OHSU

Constipation

DEFINITION

  • 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
  • 3 or more days without a BM (Exception: Breastfed and over 1 month old)

Imitators of Constipation: Normal Variations 

  • If breastfed and over 1 month old: Infrequent BMs every 4-7 days that are soft, large and pain-free can be normal. Before 1 month old, infrequent stools usually means an inadequate intake of breastmilk.
  • Grunting or straining while pushing out a BM is normal in young infants. (Reason: difficult to pass BM lying on back with no help from gravity) Infants commonly become red in the face during straining.
  • Brief straining or pushing for less than 10 minutes can occur occasionally at any age.
  • Large BM's - Size relates to amount of food consumed and BM frequency. Large eaters have larger stools.
  • Hard or dry BM's are also normal if passed easily without excessive straining. Often relates to poor fiber intake. Some children even have small, dry rabbit-pellet-like stools.

Causes 

  • High milk or cheese diet 
  • Low fiber diet
  • Postponing bowel movements
  • Slow GI transit time (genetic differences)

See More Appropriate Topic (instead of this one) If

  • Age less than 1 month, breastfed and concerns about infrequent stools, see BREAST-FEEDING
  • Doesn't meet the definition of constipation, see ABDOMINAL PAIN

WHEN TO CALL YOUR DOCTOR


Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Persistent abdominal pain over 1 hour (includes persistent crying)
  • Persistent rectal pain over 1 hour (includes persistent straining)
  • Vomiting over 3 times in last 2 hours
  • Age under 1 month old and breastfed
  • Age under 12 months with recent onset of weak cry, weak suck or weak muscles
  • You think your child needs to be seen urgently

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

  • You think your child needs to be seen, but not urgently
  • Age under 2 months (Exception: normal straining and grunting)
  • Bleeding from anal fissures (tears) Needs to pass stool BUT afraid to release OR refuses to go
  • Child may be "blocked up"

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Leaking stool
  • Suppository or enema needed recently to relieve pain
  • Infrequent stools continue after dietary changes (EXCEPTION: normal if breastfed infant over 1 month old AND BMs are not painful)
  • Toilet training is in progress
  • Painful stools occur 3 or more times
  • Constipation is a recurrent chronic problem

Parent Care at Home If

  • Mild constipation and you don't think your child needs to be seen

HOME CARE ADVICE FOR CONSTIPATION

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 usually drift into longer intervals and then develop 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

Diet for Infants Under 1 Year:

  • For infants over 1 month old only on breast milk or formula, add fruit juices 1 oz. (30 ml) per month of age per day. Pear or apple juice are OK at any age. (Reason: treating a symptom
  • For infants over 4 months old, also add baby foods with high fiber content twice a day (peas, beans, apricots, prunes, peaches, pears, plums)
  • If on finger foods, add cereal and small pieces of fresh fruit.

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 over 4 years old.

  • Limit 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 BMs
  • Avoid any pressure, punishment or power struggles about holding back poops, 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 BM. For prolonged straining, have your child sit in warm water or apply a warm wet cotton ball to the anus. Move it side to side to help relax the anus.

Flexed Position:

  • Help your baby by holding the knees against the chest to simulate squatting (the natural position for pushing out a BM). It's difficult to have a bowel movement while lying down
  • Gently pumping the lower abdomen may also help.

Call Your Doctor If:

  • Constipation continues after making dietary changes
  • Your child becomes worse


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.

 

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Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 11/14/2011
Last Revised: 11/14/2011
Content Set: Pediatric HouseCalls Symptom Checker
Copyright 1994-2012 Barton D. Schmitt, M.D.

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