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.
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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