Constipation is a very common reason for pediatric consultations, including in very young babies.

It is characterized by stools that are too rare, but also difficult to “pass” (hard and bulky).

Although the frequency of stool emission varies from child to child, it is generally accepted that infants have at least one stool per day, not hard (or even watery, especially in breastfed babies).

In babies who are bottle-fed or with a varied diet, we speak of constipation when there are less than 3 bowel movements per week.

When it occurs in an infant, constipation must imperatively be the subject of a medical consultation, because it can be due to a serious disease (endocrine or metabolic) or to an anal defect, for example.

It is especially important to pay attention to the delay in the emission of meconium, which is the baby’s “first bowel movement”. Meconium is emitted approximately 24 hours after birth. If nothing is issued after 48 hours, it is considered that there is a problem and the pediatrician must intervene for a complete examination.

A distinction must be made between constipation, which occurs secondarily in a baby who has not had a problem before, and primary constipation, which generally reveals the presence of a digestive malformation or disease.

In the first case, it is about so-called functional constipation, which can occur on the occasion of a change in eating habits or rhythm of life (community setting, change of living environment, etc.).

On the other hand, if constipation occurs in a newborn baby, from maternity or during weaning, the cause is probably organic.

The most common causes of primary constipation are:

• Hirschsprung’s disease: it is a disease due to an abnormality in the innervation of the digestive system (more precisely of the terminal part of the rectum) which prevents the proper progression of food and liquids. These stagnate, which causes a strong constipation which is revealed most often from the first days of life by a delay in evacuation of meconium.
• a malformation of the anus: a malformation of the anus or rectum is a rare but possible cause of neonatal constipation.

• Certain endocrine or metabolic diseases, such as hypothyroidism, hypokalaemia, celiac disease or cystic fibrosis (cystic fibrosis) can cause constipation from the first days or weeks of life. Diabetes also causes chronic dehydration which can result in constipation.
• Other causes can be responsible for a much rarer secondary constipation, such as certain tumors or neurological abnormalities.

Whatever the cause, constipation creates significant discomfort and should be relieved quickly.

In cases of constipation linked to an organic cause, a deterioration of the general condition can be observed, with potentially fatal consequences if no intervention is implemented quickly.

When constipation occurs secondarily, especially in a bottle-fed baby, it may be a poor adaptation to the powdered milk or mineral water used. It is advisable to use waters which are “suitable for preparing foods for infants”. In case of constipation, it is possible to use water richer in minerals for a few days.

If constipation occurs in a baby over 6 months, who has started a solid diet, it is advisable to favor mashed green vegetables or plum or prune compotes to relieve constipation. A diet low in fiber or very rich in dairy products can sometimes be to blame.

It is also necessary to make sure that the child is comfortable (if he is old enough to be on the toilet, he must have his feet resting on a stool, for example). A lubricant can be used in the early stages to facilitate the evacuation of hard stools.

In any case, if the constipation is severe, the child should be relieved by helping him to evacuate the stagnant stool in the intestine or rectum. This can be done using an enema bulb, or in the surgical department in severe cases.