drink, and it is fine to feed on demand. Formula fed babies can be offered a bit of extra water between meals.
Watch the milk volumes
We want to make sure milk intake is not excessive. We see plenty of children with very high milk intakes, and constipation is one of the side effects.
The mechanism is indirect. Excessive milk affects intake of other foods, so a baby may not be having the vegetables or the wholegrain foods that would help, because they are feeling uncomfortable and full.
Non-dietary things that help
- Tummy massage.
- Warm baths.
- Movement, including gentle bicycle legs.
- Age appropriate activity, so maximising tummy time or crawling opportunities.
Probiotics can help some children, but that is worth discussing with a healthcare provider, because not all of them help with constipation.
When to seek advice
Constipation that does not resolve with dietary changes, particularly where your baby is clearly in discomfort, is a reason to get professional advice.
Blood or mucus in the stools, or diarrhoea, is a reason to speak to your GP.
