CONSTIPATION
Definition of Constipation
- 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
- No BM after more than 2 days. (EXCEPTION: If breastfed and over 1 month old.)
Imitators of Constipation
- 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 BMs - Size relates to amount of food consumed and BM frequency. Large eaters have larger stools.
- Hard or dry BMs are also normal if passed easily without straining. Often relates to poor fiber intake. Some children even have small, dry rabbit-like-pellet stools.
Causes
- 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 FOR CONSTIPATION
Call Your Doctor Now (night or day) If
- Your child looks or acts very sick.
- Persistent abdominal pain longer than 1 hour (includes persistent crying).
- Persistent rectal pain longer than 1 hour (includes persistent straining).
- Vomiting more than 3 times in last 2 hours.
- Age less than 1 month old and breastfed.
- Age less than 12 months with recent onset of weak cry, weak suck or weak muscles.
Call Your Doctor Within 24 Hours (between 9am and 4pm) If
- You think your child needs to be seen.
- Age less than 2 months.
- Bleeding from anal fissures (tears).
Call Your Doctor During Weekday Office Hours If
- You have other questions or concerns.
- Child may be “blocked up”.
- Leaking stool.
- Suppository or enema needed recently to relieve pain.
- Days between BMs longer than 3 while eating a nonconstipating diet. (EXCEPTION: normal if breastfed infant older than 2 months AND BMs are not painful).
- Toilet training is in progress.
- Constipation is a recurrent ongoing problem.
Parent Care at Home If
- Mild constipation and you don't think your child needs to be seen.
HOME CARE ADVICE FOR CONSTIPATION
- 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. <
- 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).
- 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.
- 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.
- Sitting on the Toilet (if toilet trained): Establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially breakfast.
- 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.
- Call Your Doctor If:
- Constipation continues after making dietary changes
- Your child becomes worse
And remember, contact your doctor if your child worsens or develops any of the "Call Your Doctor" symptoms.
REFERENCES
- Abi-Hanna A and Lake AM. Constipation and encopresis in childhood. Pediatr Rev. 1998;19:23-31.
- Felt B, Wise CG, Olson A, Kochhar P, Marcus S, Coran A. Guideline of the management of pediatric idiopathic constipation and soiling. Arch Pediatr Adolesc Med. 1999;153:380-385.
- Liptak GS with Baker SS, Colletti RB, Croffie JM, DiLorenzo C, Ector W, Nurko S. Constipation. In: Moyer V, Davis RL, Elliott E, et al, eds. Evidence Based Pediatrics and Child Health. London, England: BMJ Publishing Group; 2000. p. 264-272.
- North American Society for Pediatric Gastroenterology and Nutrition. Constipation in infants and children: Evaluation and treatment. J Pediatr Gastroenterol Nutr. 1999;29:612-26.
- Nurko S, Baker SS, Colletti RB, Croffie JM et al. Managing constipation: Evidence put to practice. Contemp Pediatr. 2001;18(12):56-65.
- Schmitt BD and Mauro RD. 20 common errors in treating encopresis. Contemp Pediatr. 1992;9(5):47-65.
- Youssef, NN, Di Lorenzo, C. Childhood constipation: evaluation and treatment. J Clin Gastroenterol. 2001;33(3):199-205.
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
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