Table of Contents

What causes constipation
Dietary Treatment
Behavioral Treatment
Medications
When to Call

What is Constipation?

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

Exception: After the second month of life, many breast-fed babies pass normal, large, soft BMs at infrequent intervals (up to 7 days is not abnormal) without pain.

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 and should remind us that it is difficult to have a bowel movement while lying down. But if your baby cries excessively or takes longer than 30 minutes to have a bowel movement and the stool is hard, she is constipated.

TOP

What causes constipation?

Constipation is often due to a diet that does not include enough fiber. Drinking or eating too many milk products can cause constipation. It's also caused by repeatedly waiting too long to go to the bathroom. The memory of painful passage of BMs can make young children hold back. If constipation begins during toilet training, usually the parent is applying too much psychological pressure.

Note: 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.

TOP

DIETARY TREATMENT

Infants:

Constipation in infants can be treated with prune juice.  Use one teaspoon of prune juice in each bottle, until a soft bowel movement is passed.   Regular bottled prune juice can be used.  Be sure the bottle is fresh and has not been opened beyond its expiration date. 

If this does not relieve constipation a teaspoon of prune juice can be added to an ounce of warm water and fed from a bottle.

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 neither helpful nor constipating.

Toddlers:

Constipation in one to two year olds is usually caused by excessive milk or dairy intake. 

Decrease the amount of constipating foods in your child's diet. Examples of constipating foods are milk, ice cream, cheese, yogurt, and cooked carrots.

Make sure that your child eats fruits or vegetables at least 3 times a day (raw, unpeeled fruits and vegetables are best). Some examples are prunes, figs,

dates, raisins, peaches, pears, apricots, beans, peas, cauliflower, broccoli, and cabbage. Warning: Avoid any foods your child can't chew easily.

Increase bran. Bran is an excellent 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.

Increase the amount of fruit juice your child drinks. (Orange juice will not help constipation as well as other juices).

Constipation is very common in children who are toilet training.   It should be treated aggressively, because it can start a pattern of stool withholding, which can lead to severe constipation.

TOP

BEHAVIOR

Encourage your child to establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals. Some children and adults repeatedly get constipated if they don't do this. Ritualizing bowel habit may be useful and it is advisable to encourage a regular pattern of bowel movement. Bowel motor activity is more active after waking and after a meal. The optimal time for bowel movement is usually within the first 2 hours after waking and after breakfast.

If your child is resisting toilet training by holding back, stop the toilet training for a while and put them back in diapers or pull-ups.  Constipation is very common in children who are toilet training.  It should be treated aggressively, because it can start a pattern of stool avoidance (or stool holding), which can sometimes lead to very severe constipation.

TOP

MEDICATION

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. 

Lactulose:  Lactulose is sweet sugar that is not absorbed.  It soften bowel movements by drawing more water into the stool.  You can give your child Lactulose twice daily.  Dosing 1tsp 10lbs.  2tsps 20lbs  3tsp 30lbs and over.

Mineral Oil: Start with one to two tablespoons per day.   This can be given directly from the spoon or mixed into your child's food.  It has no taste odor or color when mixed with food, so most children will not notice that it has been added to foods.  You can keep increasing the dose of mineral oil by a tablespoon per day until your child is having regular, soft bowel movements each day. (A child should never be forced to drink mineral oil, because if they were to choke on it, it could seriously harm the lungs.)

Laxatives: Laxatives (i.e. Senokot, Ex Lax) work by stimulating bowel activity. They can be used in the short run to help constipated children. They however can be habit forming so chronic use is avoided if possible.

TOP

Call IMMEDIATELY for advice about an enema if:

• Your child develops severe rectal or abdominal pain.

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

TOP