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.

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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.

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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.

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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.

See Other Topics:

Abdominal Pain

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