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Constipation
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Symptom
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Does this describe your child's symptoms?

Definition

Pain or crying during the passage of a bowel movement (BM) OR Â
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 ConstipationÂ

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 BMâ€™s - Size relates to amount of food consumed and BM frequency. Large eaters have larger stools.
Hard or dry BMâ€™s are also normal if passed easily without straining.Â Often relates to poor fiber intake. Some children even have small, dry rabbit-pellet-like stools.

CausesÂ

High milk or cheese dietÂ
Low fiber diet
Postponing bowel movements
Slow GI transit time (genetic differences)

If not, see these topics

Doesn't meet the definition of constipation, see ABDOMINAL PAIN

Should I
Call?

Care at
Home

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

Symptom
Description

Care at
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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. Â 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: Â 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. Â
- 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.
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.
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.

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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