Functional Constipation

Functional constipation affects approximately 15% of infants1

 

Causes

The exact cause is not fully understood. Hypotheses include:
• Dietary and fluid intake (especially dehydration), dietary changes, psychological, pain, fever & medicines2.
• It is often the result of repeated attempts of voluntary withholding of faeces by a child who tries to avoid unpleasant defecation because of fears associated with evacuation3,4

Rome IV Diagnostic Criteria for Functional Constipation1:

Must include 1 month of at least 2 of the following in infants up to 4 years of age:

  1. Two or fewer defecations per week
  2. History of excessive stool retention
  3. History of painful or hard bowel movements
  4. History of large-diameter stools
  5. Presence of a large faecal mass in the rectum

 

In toilet-trained children, the following additional criteria may be used:

  1. At least 1 episode/week of incontinence after the acquisition of toileting skills
  2. History of large-diameter stools that may obstruct the toilet

 

NICE guidance on constipation3

The NICE Clinical Guidelines recognise the role nutrition plays in the management of FGIDs in infants and recommend conservative and nutritional approaches ahead of medical interventions3,5-6

The guidance states that laxatives and diet modifications may help:

  1. Try polyethylene glycol 3350 (for example Movicol Paediatric Plain) plus electrolytes. Use a stimulant laxative if this does not work
  2. Dietary modifications may then be considered to ensure adequate fluid intake; however, this is assumed to come from breastmilk

Very little guidance is given specifically for bottle-fed infants under 6 months of age with functional constipation

Practical management

• Massage the infant’s tummy in a clockwise direction, making firm but gentle circular motions from the belly button outwards.
• Put the infant lying on their back. Gently move their legs backwards and forwards – in a ‘bicycle’ motion.
• Give the infant a warm bath to relax the bowel.
• Give additional cooled, previously boiled water.

 

If education and diet are unsuccessful, other nutritional or medical options may be considered. Please click here if you would like to read more on Cow & Gate Comfort. 


References:

  1. Vandenplas Y et al., Prevalence and health outcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. J Pediatr Gastroenterol Nutr 2015; Nov 61(5):531-7
  2. Constipation in children and young people. 2010. Available at: https://www.nice.org.uk/guidance/cg99 (accessed November 2016)
  3. Benninga MA et al., Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology 2016; 150:1443-1455.
  4. Constipation in children and young people. 2010. Available at: https://www.nice.org.uk/guidance/cg99 (accessed November 2016)
  5. Tabbers MM. et al., Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014;58:265-281.
  6. Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and young people. 2015. Available at: https://www.nice.org.uk/guidance/ng1/chapter/1-Recommendations#initial-management-of-gorand-gord (accessed November 2016)
  7. Clinical Knowledge Summary. Colic. Available at: http://cks.nice.org.uk/colic-infantile#!topicsummary (GB residents only: Accessed July 2016).