Constipation  
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This Care Guide Covers:

  • Pain or crying when passing a stool (bowel movement or BM) OR  
  • Can't pass a stool after straining or pushing longer than 10 minutes OR
  • 3 or more days without passing a stool (Exception: Breastfed and over 1 month old)

If not, see these topics
When to Call Your Doctor

Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Stomach pain goes on over 1 hour (includes crying) after using care advice
  • Rectal pain goes on over 1 hour (includes straining) after using care advice
  • Vomits 2 or more times and stomach looks more swollen than normal
  • Age under 1 month old and breastfed
  • Age under 12 months with recent onset of weak suck or weak muscles
  • You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently
  • Age under 2 months (Exception: normal straining and grunting)
  • Bleeding from anus
  • Needs to pass a stool BUT afraid to or refuses to let it out
  • Child may be "blocked up"
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Leaking stool
  • Suppository or enema needed to get the stool out
  • Infrequent stools do not get better after changes to diet. (Exception: Normal if breastfed infant over 1 month old AND stools are not painful.)
  • Toilet training is in progress
  • Painful stools occur 3 or more times after changes to diet
  • Constipation is a frequent problem
Parent Care at Home If
  • Mild constipation
Causes & Health Information

Causes 

How Often is Normal?

Imitators of ConstipationNormal Patterns and Stools

 

CARE ADVICE FOR CONSTIPATION

  1. What You Should Know:
    • Constipation is common in children.
    • Most often, it's from a change in diet. It can also be caused by waiting too long to stool.
    • Passing a stool should be pleasant and free of pain.
    • Any child with pain during stool passage or lots of straining needs treatment. At the very least, they need changes in diet.
  2. Normal Stools:
    • Once children are on a regular diet, their stool pattern is like adults. The normal range is 3 per day to 1 every 2 days.
    • Kids who go every 3 days often drift into longer times. Then symptoms start.
    • Kids who go every 4 and 5 days almost always have pain with passage. They also have lots of straining.
  3. Diet for Infants Under 1 Year Old:
    • For infants over 1 month old only on breast milk or formula, add fruit juice. Give 1 ounce (30 ml) per month of age per day. Pear or apple juice are okay at any age. (Reason: Treating a symptom.)
    • For infants over 4 months old, also add baby foods with high fiber. Do this twice a day. Examples are peas, beans, apricots, prunes, peaches, pears, or plums.
    • If on finger foods, add cereals and small pieces of fresh fruit.
  4. 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. Examples are peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes, or dates. Offer these foods 3 or more times per day.
    • Increase whole grain foods. Examples are bran flakes or muffins, graham crackers, and oatmeal. Brown rice and whole wheat bread are also helpful.  Popcorn can be used if over 4 years old.
    • Limit milk products (milk, ice cream, cheese, yogurt) to 3 servings per day.
  5. Stop Toilet Training:  
    • Put your child back in diapers or pull-ups for a short time.
    • Tell him that the poops won't hurt when they come out.
    • Praise him for passing poops into a diaper.  
    • Holding back stools is harmful. Use rewards to help your child give up this bad habit.
    • Avoid any pressure or punishment. Also, never force your child to sit on the potty against his will. Reason: It will cause a power struggle.
    • Treats and hugs always work better.
  6. Sitting on the Toilet (if toilet trained):
    • Set up a normal stool routine.
    • Have your child sit on the toilet for 10 minutes after meals.
    • This is especially important after breakfast.
  7. Warm Water for Rectal Pain:
    • Warmth helps many children relax the anus and release a stool.
    • For straining too long, have your child sit in warm water.
    • You can also put a warm wet cotton ball on the anus. Move it side to side to help relax the anus.
  8. Flexed Position:
    • Help your baby by holding the knees against the chest. This is like squatting for your baby. This is the natural position for pushing out a stool. It's hard to have a stool lying down.
    • Gently pumping the lower stomach may also help.
  9. What to Expect:
    • Most often, changes in diet helps constipation.
    • After your child is better, be sure to keep him on high fiber foods.
    • Also, have your child sit on the toilet at the same time each day.
    • These tips will help to prevent the symptoms from coming back.
  10. Call Your Doctor If:
    • Constipation lasts more than 1 week after making changes to diet
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 9/1/2012

Last Revised: 1/13/2013

Content Set: Child Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.