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Constipation

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Does this describe your child's symptoms?

 

Definition

  • Pain or crying during the passage of a stool (bowel movement or BM) OR  

  • Unable to pass a stool after straining or pushing longer than 10 minutes OR

  • 3 or more days without a stool (Exception: Breastfed and over 1 month old)

Imitators of ConstipationNormal Variations

  • If breastfed and over 1 month old: Infrequent stools 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 stool is normal in young infants. (Reason: difficult to pass stool 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 stools - Size relates to amount of food consumed and stool frequency. Large eaters have larger stools.

  • Hard or dry stools are also normal if passed easily without excessive straining.  Often relates to poor fiber intake. Some children even have small, dry rabbit-pellet-like stools.

Causes 

  • High milk or cheese diet 

  • Low fiber diet

  • Postponing stools

  • Slow intestinal transit time (genetic differences)

If not, see these topics

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When to Call Your Doctor

call now

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick

  • Persistent abdominal pain over 1 hour (includes persistent crying)

  • Persistent rectal pain over 1 hour (includes persistent straining)

  • Vomiting over 3 times in last 2 hours

  • Age under 1 month old and breastfed

  • Age under 12 months with recent onset of weak cry, weak suck or weak muscles

  • You think your child needs to be seen urgently

call within 24 hours

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen, but not urgently

  • Age under 2 months (Exception: normal straining and grunting)

  • Bleeding from anal fissures (tears)

  • Needs to pass stool BUT afraid to release OR refuses to go

  • Child may be "blocked up"

call within 24 hours

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

  • Leaking stool

  • Suppository or enema needed recently to relieve pain

  • Infrequent stools continue after dietary changes (EXCEPTION: normal if breastfed infant over 1 month old AND stools are not painful)

  • Toilet training is in progress

  • Painful stools occur 3 or more times

  • Constipation is a recurrent chronic problem

home care

Parent Care at Home If

  • Mild constipation and you don't think your child needs to be seen

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HOME CARE ADVICE FOR CONSTIPATION

  1. Normal Stools:

    • Once children are on a regular diet (age 1 year), the normal range for stools 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 stool should be fun, or at least free of discomfort.

    • Any child with discomfort during stool 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 ounce (30 ml) per 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).

    • If on finger foods, add cereal and small pieces of fresh fruit.

  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) 3 or more times per day.

    • 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.)

    • Limit 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 stools.  

    • 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 stool. For prolonged straining, have your child sit in warm water or apply a warm wet cotton ball to the anus. Move it side to side to help relax 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 stool). It's difficult to have a stool 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.

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