Constipation in Children
Definition: What is Constipation?
Constipation cannot always be assessed by the amount of time between bowel movements (BM). Not only are there individual differences among children, there are also differences that will occur throughout a child’s lifespan. Constipation is defined as passing hard, dry stools, the painful passage of BM or the inability to pass stools.
Most parents are concerned about the time between bowel movements, and while this is an important piece of information, it’s not as important as noting the characteristics of the stool and the child’s difficulty or lack of difficulty in passing the stool. For example, breastfed babies may go 7 days or more without a BM but if the consistency is like peanut butter- not hard and pellet-like- the infant would not be considered constipated.
What causes constipation?
Constipation can be caused by many things. The most common cause is a diet that doesn’t contain enough fiber and/or water. Children who eat diets high in processed foods and low in fresh fruits, vegetables and whole grains may have difficulty with constipation. Also children who have a large dairy intake (e.g. milk, cheese, yogurt, ice cream) may present with constipation.
Often children may be so engaged in play that they will ignore the urge to have a BM. Perhaps they don’t want to stop what they are doing to go to the bathroom! Or perhaps a child won’t want to use the bathroom away from home, particularly at school where stalls limit privacy. Waiting past the internal urge to have a bowel movement only makes the stool harder and more difficult to pass later. If the bowel movement is painful once, the child may hold back the next time.
Constipation can also occur with normal dietary changes. For example, when an infant transitions from breast milk to formula or from baby food to solid food, it’s not uncommon for the infant to experience some short-term constipation until their body adjusts.
How will my child act if he or she is constipated?
Remember that every child will have different bowel elimination habits. Your child may be constipated if he or she is having a BM less often than usual, or if the stool is harder than usual, or if your child experiences pain/discomfort when trying to pass the stool.
If your child is unable to pass the stool, your child may complain of a stomach ache, feeling full or report that it hurts to poop. There may be a little blood on the toilet paper if the straining has caused a small anal tear.
It’s normal for young infants to grunt, strain and become red in the face while pushing out a BM. Having a BM lying down- without the aid of gravity- is more difficult than when sitting. A breastfed infant under 1 month of age with infrequent stools is usually not getting enough milk. A breastfed infant over the age of 1 month with infrequent stools is only considered constipated if the stools are hard and painful.
What should I do if I think my child is constipated?
Call your doctor right now if:
· Your child looks or acts very sick.
· Your child has persistent abdominal pain that lasts longer than 1 hour (with persistent crying).
· Your child has persistent rectal pain that lasts longer than 1 hour (with persistent straining).
· Your child is less than 1 month old and breastfed.
For infants under 1 year of age:
· For infants over 1 month of age, add fruit juices 1 oz per month of age per day (e.g. adult prune juice or pear nectar juice).
· For infants over 4 months of age, add baby foods with high fiber content twice a day (e.g. apricots, prunes, peaches, pears, plums, beans, peas, spinach).
For children over 1 year of age:
· Increase the amount of water your child drinks.
· Include raw fruits and vegetables in your child’s diet, at least 3-4 times a day (e.g. prunes, figs, dates, raisins, peaches, pears, apricots, beans, peas, cauliflower, broccoli, cabbage, apples, oranges).
· Include fiber through breads with whole grain. Fiber can’t be digested, so it moves the bowels along, whereas diets high in fat, sugar or starch will slow the bowels. Other ideas for high fiber include oatmeal and baked potatoes. Bran is an excellent natural stool softener because it has a high fiber content. Examples of foods high in bran include bran muffins (made with bran flakes), graham crackers, brown rice, shredded wheat. *Only offer foods that your child is capable of chewing well.*
· Decrease the amount of foods that may be constipating in your child’s diet. Decrease milk products to 3 servings per day (e.g. milk, ice cream, yogurt, cheese).
· Encourage physical activity. Engage your child in a game of hide and seek, playing catch, jump rope or bike riding!
· If not toilet trained, stop the toilet training process until constipation is resolved. Reassure your child that the poops won’t hurt when they come out.
· If your child is toilet trained, establish a regular time (ideally immediately AFTER a meal) of sitting on the toilet for 10 minutes. Try having your child sit on the potty after each meal, especially breakfast, to develop a routine for natural bowel movements.
· If a change in diet doesn’t relieve the constipation, make an appointment to be seen before giving any over the counter medicines.
· Avoid the use of suppositories or enemas unless your physician recommends it. They can cause irritation and your child may then choose to hold the stool next time.
· Make an appointment with your child’s physician if your child’s constipation continues after 3 days while on a non-constipating diet OR if you are concerned about your child