constipation

CONSTIPATION

  • Pain or crying during the passage of a stool (bowel movement or BM) OR
  • Unable to pass a stool after straining or pushing longer than 10 minutes OR
  • 3 or more days without a stool (Exception: Breastfed and over 1 month old)

Imitators of Constipation: Normal Variations

  • If breastfed and over 1 month old: Infrequent stools 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 stool is normal in young infants. (Reason: difficult to pass stool lying on back with no help from gravity) Infants commonly become red in the face during straining.
  • Brief straining or pushing for less than 10 minutes can occur occasionally at any age.
  • Large stools – Size relates to amount of food consumed and stool frequency. Large eaters have larger stools.
  • Hard or dry stools are also normal if passed easily without excessive straining. Often relates to poor fiber intake. Some children even have small, dry rabbit-pellet-like stools.

Causes:

  • High milk or cheese diet
  • Low fiber diet
  • Postponing stools
  • Slow intestinal transit time (genetic differences)

Home Care Advice for Constipation

  1. Normal Stools:
  • Once children are on a regular diet (age 1 year), the normal range for stools is 3 per day to 1 every 2 days.
  • The every 4 and 5 day kids all have pain with passage and prolonged straining.
  • The every 3 day kids usually drift into longer intervals and then develop symptoms.
  • Passing a stool should be fun, or at least free of discomfort.
  • Any child with discomfort during stool passage or prolonged straining at least needs treatment with dietary changes.

2. Diet for Infants Under 1 Year:

  • For infants over 1 month old only on breast milk or formula, add fruit juices 1 ounce (30 ml) per month of age per day. Pear or apple juice are OK at any age. (Reason: treating a symptom)
  • For infants over 4 months old, also add baby foods with high fiber content twice a day (peas, beans, apricots, prunes, peaches, pears, plums).
  • If on finger foods, add cereal and small pieces of fresh fruit.

3. 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) 3 or more times per day.
  • Increase whole grain foods (bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread. Popcorn can be used if over 4 years old.)
  • Limit milk products (milk, ice cream, cheese, yogurt) to 3 servings per day.

4. 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 stools.
  • Avoid any pressure, punishment or power struggles about holding back poops, sitting on the potty or resistance to training.

5. Sitting on the Toilet (if toilet trained): Establish a regular bowel pattern by sitting on the

toilet for 10 minutes after meals, especially breakfast.

6. Warm Water for Rectal Pain: Warmth helps many children relax the anal sphincter and release a stool. For prolonged straining, have your child sit in warm water or apply a warm wet cotton ball to the anus. Move it side to side to help relax the anus.

7. Flexed Position:

  • Help your baby by holding the knees against the chest to simulate squatting (the natural position for pushing out a stool). It’s difficult to have a stool while lying down.
  • Gently pumping the lower abdomen may also help.

8. Call Your Doctor If:

  • Constipation continues after making dietary changes
  • Your child becomes worse

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