Tag Archives: constipation

constipation in children

Constipation is an extremely common childhood condition. One I deal with almost on a daily
basis in clinic and one that can be surprisingly hard to get control of..

Parents are often at a loss on what to do about something that is causing their child significant
discomfort, but also something they feel should be relatively easy to treat.

The trick is to always be one step ahead of constipation when it comes to your child.

Here are some surprising truths about constipation:

  • It can really hurt and be a source of significant, recurrent abdominal pain. After a
    thorough history and physcial exam (sometimes even an x-ray, depending on the
    situation), parents are shocked to find out, that, yes excess and blocked stool is the culprit
    for the tears and complaints of pain.
  • A child can be constipated in spite of reported daily bowel movements. Often, parents
    will discount constipation as a cause of their child’s stomach pains because the child will
    report having a somewhat “normal” bowel movement. However, if the stools are small,
    hard, and difficult to pass; this could be a sign that your child is not completely emptying
    his bowels. Having abnormally large and infrequent stools is another sign of constipation.
    In both instances, stools are typically hard to pass and the child may start withholding
    which will only worsen the condition.
  • On the flipside, your child may only have bowel movements every 2-3 days and not be
    constipated. The defining features are not necessarily based on frequency but more on
    symptoms such as abdominal pain, hard and difficult to pass stools, blood streaked stools,
    or a fear of going to the bathroom due to the anticipated pain.

When children are most prone to it:

  • Transitioning to solid foods and whole milk.
  • Potty training
  • School entry

Stay one step ahead with these tips:

  • Make your child’s daily meals full of fiber rich foods. Think whole fruits, whole grains,
    fiber cereals, and green/leafy vegetables.
  • Water, water, and more water. Keep a refillable water bottle on hand and encourage your
    child to drink frequently.
  • Moderate milk intake. Too much of a good thing can be bad for your child’s digestion.
    Instead of filling up on fiber rich foods, she is filling up on this. After the age of 1 year, 500 ml per day is more than enough.
  • Make a smoothie: if you have a picky eater…have her drink her fiber. Add whole fruits,
    some skim milk, yogurt, and a splash of juice.
  • Try a daily “P” juice (prune or pear) for breakfast to get things back on track.
  • A daily fiber supplement can help fill in the fiber gap.
  • Exercise. Get your kids outside (or inside) and moving for a good hour per day.

Laxatives

Sometimes, your child just needs a laxative to get back on track. Discuss this possibility with
your child’s pediatrician. Once the cycle of constipation has set in, dietary changes alone may
not turn it around. Be sure to adhere to the plan outlined with your pediatrician and continue with
the constipation fighting foods above.

Discuss with your doctor and follow instruction carefully.. Incomplete treatment can lead to poor growth.

Regards

Dr Rahul Varma

 

Children with Constipation : what can be done

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

Regards

Dr Rahul Varma