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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 2 days
Imitators of Constipation
- 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)
- 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.
- Hard or dry BM’s are also normal if passed easily. Often relates to poor fiber intake.
Causes
- High milk or cheese diet
- Low fiber diet
- Postponing bowel movements
- Slow GI transit time (genetic differences)
If doesn't meet the definition of constipation, either normal or see ABDOMINAL PAIN.
(To go directly to this topic, click on the link following this document.)
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.
Call Your Doctor Within 24 Hours (between 9 and 4) If
- You think your child needs to be seen.
- Age under 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.
- 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.
- Constipation is a recurrent problem.
Parent Care at Home
- Mild constipation and you don't think your child needs to be seen.
Home Care Advice for Constipation
- 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 twice a day. Grape, pear, apple, cherry or prune 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).
- 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 constipating foods (milk, ice cream, cheese, yogurt, or cooked carrots).
- 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 BMs, 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.
- Call Your Doctor If:
Days between BMs continue longer than 3 after eating a non-constipating diet longer than 1 week.
Your child becomes worse or develops any of the "Call Your Doctor" symptoms.
Parent Care for Pediatric Symptoms. Copyright © 2000. Barton D. Schmitt, MD, FAAP
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