Infant Constipation

Prevalence

Constipation affects around 15% of infants in their first year of life. ¹

What is infant constipation? 

In the absence of an organic cause (or aetiology), infant constipation is painful and characterised by hard stools that are difficult for the infant to pass.² 

In the first 12 weeks, infants pass anywhere from 5 to 40 motions per week, progressively decreasing to 4–20 motions per week at 1 year of age and 3–14 per week at 3 years of age.²

Constipation in infants according to Rome IV criteria must include at least two of the following consistently observed for at least one month: ^2,3

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

What are the signs and symptoms? 

Diagnosing constipation can be difficult, as it requires a parent to assess what is considered normal for infants in terms of stool motions and behavioural issues. Infant constipation can be very stressful to witness and manage as a parent.

Symptoms can include: ³ 

• Stomach cramps (pain that comes and goes)
• Infrequent stools
• Holding on behaviour to avoid painful poo
• Hard lumps of poo may be felt in the abdomen
• Hard lumpy poos
• Behavioural issues

Supporting parents to classify the ideal stool formation is important in supporting diagnosis – the following diagram is adapted from Singh H and Connor F, 20182

Infant constipation treatment 

There are two key challenges in infant constipation – learning to toilet train and the transition from a liquid to a solid diet. It is important to treat it early, as the longer it persists, the harder it is to treat. In infants, the earlier the onset – the more likely it is to have an underlying pathophysiological cause.

Red flags to watch out for: ³ 

• Infants presenting <6 weeks of age
• Delayed passage of meconium
• Weight loss/poor growth
• Persistent vomiting
• Abdominal mass

Management of infant constipation can include parental education and dietary interventions³

1. Parental education – providing parents with information about what is normal and what is not can help relieve some of the misconceptions about stool frequency. Using the Bristol Stool Chart is a good reference point.
2. Dietary Modification - Breastfed infants should continue breastfeeding. If a baby is formula-fed, advise parents to look out for a nutritionally complete formula that’s specifically designed for the dietary management of constipation.

Pharmacological interventions should be considered only when parental education and dietary interventions are ineffective.³

FOR HEALTHCARE PROFESSIONALS ONLY