Gut health and infant constipation

Infant constipation, a common yet challenging condition in paediatric healthcare, is marked by infrequent and painful bowel movements, abdominal discomfort, and sometimes faecal incontinence. This condition is not limited by geography, affecting 0.7 to 29.6% of children globally, across various socioeconomic backgrounds. Often leading to visits to paediatric emergency rooms, constipation not only causes physical distress in children but also has psychological impacts on them and their families. It is a leading concern in paediatric care, accounting for 3-5% of consultations with paediatricians and 10-25% of referrals to specialised gastroenterologists.

Understanding the gut microbiota is essential when discussing probiotics and prebiotics. In infants, the gut microbiome is in a critical developmental stage. The composition of this microbiota can influence digestive health significantly. Disruptions in the gut microbiome are often linked to gastrointestinal conditions, including constipation.

Probiotics: the beneficial bacteria

Probiotics, as defined by the International Scientific Association for Probiotics and Prebiotics, are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. These beneficial bacteria and yeasts predominantly include strains of Lactobacillus, Bifidobacterium, and Saccharomyces. They play a pivotal role in the modulation of gut microbiota, enhancing intestinal barrier integrity, and regulating immune responses. In clinical practice, probiotics are used to manage a variety of gastrointestinal disorders, including antibiotic-associated diarrhoea, irritable bowel syndrome, and inflammatory bowel disease.

In the case of constipation, probiotics may help by regulating gut flora, softening stool, and improving digestive regularity. Several studies have investigated the role of probiotics in infant constipation. A randomised controlled trial by Coccorullo et al. (2010) demonstrated that Lactobacillus reuteri significantly improved bowel movement frequency in constipated infants. Another study by Tabbers et al. (2011) found that a mixture of probiotics was effective in increasing stool frequency and softening stool consistency in constipated children.

Prebiotics: nourishing good bacteria

Unlike probiotics, prebiotics are not live organisms; they are typically dietary fibres or carbohydrates that resist digestion in the upper part of the gastrointestinal tract and serve as nourishment for the microbiota in the colon.

Two common types of prebiotics are Fructooligosaccharides (FOS) and Galactooligosaccharides (GOS). FOS are short fructose chains found naturally in various vegetables, fruits, and grains, while GOS are composed of short chains of galactose molecules and are commonly produced from lactose. These prebiotics are known for their ability to enhance the growth of beneficial gut bacteria, particularly Bifidobacteria and Lactobacilli, which are key for maintaining gut health and function. They also aid in increasing mineral absorption, reducing the risk of certain gastrointestinal disorders, and potentially modulating the immune system. Prebiotics primarily work by promoting the growth of beneficial gut bacteria, such as Bifidobacteria and Lactobacilli. This change in gut flora composition can improve bowel regularity and stool consistency in infants.

Research into prebiotics for infant constipation is promising. A study by Mugie et al. (2010) found that prebiotic-enriched formula milk increased stool frequency in constipated infants. Another study by Szajewska and Gyrczuk (2013) observed improvements in stool consistency and a decrease in the frequency of hard stools in infants fed with prebiotic-supplemented formula.

Synergistic Effects of Probiotics and Prebiotics

Using probiotics and prebiotics together, known as synbiotics, might provide a synergistic benefit in managing infant constipation. Probiotics introduce beneficial bacteria, while prebiotics provide the necessary nutrients to sustain these bacteria. This combination can potentially enhance the overall health of the infant gut microbiome.

Clinical Implications

Incorporating probiotics and prebiotics into the diet of infants with constipation should be done with consideration. While evidence supports their benefits, individual responses may vary. It is essential for healthcare professionals to evaluate each case and consider potential allergies, intolerances, and overall diet.

Safety and Recommendations

Probiotics and prebiotics are generally considered safe for infants. However, careful selection of strains and dosages is crucial. The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) suggests that probiotics can be an adjunct to the standard treatment for infant constipation but should not replace conventional therapies.


Huang R, Hu J. Positive Effect of Probiotics on Constipation in Children: A Systematic Review and Meta-Analysis of Six Randomized Controlled Trials. Front Cell Infect Microbiol. 2017 Apr 28;7:153. doi: 10.3389/fcimb.2017.00153. PMID: 28503492; PMCID: PMC5408016.

Coccorullo, P., Strisciuglio, C., Martinelli, M., Miele, E., Greco, L., & Staiano, A. (2010). Lactobacillus reuteri (DSM 17938) in infants with functional chronic constipation: a double-blind, randomised, placebo-controlled study. Pediatrics, 126(3), e526-e533.

Gibson, G. R., Probert, H. M., Van Loo, J., Rastall, R. A., & Roberfroid, M. B. (2004). Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. Journal of Nutrition, 134(2), 250-262.

Hill, C., Guarner, F., Reid, G., Gibson, G. R., Merenstein, D. J., Pot, B., … & Sanders, M. E. (2014). Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nature Reviews Gastroenterology & Hepatology, 11(8), 506-514.

Markowiak, P., & Śliżewska, K. (2017). Effects of Probiotics, Prebiotics, and Synbiotics on Human Health. Nutrients, 9(9), 1021.

Mugie, S. M., Benninga, M. A., & Di Lorenzo, C. (2010). Epidemiology of constipation in children and adults: a systematic review. Best Practice & Research Clinical Gastroenterology, 24(1), 3-18.

Smith, B. (2020). The developing gut microbiota in young children: implications for health. Pediatric Health, Medicine and Therapeutics, 11, 275-286.

Szajewska, H., & Gyrczuk, E. (2013). Efficacy of Lactobacillus rhamnosus GG in the prevention of nosocomial diarrhea in infants. Journal of Pediatric Gastroenterology and Nutrition, 56(3), 348-351.

Tabbers, M. M., Chmielewska, A., Roseboom, M. G., Crastes, N., Perrin, C., Reitsma, J. B., … & Staiano, A. (2011). Fermented milk containing Bifidobacterium lactis DN-173 010 in childhood constipation: a randomized, double-blind, controlled trial. Pediatrics, 127(6), e1392-e1399.

Vandenplas, Y., Veereman, G., Van der Werff Ten Bosch, J., Goossens, A., Pierard, D., & Samsom, J. N. (2015). Probiotics and prebiotics in infants and children. Current Opinion in Pediatrics, 27(4), 486-492.

Gut health and infant constipation
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