Constipation in infants and the use of prebiotics

Causes of constipation

Factors provoking stool retention in infants are divided into main and rare ones.

The main ones (functional and alimentary) include:

• Autonomic dysfunctions associated with perinatal nervous system lesions (PNSL).
• Too early transition to formula feeding (bottle-feeding).
• Food allergy.
• Errors in the nursing mother's diet.

Rare (organic and iatrogenic) causes include gastrointestinal malformations, mechanical barriers, and adverse drug reactions.

Tactics during breastfeeding

The child's intestinal motility directly depends on the mother's bowel function, so treatment begins with modifying her diet.

What the nursing mother should exclude:

• Foods that cause fermentation and gas production (grapes, sweets, sodas, pastries).
• Foods with extractive substances that irritate the gastrointestinal tract (marinades, canned foods, onions, garlic, rich broths, sausages).
• Obligate allergens.
• Whole cow's milk (preferably replaced with fermented dairy products).

The mother's diet should limit animal fats, but increase the proportion of vegetable oils and foods with a laxative effect.

Helping the baby:

• Positional therapy (tummy time).
• Additional fluids (extra water, especially when starting complementary foods).
• Medication: simethicone-based antifoaming agents (for gas), lactulose preparations, probiotics (as indicated).
• First complementary foods: foods rich in dietary fiber. Vegetable purees (zucchini, cauliflower) or fruit purees (prunes, apple, plum) are suitable.

Formula selection for bottle-feeding

If the baby is formula-fed, the formula is selected taking into account the main pathogenetic factor.

• Formulas to stimulate motility: contain partially hydrolyzed protein and prebiotics.
• Formulas with lactulose: indicated for constipation if regular diet does not help.
• Adapted fermented milk formulas: used as an auxiliary measure.
• Extensively hydrolyzed protein-based formulas: prescribed for food allergies.
• Low-lactose / lactose-free formulas: used for lactase deficiency.
• Formulas with synbiotics: needed to form a healthy microbiota during functional disorders.

Therapeutic formulas are prescribed individually. They can be given in full volume or combined with a standard formula (replacing a third to half of the portion). Specialized nutrition is discontinued after achieving a persistent clinical effect (normalization of stool).

Probiotics and prebiotics in infant nutrition

These components are added to infant formulas to maintain microflora balance.

Probiotics are live microorganisms. Passing through the digestive tract, they retain viability. Their task is to form normal flora, stimulate immunity, and reduce the risk of allergies.

Prebiotics are substrates that are not digested by enzymes in the upper gastrointestinal tract. They reach the colon unchanged, where they selectively stimulate the growth of their own beneficial flora (bifidobacteria and lactobacilli). Prebiotics include human milk oligosaccharides, inulin, galactooligosaccharides (GOS), and fructooligosaccharides (FOS).

Formulas containing a combination of GOS and FOS (prebiotic) are available as regular and fermented milk formulas. They are used to prevent gastrointestinal disorders, prevent acute intestinal infections (AII), and aid recovery after them.

Class and exam questions

What else to study on this topic

• Mechanism of action of lactulose preparations as osmotic laxatives
• Features of autonomic dysfunctions in perinatal nervous system lesions (PNSL)
• Differences in the use of low-lactose and lactose-free formulas
• Synbiotics: the synergistic effect of pro- and prebiotics
• Rules for introducing additional fluids during the transition to complementary feeding

Other topics in "Chapter 3. Adaptation, Early Childhood Nutrition, Rickets"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.