Constipation

Definition of Constipation

• Pain or crying during the passage of a bowel movement (BM) OR
• Unable to pass a BM after straining or pushing > 10 minutes OR
• No BM after more than 3 days (EXCEPTION: If breastfed and > 1 month old, infrequent BMs can be normal)
• The following symptoms are NOT constipation: normal grunting, brief straining or pushing for < 10 minutes, large BMs, or BMs passed every 2 or 3 days. Hard or dry BMs are also normal if passed easily
• Main cause: high-milk diet, lack of fiber in diet, postponing BMs

See More Appropriate Topic

• If doesn’t meet the definition of constipation, either normal or see Abdominal Pain

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick
• Persistent abdominal pain > 1 hour (includes persistent crying)
• Persistent rectal pain > 1 hour (includes persistent straining)
• Vomiting > 3 times in last 2 hours
• Breastfed newborn (< 1 month old)
• Age < 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 < 2 months
• Bleeding from anal fissures (tears in the skin)
• Leaking stool

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Suppository or enema needed frequently to relieve pain
• Days between BMs > 3 while eating a nonconstipating diet (EXCEPTION: Normal if breastfed infant is older then 2 months AND BMs are not painful)
• Toilet training is in progress
• Constipation is a recurrent problem

Parent Care at Home If

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

Home Care Advice for Constipation

1. Diet for Infants Under 1 Year
   • For infants older then 1 month old that only eat breast milk or formula, add 1 oz (per month of age) of fruit juices twice a day. Grape, pear, apple, cherry or prune juice are OK at any age
   • For infants older then 4 months old, also add baby foods with high fiber content twice a day (peas, beans, apricots, prunes, peaches, pears, plums, or spinach)
2. 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, or dates)
   • Increase whole grain foods (bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread. Popcorn can be used if > 4 years old.)
   • Decrease constipating foods (milk, ice cream, cheese, yogurt, or cooked carrots)
3. 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
4. Sitting on the Toilet (if toilet trained): Establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially breakfast.
5. Call Your Doctor If
   • More then 3 days pass between BMs despite eating a nonconstipating diet for more than 1 week
   • Your child becomes worse or develops any of the “Call Your Doctor” symptoms