Constipation (the difficult passage of hard stools) is a common complaint during infancy. Breast-fed babies are rarely constipated, probably due to the more complete absorption of fats in breast milk leaving low levels of calcium soaps, which are stool hardeners. Additionally, the acid, fermentative stools of the breast-fed baby are softer and more bulky than those of the formula-fed baby. It is not unusual for breast-fed babies to pass many soft stools daily which the unwary might mistake for diarrhoea, although some infants seem to store it all up for an occasional massive, explosive episode.

Parents may become disproportionately anxious about their babies’ bowel habits and often it is reassurance that is required, rather than action because the infants are not truly constipated. Artificially-fed babies who have at least one stool every other day without excessive straining are unlikely to have serious problems.

Infant Constipation problem is more common in formula-fed babies but in the absence of organic disease is rarely severe. Stools may be small, greenish, pellet-like, and occasionally these may be blood-streaked if a fissure develops. Fissures are painful and may perpetuate the constipation.

If constipation in infant is a problem in young babies the following steps should be taken:

- check fluid intake is adequate
- ensure formula is being diluted correctly
- give drinks of boiled water or diluted fresh orange juice between feeds
- add 1 teaspoon of sugar to the bottle, this will give a higher osmolar feed which will draw fluid into the bowel and create a softer stool; use only as a short-term measure as it increases the calorie density of the feed.

If a baby is genuinely constipated, the introduction of solids at three months can help. Pureed fruits, vegetables, and cereals should be encouraged. Wholegrain cereals can be introduced gradually from six months of age and beans and pulses at a later stage. Pure bran is not recommended in young children and is not necessary if the fibre content of the diet is gradually increased using food naturally high in fibre. It is important to ensure that the infant has a good fluid intake as fibre absorbs water.

Severe infant constipation from the time of birth should be investigated and raises the possibility of Hirschsprung’s disease or anatomical abnormality.

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