Breastfed babies also have higher levels of a hormone called motiline, which increases the movement of the bowels

The composition of the mother's breast milk also changes as the baby grows older, so it will supply the needs of the baby at all times.

The bottlefed baby
Bottlefed babies frequently suffer from constipation because formula milk is harder for the baby to digest. A baby who receives only formula milk will typically have fewer bowel movements than a breastfed child. Their stools will be thicker and have a different, more greenish colour. The child needs to have daily bowel movements.

The newborn baby (0 to 6 months old)
It is equally normal for the baby to have a bowel movement several times a day or as little as once a week. In rare cases, there can be up to three weeks between bowel movements. A baby should only be given a laxative if he or she is bothered by the long intervals between bowel movements.

Breastfed babies usually have frequent bowel movements until they are two to three months old and their stools are typically yellow.

Babies aged four to six months old
Once a baby starts on transition foods or solids, the frequency of the bowel movements and the consistency and appearance of the stools will depend on the food the baby receives. The stools will start to look a bit more like ordinary stools in consistency and smell.

When the child starts eating solid food, the pattern in the bowel movements will change and the child will have movements several times a day or as infrequently as once every two to three days.

At this point, some babies may get slightly constipated. This is because the intestines have to get used to the new composition of the nutrients. Eventually, when the child's food consists of more solid food, constipation may be caused by dehydration.

The vicious circle
When a child first becomes constipated, it may be the start of a vicious circle.

It will hurt to pass the large hard stools that have gathered in the intestine. Cracks around the anus may appear and these may start bleeding and cause more pain. The baby will subconsciously start holding back the stools to avoid the pain.

This makes the food stay longer in the large intestine. The body will absorb more water from the stools making the stools even harder, and this process will make the child remain constipated.

A child who is constipated often has colic pains, because the large amount of stool in the intestines makes the intestines dilate. In some cases, the child may not want to eat and may even retch a little.

What can parents do to treat constipation?
Massage the baby's stomach. Start at the belly button and then massage outwards in circles in a clockwise direction. Some oil or cream on your fingers can also help. Only continue if the child enjoys the massage and is comfortable and relaxed.

While the baby is lying on its back, hold the legs and turn them gently in a quick cycling motion. This will make the stomach muscles move and will also, in turn, put gentle pressure on the intestines and make them move.

A warm bath can make the baby relax and the stools will then be passed more easily. Once the baby has relaxed in the bath you can also massage the stomach as before. When you wash the baby's bottom, apply some cream or vaseline around the outside of the anus.

Do not put a thermometer or anything else inside the baby's anus to stimulate the bowel movement, as this may cause damage. If the baby is on formula milk you should read the dosage instructions on the package carefully. Follow the instructions carefully, as overdosing may lead to constipation and other medical problems.

There are different brands of formula milk on the market, and they are basically of equal quality. It is important that you follow the instructions for making up the formula very closely, particularly if you change brands as different formulas may require different dilutions.

You can give the baby extra fluids with bottles of boiled, cooled water.

When babies are four to six months old you can start introducing more porridge and fruit or vegetable purees into their diet. These are rich in fibre and will help prevent constipation. Prune puree is particularly good for this purpose.

What if constipation continues?
If the suggestions above do not work, consult a doctor about special laxatives for chronic constipation.

Other causes of infant constipation
Although constipation in infants is usually caused by the food the baby receives, in some cases it can also be a symptom of a more serious underlying disease. If the baby is not gaining weight or shows any other unusual symptoms, seek the advice of a doctor.

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