How to treat constipation in infants and young children?

Many parents mistakenly believe that if their child does not have a bowel movement once a day, he or she is constipated. In reality, every child’s bowel movement pattern is different. Constipation is generally understood as difficulty or decreased frequency of bowel movements. Due to changes brought about by growth and development, the frequency and type of stool must be combined with the child\’s age, diet and development characteristics. #Normal defecation In the first week after birth, most babies have 4 or more bowel movements a day. The stool is soft or liquid. Download the PDF scanned version of the recipe for prevention and care of common pediatric diseases. In the first 3 months, some babies have bowel movements 2 or more times a day, while others have bowel movements every 1-2 days. By age 2, most children have at least one bowel movement a day. The stool is soft but solid. Each child\’s situation will be different. Some children will have a bowel movement after every meal, others will have a bowel movement every 2 days. #Infant Defecation Difficulty Definition: Obvious difficulty in defecation in infants does not necessarily indicate constipation. Under the age of 6 months, if the baby passes soft stools and is otherwise healthy and normal, and the baby strains to defecate and cries for at least 10 minutes before successfully passing soft stools, this symptom is called \”infant defecation difficulty.\” This may be caused by a failure to relax the pelvic floor during the bowel movement and a lack of abdominal muscle tone in the baby. It usually resolves on its own as the baby matures, and laxatives are usually not necessary. #Common causes In real life, functional constipation accounts for more than 90% of constipation in children. The most common reasons for constipation are the following four: 1. When you first start adding complementary foods. The complementary foods you add at the beginning often don’t have enough dietary fiber and liquid. Try to enrich the variety of complementary foods for your child at each meal. The recommended balanced diet includes fruits, vegetables and whole grains, which may help prevent or treat mild constipation. The dietary fiber in the daily diet should be at least 5g, and you can drink appropriate water after adding supplementary food. 2. Drinking too much milk Transitioning from breast milk or formula to cow\’s milk can also cause constipation in some children. In addition to milk protein allergy, excessive intake of whole milk (more than 960ml per day) will reduce intestinal motility and reduce the intake of other liquids and foods that can promote stool softening, such as water, fruits and vegetables. 3. Improper toilet training Improper and untimely toilet training can lead to reduced defecation frequency, hard stools and painful defecation, which in turn leads to further intentional refusal to defecate. Therefore, the American Academy of Pediatrics (AAP) emphasizes that parents and caregivers should avoid forcing children to toilet train and should wait until the child is ready. 4. Changes after school: The child is unwilling to use the school toilet, or the change in work and rest time may cause the child to hold back, causing constipation during the transition period to school. 5. Organic causes such as intestinal obstruction caused by congenital digestive tract malformations (congenital megacolon, anorectal developmental malformations, etc.), endocrine or metabolic diseases (congenital hypothyroidism, etc.), drug factors (iron supplements) , calcium, etc. may cause constipation), but these diseases usually have other suggestive clinical manifestations, and there are few organic lesions that only manifest as constipation. #Preventive Management▌Infants under 1 year old 1. Exclude organic causes. 2. For acute constipation in infants, you canTreat by adding indigestible, osmotically active carbohydrates to infant formula, such as sorbitol-containing juices (eg, apple, prune, or pear juice). 3. For babies who have added complementary foods, they can consume apple puree, prune puree, pear puree and other fruits. It is recommended to use 60-120ml at the beginning, and then adjust the amount of juice after observing the baby\’s reaction. 4. You can also use multigrain rice flour instead of rice flour, and you can use pea puree or prune puree instead of other fruit and vegetable purees to increase your dietary fiber intake. 5. If the stool in the rectum is very hard, Kaiselu can be used occasionally to relieve it, but it should not be used frequently to avoid tolerance. ▌Infants and children over 1 year old 1. Increase fiber intake and ensure adequate fluid intake. 2. For children with incontinence, pain during defecation, rectal bleeding or anal fissure, in addition to dietary intervention, use osmotic (polyethylene glycol) or lubricating laxatives (lactulose). 3. Use polyethylene glycol (PEG) or lactulose for several days until soft stools persist. Also change your diet to prevent recurrence. Do not give your child laxatives or enemas on your own! If used incorrectly, laxatives can be dangerous to your child. #When to seek medical attention Please seek medical attention in time for these conditions: 1. Delayed passage of meconium in newborns (first passage of meconium after 48 hours of birth) 2. Fever, vomiting or diarrhea 3. Rectal bleeding (except caused by anal fissure) 4. Severe abdominal distension, Or severe pain 5. Frequent constipation 6. No bowel movements after trying various methods for 24 hours 7. Weight loss or slow weight gain Warm reminder: Before seeking medical treatment, you can prepare 5-7 days of symptom and diet records, and pay attention to recording the frequency of bowel movements, Stool appearance and any pain involved. You can use our free mini program: Chestnut Food Diary to record it! #Prevention method 1. Increase dietary fiber intake to ensure the recommended amount of dietary fiber (age plus 5-10g/d). You can choose whole grains, vegetables and fruits, fresh beans, mixed legumes and nuts. 2. Drink enough water. Babies aged 1-2 years old need to consume about 400-600ml of water every day. 3. Develop good defecation habits. Sit on the toilet for 5 or 10 minutes after meals (if you have already started and received toilet training), and you can give a small reward. #commonmisunderstandingQ1. Can bananas treat constipation? In fact, unripe bananas contain more tannic acid, which has a strong \”astringent\” effect. On the contrary, it will inhibit the secretion of gastrointestinal juice and inhibit its peristalsis. Eating too many raw bananas can cause or worsen constipation. And because the dietary fiber content in bananas is not high, even ripe bananas have a poor laxative effect. In contrast, prunes, apricots, apples, and pears are better choices for anti-constipation fruits. Of course, there are also high-fiber vegetables such as broccoli, pumpkin, sweet potatoes, etc. Q2. Can drinking yogurt and supplementing probiotics treat constipation? Not necessarily. Probiotics are not something you can use just when you want to. There is currently insufficient evidence that probiotics alone can improve constipation, including constipation. Moreover, the possible benefits of probiotics are only realized when enough probiotics are consumed. Once a baby stops drinking formula with added probiotics, the bacteria in the gut return to their previous levels. Q3.It doesn’t matter if you don’t poop now, it will always be different. If more feces remains in the baby\’s intestines for a longer time, the rectal mucosa will continue to absorb water from the feces, making the stool dry and hard, making defecation more painful and difficult, and may even lead to anal laceration, further aggravating the problem. Pain causes children to continue to hold in their stools, causing a vicious cycle of fecal retention. Gradual dilatation of the rectum leads to megarectum, reduced rectal sensation, and loss of the urge to defecate. Therefore, if you have any problems, you must solve them as soon as possible!