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|Quick reference medical handouts used
by Pediatric offices
What is Constipation and How to Treat It
Painful passage of bowel movements: The most reliable sign of constipation
is discomfort with the passage of a bowel movement.
Inability to pass stools: These children feel a desperate urge to
have a bowel movement (BM), have discomfort in the anal area, but are unable
to pass a BM after straining and pushing for more than 10 minutes.
Infrequent bowel movements: Going 3 or more days without a BM can
be considered constipation, even though this may cause no pain in some children
and even be normal for a few. Exception: After the second month or so of
life, many breast-fed babies pass normal, large, soft BMs at infrequent intervals
(up to 7 days is not abnormal) without pain.
Common Misconceptions About Constipation
Large or hard BMs unaccompanied by any of the conditions just described
are usually normal variations in BMs. Some normal people have hard BMs daily
without any pain. Children who eat a lot of food pass extremely large BMs.
Babies less than 6 months of age commonly grunt, push, strain, draw up the
legs, and become flushed in the face during passage of bowel movements. However,
they don't cry. These behaviors are normal and should remind us that it is
difficult to have a bowel movement while lying down.
Constipation is often due to a diet that does not include enough fiber.
Drinking or eating too many milk products can cause constipation. It's also
caused by repeatedly waiting too long to go to the bathroom. The memory of
painful passage of BMs can make young children hold back. If constipation
begins during toilet training, usually the parent is applying too much
Changes in the diet usually relieve constipation. After your child
is better, be sure to keep him on a nonconstipating diet so that it doesn't
Sometimes the trauma to the anal canal during constipation causes
an anal fissure (a small tear). This is confirmed by finding small amounts
of bright red blood on the toilet tissue or the stool surface.
Diet treatment for infants less than 1 year old
For babies less than 2 months old, try giving 1 teaspoon of dark
Karo syrup twice a day. Give fruit juices (such as apple or prune juice)
twice a day to babies over 2 months old. Switching to soy formula may also
result in looser stools. If your baby is over 4 months old, add strained
foods with a high fiber content such as cereals, apricots, prunes, peaches,
pears, plums, beans, peas, or spinach twice a day. Strained bananas and apples
are neither helpful nor constipating.
Diet treatment for older children over 1 year old
Make sure that your child eats fruits or vegetables at least three
times a day (raw, unpeeled fruits and vegetables are best). Some examples
are prunes, figs, dates, raisins, peaches, pears, apricots, beans, peas,
cauliflower, broccoli, and cabbage. Warning: Avoid any foods your child can't
Increase bran. Bran is an excellent natural stool softener because
it has a high fiber content. Make sure that your child's daily diet includes
a source of bran, such as one of the new "natural" cereals, unmilled bran,
bran flakes, bran muffins, shredded wheat, graham crackers, oatmeal, high-fiber
cookies, brown rice, or whole wheat bread. Popcorn is one of the best high-fiber
foods for children over 4 years old.
Decrease the amount of constipating foods in your child's diet. Examples
of constipating foods are milk, ice cream, cheese, yogurt, and cooked
Increase the amount of fruit juice your child drinks. (Orange juice
will not help constipation as well as other juices).
Sitting on the toilet (children who are toilet trained)
Encourage your child to establish a regular bowel pattern by sitting
on the toilet for 10 minutes after meals, especially after breakfast. Some
children and adults repeatedly get blocked up if they don't do this.
If your child is resisting toilet training by holding back, stop
the toilet training for a while and put him back in diapers or
If a change in diet doesn't relieve the constipation, give a stool
softener with dinner every night for one week. Stool softeners (unlike laxatives)
are not habit forming. They work 8 to 12 hours after they are taken. Examples
of stool softeners that you can buy at your drugstore without a prescription
are Haley's M-O, Metamucil, Citrucel, and mineral oil. Give 1/2 to 1 tablespoon
Common mistakes in treating constipation
Don't use any suppositories or enemas without your physician's advice.
These can cause irritation or fissures (tears) of the anus, resulting in
pain and stool holding. Do not give your child strong oral laxatives without
asking your physician because they can cause cramps and may become
Relieving acute rectal pain
If your child has acute rectal pain needing immediate relief, one
of the following will usually provide quick relief:
sitting in a warm bath to relax the muscle around the anus (anal
giving your child a glycerine suppository
gently putting a thermometer in the anus for 10 seconds to stimulate
the rectal muscle.
If these measures fail, use a saline enema, but only if you have
your physician's approval. The normal saline enema is made by adding
2 teaspoons of table salt to a quart of lukewarm water. Do not use enemas
with soapsuds, hydrogen peroxide, or tap water. They are dangerous. Your
child should lie on his stomach with his knees pulled under him. The enema
tube should be lubricated and inserted 1 and 1/2 inches to 2 inches into
the rectum. The enema fluid should be delivered gradually by gravity, with
the enema bag no more than 2 feet above the level of the anus. Your child
should hold the enema until a strong need to have a bowel movement is felt
(2 to 10 minutes). If you do not have an enema apparatus, you can use a rubber
The amount of normal saline solution that should be given to children
at various ages is:
1 year. . . . . . . . . . . . . . . . 4 ounces
1 to 3 years . . . . . . . . . . . . . 6 ounces
3 to 6 years . . . . . . . . . . . . . 8 ounces
6 to 12 years. . . . . . . . . . . . 12 ounces
Adolescents and adults. . . . . . . . 16 ounces
Call Your Child's Physician Immediately for Advice About an Enema
or Suppository If:
Your child develops severe rectal or abdominal pain.
Call Your Child's Physician During Office Hours If:
Your child does not have a bowel movement after 3 days on the
You are using suppositories or enemas.
You have other concerns or questions.
Written by B.D. Schmitt, M.D., author of "Your Child's
Health," Bantam Books. Copyright 1999 Clinical Reference Systems
As a reminder, this information should not be relied on as
medical advice and is not intended to replace the advice of your childs pediatrician.
Please read our full disclaimer.