Constipation in a 4-month-old child: identifying causes and finding solutions

Normal stool in a newborn can significantly change its appearance depending on the influence of external factors, so it is difficult to give its exact description. In some cases, frequent stool in a baby is a feature of its development or a response to specific feeding, and sometimes it can indicate the presence of problems.

In order not to constantly consult a doctor about the quality and frequency of your child’s bowel movements and not worry for no reason, you need to understand what ranges the norm may lie in and what factors you need to pay attention to when assessing it. For the most part, experts call for suspecting problems not when the condition of the baby’s stool has changed, but if this is associated with the appearance of other negative symptoms and a change in the baby’s behavior.

What is constipation in infants?

Constipation is a complete absence or delay in emptying the large intestine associated with forced straining, slowing of the age-related rhythm and difficulty in defecation, resulting from a violation of the evacuation function of the intestine. In this case, the baby is often restless, refuses to eat, regurgitates and accumulates gases in the intestines. Therefore, the normal number of bowel movements in infants individually ranges from 8 times a day to 1 time every 3 days. At the same time, you need to know that during breastfeeding, stool may be absent for several days, and this will not be considered a pathology, provided that this phenomenon: • does not cause concern to the infant; • gases are actively released; • the baby is gaining weight well; • there is a significant volume of excreted feces, and it does not have a putrefactive odor; • the child produces a sufficient volume of urine. Also, when breastfeeding, there is the concept of starvation constipation - if the mother does not have enough milk, all food is completely absorbed in the intestines and there is not enough feces to form stool. This constipation is accompanied by the baby's moodiness and even crying, insufficient weight gain and urine output, and the mother experiences a progressive decrease in her milk supply. If there is even a minimal likelihood of developing constipation, you need to contact your local pediatrician, carry out a control weighing to clarify the one-time amount of milk for feeding and eliminate the cause of hypogalactia.

Consequences of constipation

If constipation in a child is a fairly common occurrence, then you should contact a specialist immediately. The doctor will prescribe the necessary treatment to help the child’s intestines work better. Otherwise, complications may arise. Due to frequent pushing and pressure, cracks and tears may appear in the sphincter area. Not only will they cause discomfort and pain to the baby, but they can also cause permanent anal fissures and even hemorrhoids. Sometimes surgery will be necessary to correct the situation.

With constant and strong pushing, the baby's intestines become very tense. And this can lead to prolapse of the rectum, as a result, part of the mucous membrane of this organ will be visible from the anus.

If constipation becomes a chronic disease, it can subsequently lead to fecal incontinence, rectal hernia and bleeding.

Causes of stool retention in a child under one year old

There are many reasons for constipation in infants, and the number of bowel movements in newborns and infants depends on the following factors: • type of feeding (natural, mixed, artificial); • intensity of digestion and absorption processes; • the amount of enzymes released; • activity of intestinal motility; • the degree of maturity of all organs of the body, including the digestive and nervous systems; • the presence of functional failures and pathological processes of the digestive tract.

Symptoms

There are several main symptoms of constipation in children, namely:

Lack of regular bowel movements for more than two days.
Abdominal muscle tension.
Changes in the texture of stool.
During attempts to defecate, the child behaves restlessly and may cry and scream.
The presence of mucus or blood in the stool.
Increased gas formation.
During inflammatory processes in the body, body temperature may increase.

Causes of stool retention during breastfeeding

There are several main causes of constipation during breastfeeding: the main types of this pathology:

1. Errors in the nutrition of a nursing mother - if a baby who is breastfed has constant stool retention and the stool has a dense consistency, then the mother needs to pay attention to the diet and exclude all foods that can cause constipation: baked goods, rice, fatty fish and meats, cheeses, coffee, ripe bananas, peanuts, strong black tea. 2. A nursing mother needs to pay attention to medications that need to be taken constantly: iron supplements, no-spa, diuretics, medications for gastritis. 3. High saturation of breast milk with sugars (lactose) and fats - in this case, the baby has fermentopathy or lactase deficiency. 4. Malformations of the large intestine: Hirschsprung's disease, megadolichosigma, megarectum, anorectal stenosis and diseases associated with anomalies in the development of innervation of the large intestine 5. Psychological constipation - in children at an early age, it often occurs against the background of improper weaning or separation from the mother. 6. Abrupt transfer of the baby to artificial feeding - the correct introduction of supplementary feeding for hypocalactia. 7. Incorrect introduction of complementary foods. 8. Dysbacteriosis in infants.

