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Constipation is defined as a delay or difficulty in defecation, lasting two or more weeks.
It is a common problem often experienced by infants and young children and can start in the first year of life.1 During the first week of life, newborns will typically pass an average of 4 stools per day; this number decreases as the infant reaches 12 months.1 It is also perfectly normal for a breastfed infant not to pass stools for several days or more.2
Average frequency of stool passages in infants3,4
What causes constipation in infants?
In most cases, the cause of infant constipation is functional,5 most commonly due to painful bowel movements resulting in an infant withholding faeces in order to avoid painful defecation. This may be caused by an intercurrent illness, a stressful event, or a change in routine or diet.1 Severe infant constipation rarely has a medical cause and constipation only has an organic cause in a small minority of children.6
Constipation as a symptom of Cow’s Milk Protein Allergy
Chronic constipation in infants has been shown to be related to the ingestion of cow’s milk and a symptom of CMPA.7,8 In some cases, the frequency of CMPA can be as high as 80% in constipated infants.7
The majority of infants affected with CMPA have at least two symptoms affecting at least two different organ systems.9,10 If, in addition to constipation, your patient shows any of the signs and symptoms that can be related to CMPA11 (see below), you can use the CoMiSS® tool12 to score the combination of their symptoms and assess the likelihood of CMPA.
Signs and symptoms related to CMPA11
How to score this symptom with the CoMiSS® tool
· The CoMiSS® tool uses the well-established Bristol stool scale13 to evaluate stool consistency
· Constipation should only be scored if it lasts for at least one week
· In addition to the stool score, if any of the following signs or symptoms related to CMPA are also present, they should also be given a score using the CoMiSS® tool. These include crying, regurgitation, skin (atopic dermatitis and urticaria) and respiratory symptoms
1. Clinical Practice Guideline. J Pediatr Gastroenterol Nutr 2006;43(3) e1–13
2. Hyams JS., et al. Pediatr. 1995;95:50–4
3. den Hertog., et al. Arch Dis Child Fetal Neonatal Ed. 2012;97:6 F465–70
4. Fontana M., et al. Acta Paediatr Scand. 1987;78;682–4
5. Leung A., et al. Am Fam Physician. 1996;54(2):611–8, 627
6. Baker S., et al. J Pediatr Gastroenterol Nutr. 1999;29(5):612–26
7. Dehghani SM., et al. Iran J Pediatr. 2012;22(4) 468–74
8. Iacono G., et al. N Engl J Med. 1989;339:1100–4
9. Lifschitz C. and Szajewska H. Eur J Pediatr. 2015;174:141–50
10. HØst A. Pediatr Allergy Immunol. 1994;5:1–36
11. Koletzko S., et al. J Pediatr Gastroenterol Nutr. 2012;55(2):221–9
12. Vandenplas Y., et al. Acta Paed. 2015;104:334–39
13. Lewis S. and Heaton K. Scand J Gastroenterol. 1997;32(9):920–4