Constipation in children is
said to occur if there is fewer than three stools per week or the passage of
hard, large diameter or pellet like stools. It is usually associated with
pain and or excessive straining.
Normally frequency of stools in children can range from 2-3 a day to 1 every
other day. Breast fed babies after four weeks of age can go once a week,
however, the stools are soft. Babies normally grunt, strain and draw up
their legs while defecating and can turn red in the face. Formula fed
babies usually have 1-3 stools a day.
What causes constipation?
The most common cause of constipation in children is functional and not a
disease. Constipation starts with the passage of an unusually hard
painful stool. The child delays going to the bathroom because he or she
is too busy playing or doesn't want to go to the bathroom at school, or at a
friend's house. Holding the urge to go makes the stools hard. When
the child finally goes it may hurt the rectum. This encourages more
holding and makes the stools harder, starting a hold, hard, hurt cycle.
Sometimes, children will sit on the toilet attempting to go when they may be
actually straining to hold it in. Hard stools and straining can cause a
tear in the rectum called a rectal fissure. Blood may be seen on wiping,
or on the surface of the stool.
Usually constipation in children is not due to a lack of fiber, too much milk
or cheese, or too little water. However, some children may be affected by
these. Compared to breast milk, formula is more constipating.
How is it treated?
Constipation can be treated in infants >2 months of age by giving apple,
pear or prune juice, 2-4oz. per day. Older babies can have pureed baby
prunes, 6oz. per day. Or by adding one tablespoon, karo syrup to 3oz. of
formula, three times a day.
In order to break the hold hard hurt cycle in
older children, stool softeners can be used. See table.
to 1 capful, a day to dissolve in 8oz. fluid
11 yrs.: 1-4 tsp. divided 1-2 times a day
11 yrs. & older: 1-3 Tbsp. divided 1-2 times a day
6 yrs.: 1 tsp. - 1 Tbsp. divided 1-2 times a day
6 yrs. & older: 1-2 Tbsp. divided 1-2 times a day
These children should
be made to sit on the toilet for 10-15 minutes after at least two meals a
day. This exercise should be continued daily for as long as it takes, to
get the stools to pass painlessly and regularly. Gradually the stool
softeners can be stopped. Children that get constipation because
they are fighting toilet training should be placed back in diapers.
Toilet training can be resumed when the child shows readiness for it.
Visit your pediatrician if your baby is constipated in the first week of life
or has severe symptoms, or if you are concerned about an organic cause of