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INFANT CONSTIPATION

The purpose of this article is to present medical aspects of constipation in infants and children.

Infant constipation is a common phenomenon among pediatricians, and most cases are the result of inappropriate nutrition. It is a phenomenon that is frequently present in pediatrics in the last twenty years, emphasized by eating mistakes.

The frequency of stools evacuated and their consistency can define constipation. For infants, 1-2 stool evacuations per day are considered to be normal.

The absence of stool evacuations for more than 2 days is what we call constipation.

Infant constipation can be easily recognized when the newborns or nurslings eliminate the stool with difficulty or pain. You can see them how they gather, round up, their face turns red, they crinkle and the stool evacuated has a hard consistency, under the form of small and hard cranberry.


What can be considered normal in infant constipation?

The normal area of infant constipation and diarrhea is very large, depending on what the children are eating and their age.

Infants can eliminate a stool after every meal. This thing is not diarrhea. They can eliminate a stool maybe once a week. It is also a normal thing if the stool is not eliminated with difficulty and doesn`t have a hard consistency.

The baby that poops after every meal will do it in small quantities.

  • usually, it gets out with power, with a sound that you can hear.
  • it also gets out with pressure.
  • it squirts into the diaper.
  • you can feel it in your hand.

The infant that doesn`t poop often (several days or longer) will eliminate a large quantity of stool. If the stool eliminated will be hard at the beginning and afterward has the composition of a soft paste then this is a normal thing.

Also, if the stool is evacuated without difficulty and has a soft consistency, then this is also considered normal.

Opposite to the things mentioned above, the lack of defecation longer than 48 hours (once every three days) is not normal. Also, if the infant eliminates a hard stool frequently in very small quantities, or not at all, it is an important signal.

The infant that suffers from constipation will poop rarely with difficulty. He can be helped using physical methods. The most common method is a specific tummy massage described in details in the chapter below. But the principle behind this is to massage the baby`s tummy, clockwise, in a circular way.


Stool evacuation and constipation in infants

It depends on the age of every child and newborn. Newborns and infants have different numbers of stool evacuations than adults. Also, newborns and especially nurslings have a different number of stool evacuations than older nurslings, whose diversification in diet already happened.

Constipation is often present in infants who are breastfed with fatty milk. Apparently and inexplicable, this is one of the causes of constipation.

Infant constipation does not have an immediate consequence, and it is not considered a disease in the context of small age. Pediatricians and specialists are trying to briefly tell mothers that, for short periods of time the infants will have to change their diet.

There is a recommendation for nurslings which consists of a few slightly maneuvers. These maneuvers consist in

  • the administration of certain laxative liquids.
  • nowadays, in the modern era, lactulose is universally accepted.

In a modern way, the presence of fiber in the diet of the infants has a nurturing role. The feces structure can form properly around the fiber from the food. This thing also helps the stool movement through the intestines. It is for common sense.

Another problem appears when, the diet is poor in fiber and there is no solid, undigestible structure in the intestines. The fecal matter will eliminate slow and will form shapes that will stick to the intestine walls.

Often, this elimination will have liquid matter at the beginning. Later on, hard fecal matter will move very slow for evacuation. As liquid fecal matter starts to evacuate, infant constipation will start to develop over periods of time.

The first signs of these symptoms in infancy, present less frequent stool evacuations.

As an immediate local complication, besides the sensation of discomfort, there is also the pain when defecating and anal fissures. These are the most frequent problems which doctors have to confront all the time.

The most serious cases of constipation in infancy go to the surgical services, for a rather simple intervention. Despite this fact, most of the times it is a salvage-like intervention namely like the enema or even the rectal cough evacuation, most often, of a structure called fecaloma.


Diet in infant constipation

Parents are encouraged to administer to their children`s diet cooked or green vegetables like

  • carrots
  • broccoli
  • cabbage
  • cauliflower

It can be the main dish or as a salad besides.

Vegetables can be cooked on the grill or boiled in water and a few drops of salt. It is important that the cooking time will be as short as possible in order or the fiber to maintain its hard structure and keep all vitamins.

Fruits have to be part of babies and older children`s diet. It is important to eat peeled fruits at the beginning and unpeeled fruits later, only on an empty stomach. As a great remedy for constipation in infants, fruits like plums are known for their light laxative effect, whose mechanism is simple and immediate.


Neuropsychiatry in infancy

Another side of understanding and treating constipation goes to children`s neuropsychiatry. This side refers to the behavior of the infants or children that have violence their family. Also, the fear of eating due to constant constipation feeling which is present in their developing subconscious.

It can turn into a phobia for some babies, for older ones or children.

