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 constipation 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.

 Mira Lax 

 1/4 to 1 capful, a day to dissolve in 8oz. fluid

 Mineral Oil

 Under 11 yrs.: 1-4 tsp. divided 1-2 times a day
 11 yrs. & older: 1-3 Tbsp. divided 1-2 times a day

 Milk of Magnesia  

 Under 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 constipation.