Q. My 8-month-old son often goes three or four days without a bowel movement, and when he tries to have one, he turns red and screams as if he's in pain. I breastfed him for 5 months before switching him to formula, and since then he's been eating cereal, fruits, and vegetables. Is his diet to blame?
A. Constipation is generally defined as the passage of infrequent (usually less than three per week), painful, and hard bowel movements. Although the condition is often self-correcting, it can become a recurrent problem if a child starts to withhold difficult stools. In fact, 25 percent of chronic childhood constipation begins in infancy, so it's important to recognize and treat the problem.
The frequency, size, and consistency of stools passed at different ages varies widely. As a child grows, it takes longer for food to pass through the intestines. Between 1 and 10 weeks of age, it is normal for infants to grunt and strain to pass a soft bowel movement. Breastfed infants commonly have more frequent stools than formula-fed infants, but by 4 months of age, most babies average two bowel movements a day. Your son's pattern of passing infrequent stools with difficulty is typical of constipation.
Constipation in infants and toddlers can be caused by inactivity, illness, medications, fever, dehydration, or most commonly, dietary changes. A change in diet is also the first-line remedy. For infants, add one to two teaspoons of Maltsupex (a malt extract from barley) to formula 2 to 3 times daily. If the infant is breastfed, add to expressed breast milk or water. Sometimes changing from a cow's-milk-based formula to a formula containing whey protein or to a soy formula also may help. (Talk to your pediatrician before switching.)
For babies like yours who are already on solids, you can increase fiber-rich foods such as prunes, peas, plums, pears, peaches, beans, and whole-grain cereals. Avoid applesauce, bananas, and carrots, which can be binding. You can also offer a daily serving of fruit juice, such as grape, cherry, or prune. For babies over one year, avoid an excessive intake of dairy products.
If dietary changes are not effective, your baby's doctor may prescribe a mild laxative or stool softener (such as milk of magnesia, sorbitol, or mineral oil). Never give your child a laxative, suppository, or enema without consulting his doctor.
Rarely, constipation can be traced to physical problems, including abnormalities of the bowel or rectum or illnesses such as hypothyroidism. Parents should call their baby's doctor immediately, if the condition is severe and unresponsive to treatment, begins in the baby's first days of life, or is associated with vomiting, persistent distention of the abdomen, or poor growth.