Constipation

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In its most extreme form, constipation refers to the infrequent (every 3-4 days or longer) painful passage of extremely large, hard stools. It is often accompanied by abdominal pain and cramping. Less severe forms of constipation involve the passage of small, pebble-like stools. Constipation often becomes a vicious cycle – the child learns that passing stools is painful and thus tries to avoid going, worsening the problem.

It is important to know that breastfed babies, after a month or two of age, might only poop once or twice a week. As long as the stool is soft and baby is comfortable, these babies aren’t constipated. Once bottle or breast-fed babies start taking solids, constipation becomes more of an issue and the stools often become pebble-like. There are several measures you can take to improve your child’s constipation, depending on their age. In babies and toddlers, a good remedy is an ounce or two of prune juice once or twice a day. Alternatively, you can add 1-2 teaspoons of Karo syrup to 4 ounces of formula once or twice a day. You can also try to avoid the more constipating foods like rice cereal, bananas, applesauce and carrots. Offer oatmeal cereal, prunes, pears, peaches, apricots and peas instead. If these measures don’t work, it is ok to use half of an over-the-counter glycerin suppository one to two times a day for no longer than a day or two at a time.

In older kids, remember that dairy products can contribute to constipation. In this case, offer milk with meals only, giving water between meals. Pulpy juices like prune, pear and orange juice can be helpful. High fiber foods like fruits and vegetables, bran muffins, whole wheat breads and cereals (Frosted Mini Wheats, Cracklin’ Oat Bran) should be offered. Bowel training might also be helpful. Encourage your child to sit on the toilet for at least 5-10 minutes shortly after meals when the body has a natural urge to defecate. If these measures aren’t enough, add 1-2 teaspoons of Milk of Magnesia twice a day. Gradually increase the amount of Milk of Magnesia until your child is having a soft stool every day or two. Unlike suppositories, it is safe to use Milk of Magnesia for an extended period of time in older children.

At times, constipation can become so severe that loose stool leaks around a large constipated ball of stool in the child’s rectum. In these cases, there are often smears of stool in the child’s underwear. Over the counter pediatric Fleets enemas sometimes must be used once or twice, followed by a prescription strength medication. It can take months to retrain the stretched-out rectum to handle stools normally.

Be sure to call the office if your child has constipation accompanied by severe abdominal pain, recurrent rectal bleeding or continued problems with constipation despite the above measures.

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