Constipation
Description / Symptoms
- Pain or crying during the passage of a bowel movement, or
- Unable to pass a bowel movement after straining, or
- Pushing > 10 minutes, or
- No bowel movement after more than 3 days
EXCEPTION: If breastfed and > 1 mo., infrequent bowel movements every 6-7 days that are soft, large and pain-free can be normal.
The following symptoms are NOT constipation:
- normal grunting, brief straining or pushing for < 10 minutes
- hard or dry bowel movements (can be normal for some people)
- large bowel movements
- bowel movements passed every 2 or 3 days
Cause
High-milk diet, lack of fiber in diet, postponing bowel movements.
See More Appropriate Topic (instead of this one)
If doesn't meet the definition of constipation, then your child's bowel movements are normal, or see Abdominal Pain.
When to Call Your Doctor for Constipation
Call Your Doctor Now If:
- Your child looks or acts very sick
- Persistent abdominal pain > 1 hour (includes persistent crying)
- Persistent rectal pain > 1 hour (includes persistent straining)
- Vomiting > 3 times in last 2 hours
- Age < 1 month old and breastfed
- Age < 12 months with recent onset of weak cry, weak suck or weak muscles
Call Your Doctor Within 24 Hours If:
- You think your child needs to be seen
- Age < 2 months
- Bleeding from anal fissures (tears)
Call Your Doctor During Weekday Hours If:
- You have other questions or concerns
- Leaking stool
- Suppository or enema needed recently to relieve pain
- Days between bowel movements > 3 while eating a nonconstipating diet. (EXCEPTION: Normal if breastfed infant > 2 mo. AND bowel movements are not painful)
- Toilet training is in progress
- Constipation is a recurrent ongoing problem
Home Care (Read "Call Your Doctor…" first):
Normal Bowel Movements
Once children are on a regular diet (age 1 year), the normal range for bowel movements 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 drift into periods of 4-day intervals with symptoms.
Passing a bowel movement should be fun, or at least free of discomfort. Any child with discomfort during bowel movement passage or prolonged straining at least needs treatment with dietary changes.
Diet for Infants Under 1 Year
- For infants > 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
- For infants > 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. Popcorn can be used if > 4 years old)
- Decrease milk products (milk, ice cream, cheese, yogurt) to 3 servings per day
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 stools. Avoid any pressure, punishment or power struggles about holding back stools, 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 bowel movement.
For prolonged straining, have your child sit in warm water or apply a warm wet cotton ball to the anus.
Call Your Doctor If:
- Days between stools continue > 3 after eating a nonconstipating diet > 1 week
- Your child becomes worse or develops any of the "Call Your Doctor…" symptoms
Parent Care for Pediatric Symptoms. Copyright 2000-2006.