The atmosphere in kindergartens can have a negative impact the emotional state of infants. Combined with a dirty environment, it can also negatively affect digestion.

If parents have abusive and tensed behavior, the forming of the baby`s subconscious and the way of communication can also have a negative impact. This aspect relates more to the psychopathology and is the focus of psychiatric specialists.

The complications of infant constipation are: discomfort feeling, having pain when defecating and anal fissures.


Signs, causes and abdominal colic in infants

The problem with constipation in infants is that for newborns and babies, constipation is one of the causes of abdominal colic. Abdominal colic is a symptom that causes severe spasmodic pain in the belly area (abdomen).

The main causes abdominal colic are intestinal inflammation, distention, obstruction, and constipation. This symptom that causes pain may develop gradually or appear all of a sudden.

Abdominal colic creates discomfort and pain in the tummy area. This thing usually makes babies cry and feel agitated without no reason.

It`s like having long hours of crying and screaming without any sign of external pain. More important, the baby is pointing with his hands to the tummy area.


Signs and causes of infant constipation:

  • New foods or different milk consistency – the change in diet can influence the digestion process because babies can`t have the ability to digest properly some types of food.
  • Slow metabolism – babies can have a fast or a slow metabolism and that can expand the time between meals (more time than usual) – that leads to eating more frequent than usual.
  • Lack of hydration or staying in a hot environment.
  • Lack of movement – staying for too long in a certain position.

Example. If the baby is breastfed and poops normally 7 times a day and suddenly stops pooping for one or two days. This thing is the sign of episodic constipation.

For breastfed babies, the number of times they defecate is about 7-10 times a day. For other babies, as soon as the meal ends, they defecate. This thing is normal. The stool can be liquid or have the consistency of mustard. These things present a normal baby intestinal transit digestion.

For babies fed with powder milk (dried milk), the normal defecation number is between 1-3 times a day. The reason is the consistency of the milk. Babies fed with solid food have stools that become more formed and defecate less frequent.


Causes for infants that have passed the baby phase:

  • Emotional causes (due to the younger age).
  • The inability to digest properly certain types of food.
  • Obesity
  • The lack of hydration and staying in a hot environment.
  • Lack of sports and movement.

If any of the mentioned above can be recognized then, it`s time to visit a doctor. Constipation in this delicate period of a baby`s life is very important. It`s also the time to ask for medical help.


There are a few remedies that can relieve infant constipation:

  • Glycerin suppositories (help to relax the sphincter and succeed to eliminate stool).
  • Warm baths (staying in a warm place for no less than 20 minute – to help muscles relax).
  • Light laxatives (that help keep water in the intestines).
  • Abdominal massage (help intestinal muscles move stool)

MASSAGE FOR CONSTIPATION RELIEF IN INFANTS

THE “I LOVE U” INFANT TUMMY MASSAGE.

The large intestine of the infant is the place where all the remains of matter stay before elimination.

The colon divides into three parts: the descending colon, the transverse colon, and the ascending colon. Following this order and focusing on emptying these segments, the large intestine can eliminate the stool blocked inside easily.

The purpose of this massage is to relieve infant constipation by emptying the large intestine, following these steps.

Step 1 – massage the descending colon

  • With your hand, slowly massage the tummy from top to bottom (over the descending colon).
  • Start from under the ribs and move down towards the inguinal area and push slowly 2-3 times.

Step 2 - massage the transverse colon

  • After that, you can massage the tummy on the transverse colon horizontally.
  • This action moves the fecal matter from the transverse colon to the descending colon.
  • Massage with your hand slowly 2-3 times.

Step 3 - massage the ascending colon

  • Finally, similar to the steps above, slowly massage the ascending colon towards the transverse one and finally going down to the descending colon.
  • Repeat these steps with gentle care 2-3 times.

This is the “I Love U” massage.

This massage is great for constipation in infants, because of the shapes created by the position of the hands. The hand movements form the following letters “I” (step 1 - descending colon), “L” (step 2 – transverse colon) and “U” (step 3 – ascending colon).


THE “MOON AND SUN” INFANT TUMMY MASSAGE

The purpose of this massage is to empty the large intestine. The massage requires the use of 2 hands simultaneously, following these steps:

Step 1 – The right hand

  • The right hand is circularly massaging over the colon and over the small intestine (making the circular shape of the Sun).

Step 2 – The left hand

  • The left hand is pushing slowly in the “C” shape, strictly over the large intestine contour (making the “C” shape similar to the Moon).

This “Moon and Sun” type is similar to “I love U”. These types of massage help relieve infant constipation o short and long term.


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