mars 29, 2017

“As healthcare professionals, we can play a vital role in establishing a healthy trajectory for infants.”

Even though constipation might be a transient phase, chronic constipation accounts for at least 25% of healthcare professional visits annually and remains a concern for parents and caregivers. Furthermore, constipation can have long-term feeding consequences.1

The cause of constipation is multi-factorial and poorly understood. More recently the option of a dysfunctional gut microbiota has been put forward as a contributor to chronic constipation. Intestine microbiota have important functions such as the breakdown of food products; stimulation of the immune system; and the production of a number of bioactive compounds. 

Mucin is an example of a bioactive compound that assists in stool softening and creates a smooth surface for faecal matter movement. Other bioactive compounds include Short Chain Fatty Acids (CSFAs) and water as metabolites that assist in peristaltic activity and stool softening. 

Changes in a healthy microbiota have significant effects, as has been observed in other disease states such as Irritable Bowel Syndrome (IBS), obesity, diarrhoea, etc.

An observational study, published in 2016 by de Moraes, looked at the differences in gut microbiota between constipated and non-constipated children. The study found that the Bifidobacteria were similar, but showed that the constipated children had lower concentrations of Lactobacilli-per-milligram of stool. Furthermore, the constipated children consumed higher volumes of dairy products; were more frequently born via caesarean section; and were introduced to solid foods earlier than their non-constipated counterparts.2  

All these factors are indicative of a change in the gut microbiota. Normal vaginal delivery and breastfeeding support the development of a healthy gut flora. 

As healthcare professionals, we should therefore strive to empower mothers to have natural deliveries (as far as possible) and support breastfeeding. Should babies not be breastfed, healthcare professionals should look for options that will support the development of a healthy flora similar to that of breastfed infants.

As healthcare professionals, we can play a vital role in establishing a healthy trajectory for infants.  Through continuous education and support for mothers, complementary feeding advice and alerting caregivers to pitfalls such as excessive dairy consumption (especially cow’s milk) will go a long way in helping to prevent the onset of chronic constipation.

1 Organic and Nonorganic Feeding Disorders. Anna Rybak. Department of Gastroenterology, Hepatology, Nutrition Disorders and Paediatrics at the Children’s Memorial Health Institute, Warsaw, Poland. Feeding Disorders in Infants and Children reprinted with permission from: Ann Nutr Metab 2015; 66 (suppl 5):16–22.   

2 Faecal Microbiota and Diet of Children with Chronic Constipation. Joyce Gomes de Moraes;  Maria Eugênia Farias de Almeida Motta; Monique Ferraz de Sá Beltrão; Taciana Lima Salviano and Giselia Alves Pontes da Silva. International Journal of Paediatrics. Volume 2016