Constipation

Definition and Causes

Constipation, the painful or difficult passage of large or hard stools, is a common complaint of childhood.  Normal frequency of stooling varies widely. For newborns, especially breast-fed infants, 5 to 10 stools per day may be normal.  For older infants and children, intervals of as much as 4 to 7 days between bowel movements in the absence of pain, unusual posturing, or straining are normal.

The vast majority of cases of constipation are due to functional problems such as faulty diet, improper use of medication, inadequate fluid intake, toileting problems, or behavioral stool holding.

Symptoms

The most reliable sign of constipation is pain or discomfort with the passage of hard or large bowel movements that usually manifest as crying, grunting, or straining. Infants normally will grunt, strain, and turn red or purple in the face for a few moments before the passage of stool. This is abnormal only if it is prolonged for more than a few minutes, if accompanied by forceful crying, or if it occurs repeatedly without a stool being produced.

Home Care

The following recommendations may be followed in managing constipation.

Newborn to One Year

Increase fluid intake with water and/or juice. A juice high in sorbitol, which softens the stool, is best. Prune juice and pear juice or nectar are examples. For infants under 4 months, the juice should be diluted half-and-half with water and 2 to 4 ounces should be given each day.  Commercial formulas cause a firmer, denser stool than the loose breast milk stool.  Frequent formula changes may aggravate constipation. Further, controlled studies have conclusively shown that the iron in iron-containing formulas does not cause constipation.

For infants over 4 months, the juices mentioned above may be given diluted or full strength and strained foods high in fiber such as peaches, plums, prunes, apricots, spinach, or peas can be given. Avoid constipating foods such as bananas, applesauce, carrots, or squash. Remember to avoid foods, which are choking hazards for older infants and toddlers such as raw vegetables, stringy vegetables, peanut butter, and popcorn. Do not use rectal stimulation, suppositories, enemas, or laxatives without first consulting with your pediatrician’s office.

Over One Year

Toddlers who are in the process of toilet training are especially prone to constipation due to toilet resistance and resultant stool holding. A casual, non-forceful approach to toilet training can prevent this. Further, a toddler may have had a large painful bowel movement, which may even result in a small anal tear called a fissure. This can cause avoidance of stooling due to pain.

To soften the stool at all ages regardless of the cause of the constipation, one must avoid or decrease consumption of constipating foods: bananas, white rice, white bread, cheese, milk, ice cream, yogurt, and cooked carrots. Foods which soften stools include prunes, figs, dates, raisins, peaches, apricots, plums, beans, celery, peas, cauliflower, broccoli, cabbage, whole wheat bread, bran muffins, natural bran containing cereals, shredded wheat, graham crackers, oatmeal, high fiber cookies, brown rice, popcorn, melons, and berries. Increasing fluid intake of water or juices such as prune or pear juice is important at all ages.

When to Call the Doctor

Contact our office if the stools are recurrently blood-streaked, constipation does not resolve promptly, severe abdominal pain and/or vomiting is experienced, or if your child is consistently passing stool matter in his/her underwear.