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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 bowel movement (BM) OR  
  • Unable to pass a BM after straining or pushing longer than 10 minutes OR
  • 3 or more days without a BM (Exception: 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 BM’s - Size relates to amount of food consumed and BM frequency. Large eaters have larger stools.
  • Hard or dry BM’s are also normal if passed easily without 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 bowel movements
  • Slow GI transit time (genetic differences)
If not, see these topics
When to Call Your Doctor
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
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen
  • Age under 2 months
  • Bleeding from anal fissures (tears)
  • Needs to pass stool BUT afraid to release OR refuses to go
  • Child may be "blocked up"
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 BMs are not painful)
  • Toilet training is in progress
  • Painful stools occur 3 or more times
  • Constipation is a recurrent chronic problem
Parent Care at Home If
  • Mild constipation and you don't think your child needs to be seen
HOME CARE ADVICE FOR CONSTIPATION
  1. 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.
  2. 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).
  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).
    • 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.
  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 BMs.  
    • 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 BM. For prolonged straining, have your child sit in warm water or apply a warm wet cotton ball to 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 BM). It's difficult to have a bowel movement 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.

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.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/19/2009

Last Revised: 6/12/2008

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.