Causes of Constipation in Infants

Constipation in infants, known in English as “infant constipation,” can arise from a variety of factors. The most prominent reasons are outlined below:

Withholding Stool: Infants may withhold their stool due to a fear of pain during defecation, especially if they have experienced discomfort from passing hard stools. This behavior can also occur if they suffer from diaper rash, which makes the act of defecation painful.
Inadequate Fluid Intake Due to Warm Weather: Infants who rely on formula may require additional fluids, such as cooled boiled water, between feedings. Conversely, breastfed infants may benefit from increased breastfeeding sessions throughout the day.
Improper Formula Preparation: Mixing too much formula powder with insufficient water can elevate the risk of constipation in infants.
Switching to an Unsuitable Formula: Changing to a formula that does not agree with the infant’s digestive system, such as cow’s milk or formulas closely resembling cow’s milk (known as follow-on formulas), can lead to constipation.
Inappropriate Solid Food Introduction: Overexposing infants to fiber-rich foods and legumes, such as lentils and peas, may not be suitable for younger infants. Thus, it is essential for parents to choose age-appropriate meals.
Infection: Certain infections can lead to symptoms such as decreased appetite, diarrhea, or vomiting, which may subsequently cause dehydration and constipation in infants.
Psychological Stress: Situations like travel, weather changes, or relocating to a new environment can induce stress in infants, potentially affecting their physical health and altering their bowel movement frequency, which may increase the likelihood of constipation.
Rare Causes: Some infants may experience constipation due to specific medical conditions that are less common than the aforementioned causes. The following are notable examples:
- Hirschsprung’s Disease: This condition is characterized by the absence of certain nerve cells called ganglion cells in part of the infant’s intestines. This congenital defect results in the loss of muscle contractions in the intestines needed to move stool through the digestive tract.
- Hypothyroidism: Newborns may develop hypothyroidism due to issues with thyroid structure. Initially, infants may show no symptoms, but over time, symptoms—including constipation—may emerge.
- Cystic Fibrosis: A hereditary disease that primarily affects the respiratory and digestive systems due to the accumulation of thick mucus in the infant’s body. Symptoms can include large, foul-smelling, or fatty stools, as well as constipation or stomach pain.
- Spinal Cord Disorders: Conditions such as spinal tumors, spina bifida, or tethered cord syndrome can impact the nerves controlling the anal sphincter, leading to difficulties in stool passage and severe constipation.
- Anorectal Malformations: This includes conditions like anal stenosis or anterior displacement of the anus, which can obstruct proper stool passage and result in constipation.
- Other Disorders: Issues with nutrient absorption or additional gastrointestinal disorders can also contribute to constipation in infants.

Normal Bowel Movements in Infants

The nature and frequency of bowel movements in infants depend on two primary factors: age and dietary intake. Many newborns may have bowel movements once or twice daily, with this number increasing to between five to ten times a day by the end of the first week. The frequency often decreases by the end of the first month as infants require more milk and begin to mature. By the time an infant is three to four weeks old, it is not uncommon for them to have fewer daily bowel movements, which is typically normal as long as they appear healthy and are growing adequately without difficulty passing stool. It is also worth noting that breastfed infants usually experience more frequent bowel movements than those on formula. For breastfed infants, the average is about three times a day in the first three months, and bowel movements often follow feeding sessions. However, some may only pass stool once a week, which can also be normal. For formula-fed infants, the frequency can vary depending on the specific type of formula given, but generally, they have two to three bowel movements daily.

The color and consistency of an infant’s stool can change significantly during the initial days, weeks, and months after birth. These variations are entirely normal and do not typically raise concerns. In the first few days, stools may appear thick, sticky, and dark green to black, referred to as meconium. Within a few days, the stool color usually transitions to green, then to yellow or brownish-yellow by the end of the first week. Generally, stools from breastfed infants tend to be more yellow compared to those from formula-fed infants. Additionally, it is expected for the stools of breastfed infants to be more liquid or paste-like.

When to Consult a Doctor

It is advisable to seek medical attention if an infant experiences constipation lasting two days or longer alongside any of the following symptoms:

Presence of blood in the stool.
The infant appears irritable or distressed.
Abdominal pain in the infant.
No improvement despite taking necessary measures to relieve constipation.