Constipation

DEFINITION

• Pain or crying during the passage of a bowel movement (BM) OR  
• Unable to pass a BM after straining or pushing longer than 10 minutes OR
• 3 or more days without a BM (Exception: Breastfed and over 1 month old)

• If breastfed and over 1 month old: Infrequent BMs every 4-7 days that are soft, large and pain-free can be normal. Before 1 month old, infrequent stools usually means an inadequate intake of breastmilk.
• Grunting or straining while pushing out a BM is normal in young infants. (Reason: difficult to pass BM lying on back with no help from gravity) Infants commonly become red in the face during straining.
• Brief straining or pushing for less than 10 minutes can occur occasionally at any age.
• Large BM’s - Size relates to amount of food consumed and BM frequency. Large eaters have larger stools.
• Hard or dry BM’s are also normal if passed easily without straining.  Often relates to poor fiber intake. Some children even have small, dry rabbit-pellet-like stools.

• High milk or cheese diet 
• Low fiber diet
• Postponing bowel movements
• Slow GI transit time (genetic differences)

See More Appropriate Topic (instead of this one) If

• Doesn't meet the definition of constipation, see ABDOMINAL PAIN

WHEN TO CALL YOUR DOCTOR

HOME CARE ADVICE FOR CONSTIPATION

1. Normal BMs:
   • Once children are on a regular diet (age 1 year), the normal range for BMs is 3 per day to 1 every 2 days.
   • The every 4 and 5 day kids all have pain with passage and prolonged straining.
   • The every 3 day kids usually drift into longer intervals and then develop symptoms.
   • Passing a BM should be fun, or at least free of discomfort.
   • Any child with discomfort during BM passage or prolonged straining at least needs treatment with dietary changes.
2. Diet for Infants Under 1 Year:
   • For infants over 1 month old only on breast milk or formula, add fruit juices 1 oz./month of age per day. Pear or apple juice are OK at any age. (Reason: treating a symptom)
   • For infants over 4 months old, also add baby foods with high fiber content twice a day (peas, beans, apricots, prunes, peaches, pears, plums).
3. Diet for Children Over 1 Year Old:
   • Increase fruit juice (apple, pear, cherry, grape, prune) (note: citrus fruit juices are not helpful).
   • Add fruits and vegetables high in fiber content (peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes, dates).
   • Increase whole grain foods (bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread.  Popcorn can be used if over 4 years old.)
   • Decrease milk products (milk, ice cream, cheese, yogurt) to 3 servings per day.
4. Stop Toilet Training:  Temporarily put your child back in diapers or pull-ups.
   • Reassure him that the poops won't hurt when they come out.
   • Praise him for the release of BMs.  
   • Avoid any pressure, punishment or power struggles about holding back poops, sitting on the potty or resistance to training.
5. Sitting on the Toilet (if toilet trained): Establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially breakfast.
6. Warm Water for Rectal Pain: Warmth helps many children relax the anal sphincter and release a BM. For prolonged straining, have your child sit in warm water or apply a warm wet cotton ball to the anus.
7. Flexed Position:
   • Help your baby by holding the knees against the chest to simulate squatting (the natural position for pushing out a BM). It's difficult to have a bowel movement while lying down.
   • Gently pumping the lower abdomen may also help.
8. Call Your Doctor If:
   • Constipation continues after making dietary changes
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.