Constipation means that bowel movements are difficult, painful to pass, harder or less frequent than usual.
A child with constipation feels a desperate urge to have bowel movement (BM) and has discomfort in the anal area, but is unable to pass a BM after straining and pushing for more than 30 minutes.
Going 3 or more days without a BM can be considered constipation, even though this may cause no pain in some children. Exception: After the second month or so of life, many breast-fed babies pass normal, large, soft BMs at infrequent intervals (up to 7 days is not abnormal) without pain.
Common misconceptions about constipation
Large or hard BMs unaccompanied by any of the conditions just described are usually normal variations in BMs. Some normal people have hard BMs daily without pain. Children who eat a lot of food pass extremely large BMs.
Babies less than 6 months of age commonly grunt, push, strain, draw up legs, and become flushed in the face during a passage of bowel movements, and often cry during pushing. These behaviors are normal and should remind us that it is difficult to have a bowel movement while lying down.
What is the cause?
Constipation is often due to a diet that does not include enough fiber. Drinking or eating too many milk products can cause constipation. It is also caused by repeatedly waiting too long to go to the bathroom. The memory of a painful passage of BMs can make children hold back. If constipation begins during toilet training, usually the parent is putting too much pressure on the child about using the toilet.
How long will it last?
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.
How can I take care of my child?
Diet treatment for infants less than 1 year old:
Give fruit juices (such as apple or pear juice), 2 oz prune juice added to 2 oz water, twice a day to babies over 2 months old. If your baby is over 6 months old, add strained foods with high fiber content such as apricots, prunes, peaches, pears, plums, beans, peas or spinach twice a day.
Diet treatment for older children over 1 year old:
Make sure that your child eats fruits and vegetables at least 3 times a day. 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 foods for children over 4 years old.
Decrease the amount of constipating foods in your child's diet to 3 servings per day. Examples of constipating foods are cow's milk, ice cream, cheese, yogurt, apples and bananas
Increase the amount of pure fruit juice your child drinks to 4 ounces per day. (Orange juice will not help constipation as well as apple or prune juice).
Sitting on the toilet (children who are toilet trained)
Encourage your child to establish a regular bowel pattern by sitting on the toilet for 5 minutes after meals, especially after breakfast. Some children and adults repeatedly get blocked up if they don't do this.
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.
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. They work 8 to 12 hours after they are taken. An example of a stool softener that you can buy at your drugstore without a prescription is Miralax. Give 1/2 to 1 tablespoon daily, and mix in 8 oz. of milk, juice or water.
Common mistakes in treating constipation
Don't use any suppositories or enemas without your health care provider's advice. These can cause irritation of the anus, resulting in pain and stool holding. Do not give your child strong oral laxatives without consulting your physician because they can cause cramps.
Relieving rectal pain
If your child has rectal pain needing immediate relief, the following will usually provide quick relief:
Sitting in a warm bath to relax the muscle around the anus (anal sphincter)
If your child is still having problems with constipation after trying the treatment guidelines above, talk to your healthcare provider about using an enema.
When should I call my child's health care provider?
Call IMMEDIATELY for advice about an enema if:
Your child develops severe rectal or abdominal pain.
Call during office hours if:
Your child does not have a bowel movement after 3 days on the nonconstipating diet.