Constipation

Constipation means that bowel movements are difficult or painful to pass and less frequent than usual.

A child with constipation feels a strong urge to have a bowel movement (BM) and has discomfort in the anal area, but is unable to pass a BM after straining and pushing for more than 10 minutes.

After the second month or so of life, many breast-fed babies pass normal, large, soft BMs at infrequent intervals (up to 7 days is not abnormal) without pain. For older children, going 3 or more days without a BM can be considered constipation, even though this may cause no pain in some children and even be normal for a few.

Some people have hard BMs daily without any pain. Children who eat a lot of food pass extremely large BMs. Babies less than 6 months of age commonly grunt, push, strain, draw up the legs, and become flushed in the face during passage of bowel movements. However, they don't cry. These behaviors are normal since it is difficult to have a bowel movement while lying down.

Constipation is often due to a diet that does not include enough fiber. Drinking or eating too many milk products can cause constipation for many people. It may also be caused by repeatedly waiting too long to go to the bathroom, not drinking enough liquids, or not getting enough exercise. The memory of painful passage of BMs can make young children hold back. If constipation begins during toilet training, usually the parent is putting to much pressure on the child about using the toilet.

Changes in the diet usually relieve constipation. After your child is better, be sure to keep him on a nonconstipating diet so that it doesn't happen again.

Sometimes the trauma to the anal canal during constipation causes an anal fissure (a small tear). If your child has an anal fissure, you may find small amounts of bright red blood on the toilet tissue or the stool surface.

Diet treatment for infants less than 1 year old 

• Give fruit juices (such as apple or pear juice) twice a day to babies over 2 months old. Switching to soy formula may also result in looser stools. If your baby is over 4 months old, add strained foods with a high fiber content such as cereals, apricots, prunes, peaches, pears, plums, beans, peas, or spinach twice a day. Strained bananas and apples are also helpful.

Diet treatment for older children over 1 year old 

• Make sure that your child eats fruits or vegetables at least 3 times a day. Some examples are prunes, figs, dates, raisins, bananas, apples, peaches, pears, apricots, beans, peas, cauliflower, broccoli, and cabbage. Warning: Avoid any foods your child can't chew easily. 
• Increase bran. Bran is a natural stool softener because it has a high fiber content. Make sure that your child's daily diet includes a source of bran, such as one of the "natural" cereals, unmilled bran, bran flakes, bran muffins, shredded wheat, graham crackers, oatmeal, high-fiber cookies, brown rice, or whole wheat bread. Popcorn is one of the best high-fiber foods for children over 4 years old. 
• Decrease the amount of constipating foods in your child's diet to 3 servings per day. Examples of constipating foods are cow's milk, ice cream, cheese, and yogurt. 
• Increase the amount of pure fruit juice your child drinks. (Orange juice will not help constipation as well as other juices).

Sitting on the toilet (children who are toilet trained) 
Encourage your child to establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially after breakfast. Some children and adults repeatedly get blocked up if they don't do this.

If your child is resisting toilet training by holding back, stop the toilet training for a while and put him back in diapers or pull-ups.

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.

Stool softeners 
If a change in diet doesn't relieve the constipation, give a stool softener with dinner every night for one week. Stool softeners (unlike laxatives) are not habit forming. They work 8 to 12 hours after they are taken. Examples of stool softeners that you can buy without a prescription are Metamucil, Citrucel, and mineral oil. Give 1/2 to 1 tablespoon daily.

Common mistakes in treating constipation 
Don't use any suppositories or enemas without your healthcare provider's advice. These can irritate the anus, resulting in pain and stool holding. Do not give your child laxatives such as products that contain senna without consulting your healthcare provider because they can cause cramps.

Relieving rectal pain 
If your child is very constipated and has rectal pain needing immediate relief, one of the following will usually provide quick relief: 

• sitting in a warm bath to relax the muscle around the anus (anal sphincter) 
• placing a warm wet cotton ball on the anus and applying pressure to stimulate the rectal muscle 
• giving your child a glycerin suppository (through the anus)

If your child is still having problems with constipation after trying the treatment guidelines above, talk to your healthcare provider about using an enema.

If you feel that your child needs immediate medical care.

• Your child develops severe rectal or abdominal pain.

• Your child does not have a bowel movement after 3 days on the nonconstipating diet. 
• You are using suppositories or enemas. 
• You have other concerns or questions.

Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.