Constipation means that stools are difficult or painful to pass and less frequent than usual.
A child with constipation feels a strong urge to have a stool and has discomfort in the anal area, but is unable to pass a stool after straining and pushing for more than 10 minutes.
After 4 weeks or so of life, some breast-fed babies pass normal, large, soft stools at infrequent intervals (up to 7 days is not abnormal) without pain. For older children, going 3 or more days without a stool can be considered constipation, even though this may cause no pain in some children and even be normal for a few.
Common Misconceptions About Constipation
Some people normally have hard stools daily without any pain. Children who eat a lot of food pass extremely large stools. Babies less than 6 months of age commonly grunt, push, strain, draw up the legs, and become flushed in the face during passage of stools. However, they usually don't cry. These behaviors are normal since it is difficult to produce a stool while lying down.
Constipation is often due to a diet that does not include enough fiber. Drinking or eating too many milk products can cause constipation for many people. It may also be caused by repeatedly waiting too long to go to the bathroom, not drinking enough liquids, or not getting enough exercise. The memory of painful passage of stools can make young children hold back. If constipation begins during toilet training, usually the child is strong-willed and the parent is putting to much pressure on the child about using the toilet.
Changes in the diet usually relieve constipation. After your child is better, be sure to keep him on a nonconstipating diet so that it doesn't happen again.
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.
Give fruit juices (such as apple or pear juice) twice a day to babies over 2 months old. 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 also helpful.
Encourage your child to establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially after breakfast. Some children and adults repeatedly get blocked up if they don't have regular sit times.
If your child is resisting toilet training by holding back, stop the toilet training for a while and put him back in diapers or pull-ups.
Help your baby by holding the knees against the chest to simulate squatting (the natural position for pushing out a stool). It’s difficult to have a stool while lying down. Gently pumping the lower abdomen may also help.
If a change in diet doesn't relieve the constipation and your child is over 1 year old, give a stool softener with dinner every night for one week. Stool softeners are not habit forming. They work 8 to 12 hours after they are taken. Examples of stool softeners that you can buy without a prescription are Miralax, Metamucil, Citrucel, milk of magnesia, and mineral oil. Give 1/2 to 1 tablespoon daily.
Don't use any suppositories or enemas without your healthcare provider's advice. These can irritate the anus, resulting in pain and stool holding. Do not give your child laxatives such as products that contain senna without consulting your healthcare provider because they can cause cramps.
If your child is very constipated and has rectal pain needing immediate relief, one of the following will usually provide quick relief:
If your child is still blocked up after trying this advice, talk to your healthcare provider now about being seen or using an enema.
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