Constipation

Constipation may be suspected if there is pain during defecation, an inability to release a stool after 10 minutes of pushing, or 3 or more days have passed without the passage of a stool. Once children are on a regular diet (age 1 year), the normal range for stools is 3 per day to 1 every 2 days. Most constipation is a result of diet changes or waiting too long to use the bathroom.

Symptom Management

Diet for Infants Under 1 Year:

For infants over 1 month old only on breast milk or formula, you may add fruit juices 1 ounce per month of age per day (e.g., 3 months old = 3 ounces a day). Limit amount to 4 ounces per day. Pear and apple juice are good choices. After 3 months, you can also use prune juice - no more than 2oz in 24hrs.
For infants over 4 months old, also add baby foods with high fiber content twice a day (e.g., peas, beans, apricots, prunes, peaches, pears, plums).
If on finger foods, you can add in cereal and small pieces of fresh fruit.

Diet for Children Over 1 Year Old:

Increase fruit juice and vegetable juice. (Note: Citrus fruit juices are not helpful)
Add fruits and vegetables high in fiber content (e.g., peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes, dates) 3 times or more per day.
Increase whole grain foods (e.g., Cracklin Oat Bran cereal (tastes like oatmeal cookies), bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread).
Popcorn can be used if the child is over 4 years old.
Limit milk products to 3 servings per day.
Give enough fluids to keep your child well hydrated.

Stop Toilet Training (if Not Trained):

Temporarily put your child back in diapers or Pull-Ups.
Reassure your child that the poops won’t hurt when they come out.
Praise them for the release of stools.
Holding back stools is harmful. Use rewards to help your child give up this bad habit.
Avoid any pressure, punishment, or power struggles about holding back poops, sitting on the potty, or resistance to training.

Encourage Sitting on the Toilet (if Toilet Trained):

Establish a regular bowel pattern by sitting on the toilet about 20 minutes after meals, especially breakfast.
How long to sit: About 5 minutes.
If you observe your child holding back, take them to sit on the toilet at that time as well.

Warm Water to Relax the Anus (for Young Children):

Warmth helps many children relax the anal sphincer and release a stool.
Apply a warm, wet cotton ball to the anus. Vibrate it side-to-side for about 10 seconds to help relax the anus.

Flexed Position to Help Stool Release:

Hold the knees against the chest to stimulate squatting (the natural position for pushing out a stool).
Relax the legs, then press again. Move them like riding a bike.
Gently pump on the lower abdomen. This may work even better.
If no stool releases within 5 minutes, stop. It will usually work next time your baby is straining.

Expected Course

Improvements in diet usually relieve constipation. Once your child feels better, try to keep them on a high-fiber, non-constipating diet so that it doesn’t happen again. Sitting on the toilet at regular intervals daily may help to prevent recurrences.

When to Call the Office

Constipation continues after making dietary changes.
Pain or crying with the passage of stools
Your child becomes worse.

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances