Constipation in Infants, Toddlers and Older Children
Constipation in Infants
After the first month of life, Formula-fed infants can go 3-4 days without a stool. Breast fed infants may go several days or even a week between bowel movements, using every drop they eat to make more baby and not more poop.
Infants normally work really hard to have a bowel movement, so straining at the stool isn’t necessarily alarming, even when the infant cries or gets red in the face. Infants often cry, fuss, turn red, and sweat when passing normal stools or even “gas.” The fussiness may last five to 15 minutes and most likely represents a behavior pattern, not a disease. For an infant to have a bowel movement can be a major effort, and it shows. Just imagine trying to poop lying on your back and you’ll get the picture. So straining isn’t a sign of constipation.
Therefore, after 1 month of age, if a baby has not had a BM after 3 days (formula) or 5-7 days (breastfed only) or has increasingly hard stools or pebbles, then you can try giving him or her a little apple, prune or pear juice. Start with 1-2 oz once a day. The sugars in these fruit juices (grape, pear, apple, cherry, or prune) aren’t digested very well, so they draw fluid into the intestines and help loosen stool. If an infant is 2 months or older, you can try increasing to 2-4 oz of juice twice daily to achieve soft stools (playdoh to mash-potato consistency).
Once your infant is taking solids you can try vegetables and fruits (peas, beans, apricots, prunes, peaches, pears, plums, and spinach) and/or oatmeal cereal twice daily. If these dietary changes don’t help, it’s time to be seen in the office.
Constipation in Toddlers and Older Children
Constipation is the delayed or infrequent passage of hard stools in toddlers and older children. Constipation means different things to different people. However, it is usually defined by two primary symptoms: more than three days between bowel movements and/or hard and large stools are passed with pain.
One-year-old babies eating table food have pasty to formed stools. Stools may be passed between three times a day to once every three days. Toddlers and older children normally pass stool, which varies in color and consistency, anywhere from three times a day to once every three days.
Constipation usually occurs because of the slow movement of stool through the colon. The stomach and the small intestine work normally. Parents can expect to see these associated problems when children are constipated.
- Stomach aches
- Decreased appetite and eating
- Abdominal fullness
- Small amounts of blood passed with or just after the stool due to small tears or fissures in the rectum
- Smears or leakage of stool into underwear (encopresis or soiling)
- Repeated urinary infections
Some children can develop stool-holding because of chronic constipation. When bowel movements have been painful in the past, children often try to “hold back” or delay bowel movements. They are afraid that passing stool will hurt again. When they do pass stools after holding back, the stools are large, hard, and painful. These experiences reinforce their determination to hold their stools. This cycle often is repeated many, many times. Even after constipation improves, children’s fears and anxiety about possible pain can lead them to cry when they feel the urge to pass stools. When toddlers resist the urge to “go,” they often will:
- Turn red
- Stiffen their bodies
- Stand in a corner
- Lay on the floor
- Hold onto a table or chair
Often, parents think that their children are trying to push stool out. However, the children are working hard to hold the stool in. Some toddlers, however, may pass small amounts of stool or smears from the rectum despite their best efforts to hold it back.
Treatment for Constipation in Children Under 1 Year of Age
During your office visit, we will outline the first three steps of treatment. These steps include:
- Cleaning the colon with oral medication (MiraLAX +/- Senekot), suppositories, or enemas
- Lubricating the colon and softening the stool to help stool slide along more easily (continued use)
- Having your child try to have bowel movements twice a day
By the time our treatment program is started, many children have had constipation for months or even years. As a result, it sometimes takes weeks or months for the treatment program to improve constipation. The normal treatment cycle is:
- For three to six months, take the lubricant medications and make regular efforts to have bowel movements.
- By six months of treatment, approximately 75% of children have made good progress. Stools are more regular and soiling accidents have been resolved or improved.
- Several months later if constipation or soiling recurs, the same treatment program may need to be started again.
- After the medication stops if the child’s bowel movements slow down, the original medicine can be restarted. This may prevent a build-up of stool and reduce the need for enemas.
Does a Special Diet Help Resolve Constipation?
Many experts suggest young children with constipation change their diets to include higher fiber foods or fiber supplements. To get the best results, consider including high fiber foods in your entire family’s diet. This will encourage the child who needs the fiber the most to eat it along with regular meals. Adding fruit, fruit juices, and fruit nectars to a child’s diet can help resolve constipation issues because the sugars in each are not well-absorbed in the intestine and basically hold water in the stool, making it looser and softer. While some foods help eliminate constipation, no particular foods cause constipation.
Recommended Fiber Intake
Age 1 to 3 Years Age 4 to 6 Years Age 7 to 10 Years
Food Serving Minimum serving Dietary Fiber Minimum serving Dietary Fiber Minimum serving Dietary Fiber
Fruit 1/2-1 small 2 2-4g 2 2-4g 2 2-4g
Vegetable 1/4 cup 2 2g 2.5 2.5g 4 4g
Grains 1 slice bread 2 4g 4 8g 4 8g
1 cup dry cereal
Totals/day 8-10g 12.5-14.5g 14-16g
A Summary of Constipation in Children
- Constipation and soiling rarely result from serious disease.
- Cleansing of the colon usually minimizes or eliminates accidents and helps the colon to work better.
- Lubrication medication may be needed for several months to promote regular passage of stool
- Dietary changes and increased exercise are the ideal daily management for chronic constipation
- Children with constipation must try to pass stools at least twice a day.
- Even though the treatment program works well at the start, the same problems may recur.
- Children may need to restart the program.