Constipation refers to changes in stool frequency, size, consistency, and ease of passage which results in an overall decrease in the amount of stool. Constipation is often due to too little fiber in the diet. In children, this is often related to too much dairy (milk, cheese) in the diet. It may be caused by a child ignoring the urge to go. Sometimes constipation occurs while toilet training and may be due to the child feeling pressured. The normal frequency of stools varies considerably but, for most people, 4 days without a bowel movement (BM) is longer than usual. One exception is the breast-fed baby who, after age 2 months, may pass large, soft stools less frequently. Babies less than age 6 months commonly grunt, push, strain, draw up legs, and become flushed in the face during BM passage. This is normal and does not indicate pain or constipation.

Symptoms may include:

• Inability to pass stools or infrequent movements
• Pain with passage of stools, a feeling of abdominal discomfort or bloating
• Constipation can cause a small tear to the anal canal (opening in the bottom) with a slight amount of bright red blood appearing.

What your doctor can do:

• Diagnose the problem by asking about symptoms, doing a physical exam, possible laboratory blood tests, and possible x-rays.
• Recommend treatment that normally includes changes in diet first, if there are no underlying problems. A switch to soy formula for infants may help.

What you can do:

• For infants not yet taking solid food, give diluted fruit juice twice daily.
• If taking solid foods, add two daily servings of strained, high-fiber foods such as cereals, fruits including prune, plums, peaches, and apricots; and legumes.
• For children over 1 year, raw, unpeeled fruits and vegetables should be offered at least 3 times a day along with increased bran.
• Increased fluids, especially water, should be encouraged.
• Decrease constipating foods including dairy products, bananas, apples and applesauce; cooked carrots; and any kind of squash.
• Avoid foods that are difficult to chew and encourage your child to chew well.
• If your child is toilet trained, encourage him to sit on the toilet for a few minutes following meals.
• You may want to consider using a stool softener for a short time. Stool softeners are not habit-forming. However, do not use suppositories, enemas, or laxatives without talking with your doctor first. Laxatives are habit-forming and can cause increased difficulty in the long run.

Contact your doctor if ongoing constipation occurs despite dietary changes or if, with a high fiber diet, your child has no BM after 3 days; or if he soils himself (leaking BMs). Notify your physician immediately if your child experiences constant pain with constipation for 2 hours or more.

Contact Lake Area Pediatrics at
(936) 582-5620