Main causes of constipation

Abrupt transfer from breast milk to various formulas. Natural feeding must be stopped gradually, otherwise you can cause a shock to the child’s digestive system, which will cause constipation.
The digestive system does not tolerate lactose, which is often found in cow's milk.
The baby's formula is not absorbed by his body. The mixtures have different compositions, so some cause intolerance to the digestive system, while others may well be suitable for your baby. This is individual for each baby. Therefore, before transferring him to artificial nutrition, you should definitely consult with your pediatrician.
The iron contained in some formulas can cause problems with bowel movements. Therefore, sometimes it is necessary to change the diet to a mixture in which this component is absent or in smaller quantities.
With natural feeding, the reason may be the mother’s failure to comply with the diet. Namely, eating large quantities of bananas, rice, confectionery, meat, coffee, etc.
A nursing mother should not take such dosage forms as no-spa, pentalgin, papaverine, and diuretics. They cause difficulty in removing feces in children. Before using any medications, be sure to read the instructions and assess the level of impact on the baby’s well-being.
Disruption of the intestinal microflora in a baby is also fraught with difficulty with bowel movements. Typically, this problem affects children who have not been fed breast milk since birth.
A lack of water can also make it difficult to pass stool. Therefore, the baby must be given water to drink throughout the day.
Nervous system lesions.
Rickets
Insufficient development of the nervous system.
Teething can cause constipation.
Cold.

Constipation due to improper introduction of complementary foods

Stool retention during the introduction of complementary foods is often observed in infants. This is due to the difficulty of digesting new foods. The most common causes of constipation are: • early introduction of complementary foods; • accepting large volumes of new dishes at once; • early introduction of whole milk; • excess of meat dishes or fatty foods in the diet; • insufficient drinking regime. Therefore, it is necessary to observe the basic principles of introducing complementary foods: • compliance with age norms and volumes; • a minimum amount of a new product with a gradual increase; • proper preparation of complementary foods – homogeneous, puree, semi-liquid; • exclude force feeding of the child; • all dishes must be freshly prepared and offered to the baby warm; • if there is any change in the baby’s well-being after introducing a new product into the diet, including constipation, it is necessary to discontinue the product and wait for digestion to normalize.

Infant diseases that lead to constipation

Dolichosigma is a disease that is characterized by elongation of the sigmoid colon. As a result of the numerous bends of the organ, stool can become stuck and difficult to pass. Excessive pressure on the sigmoid colon also prevents emptying.
Hirschsprung's disease is characterized by a disturbance in the supply of nerve cells to organs and tissues. In this case, some parts of the intestine do not perform their functions.
Lactase deficiency is caused by a deficiency of enzymes produced by the infant's digestive system. This disease is generally characterized by the alternation of constipation with diarrhea, and vice versa.

Constipation in an infant as a sign of illness

Most often, persistent constipation in newborns and infants occurs: • with persistent immaturity and insufficient differentiation of the digestive system against the background of lactase deficiency, enzymopathies and dysbacteriosis. • with congenital anomalies of the digestive tract; • for pathology of the nervous system; • colitis in infants; • with stool retention, which is accompanied by severe anxiety and screaming with impaired passage of gases, acute intussusception cannot be ruled out.

First aid for constipation

At home, you can independently help your child’s body speed up the process of natural bowel movements using the following methods:

Gymnastics and light abdominal massage if the child does not experience any discomfort in this area. We bend and unbend the legs, stroke the stomach between meals to activate the work of the abdominal muscles.
In a hopeless situation, when you need to quickly remove toxins from the digestive system, you can do an enema.
It is necessary to increase the amount of fluid intake to speed up the softening of solid waste in the body.
Only as a last resort and only after the doctor’s permission do we use medications.

Diagnosis of the causes of constipation

You need to know that proper treatment of stool retention depends on identifying and eliminating the causes of constipation. To do this, you need to contact a specialist in a timely manner: • scrupulously collecting complaints and medical history, clarifying the course of pregnancy and feeding; • general clinical examinations of blood and urine; • coprogram; • stool culture for pathogenic microflora and dysbacteriosis; • Ultrasound of the abdominal organs; • biochemical blood tests (liver and kidney tests). Constipation in infants is most often a consequence of malnutrition, insufficient drinking regimen and physical activity, and its treatment must begin with correction of the baby's diet.

pediatrician Sazonova Olga Ivanovna

Preventive measures

In order to prevent the development of constipation in a child at 4 months, you need to adhere to the following simple rules:

During lactation and artificial feeding, especially in the summer, the child should be given additional fluids.
Daily abdominal massage; gymnastics aimed at stimulating the work of all muscle groups.
After an illness or drug treatment, it is imperative to undergo a course of probiotic treatment to restore the balance of digestive bacteria in the child’s body.
During lactation, mothers should adhere to the principles of a rational and balanced diet.

Doctors' recommendations for treating constipation in a 4-month-old child

Doctors usually recommend certain medications that are safest for babies. Firstly, they include Duphalac. This drug is usually taken in a course. It normalizes intestinal function, fights dysbiosis in the baby, as well as various reasons that make defecation difficult.

The second remedy recommended by pediatricians is aimed at ridding babies of gas. The most common are Espumisan, Bobotik and Sub-simplex. The choice of such a medicine must be made individually. Some people benefit from one drug, others from another. The assessment must be made based on the baby’s well-being.

In such cases, it is also recommended that children drink dill water or Plantex. This also contributes to the normal functioning of the intestines, eliminating gas and unwanted colic in it.

If lactose deficiency is detected, the baby may be prescribed Glycelax suppositories. They act instantly and have no side effects. However, it should not be taken for more than one week. Otherwise, the body gets used to artificially caused urges.