CONSTIPATION

Definition of Constipation

  • Pain or crying during the passage of a bowel movement (BM) OR  
  • Unable to pass a BM after straining or pushing longer than 10 minutes OR
  • No BM after more than 3 days. (EXCEPTION: If breastfed and > 1 mo. infrequent BMs 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 less than 10 minutes, large BMs, or BMs passed every 2 or 3 days.  Hard or dry BMs are also normal if passed easily.

Causes

  • High-milk diet, lack of fiber in diet, postponing BMs.

See More Appropriate Topic (instead of this one) If

  • Doesn't meet the definition of constipation, either normal or see ABDOMINAL PAIN.

WHEN TO CALL YOUR DOCTOR FOR CONSTIPATION

Call Your Doctor Now (night or day) If:

  • Your child looks or acts very sick.
  • Persistent abdominal pain longer than 1 hour (includes persistent crying).
  • Persistent rectal pain longer than 1 hour (includes persistent straining).
  • Vomiting more than 3 times in last 2 hours.
  • Age less than 1 month old and breastfed.
  • Age less than 12 months with recent onset of weak cry, weak suck or weak muscles.

Call Your Doctor Within 24 Hours (between 9am and 4pm) If:

  • You think your child needs to be seen.
  • Age less than 2 months.
  • Bleeding from anal fissures (tears).

Call Your Doctor During Weekday Office Hours If:

  • You have other questions or concerns.
  • Leaking stool.
  • Suppository or enema needed recently to relieve pain.
  • Days between BMs longer than 3 while eating a nonconstipating diet.  (EXCEPTION:  normal if breastfed infant older than 2 months AND BMs are not painful).
  • Toilet training is in progress.
  • Constipation is a recurrent problem.

Parent Care at Home If:

  • Mild constipation and you don't think your child needs to be seen.
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HOME CARE ADVICE FOR CONSTIPATION

  1. Normal BMs: Once children are on a regular diet (age 1 year), the normal range for BMs 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 BM should be fun, or at least free of discomfort. Any child with discomfort during BM passage or prolonged straining at least needs treatment with dietary changes.

  2. Diet for Infants Under 1 Year:
    • For infants older than 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 older than 4 months old, also add baby foods with high fiber content twice a day (peas, beans, apricots, prunes, peaches, pears, plums, spinach).
  3. 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 older than 4 years old.)
    • Decrease milk products (milk, ice cream, cheese, yogurt) to 3 servings per day.
  4. 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.
  5. Sitting on the Toilet (if toilet trained):  Establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially breakfast.
  6. Call Your Doctor If:
    • Days between stools continue longer than 3 after eating a nonconstipating diet longer than 1 week.
    • Your child becomes worse or develops any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Pediatric HouseCalls Online. Copyright © 2000-2004 Barton Schmitt, M.D. FAAP

Reviewed 8/2004

Revised 8/2004

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