Constipation is a very common and frustrating problem in children. It is usually defined as the passage of hard and painful stools or going four or more days without a bowel movement. Constipation is most commonly caused by a diet that is low in fiber, but can also be caused by drinking too much milk (more than 12-16oz/d), not drinking enough water or waiting too long to go to the bathroom.
Once a child develops constipation and has hard and painful stools, he will then begin to hold in his bowel movements to prevent it from hurting again. This creates a cycle that makes the constipation continue and become worse.
Constipation is best treated by making changes in your child's diet. Until the constipation has improved with a non-constipating diet, your child will most likely also be on stool softeners. The goal of treatment is for your child to have one to two soft stools each day.
Diet Treatment for Infants
Constipation is uncommon in breastfed infants. Because breastmilk is digested so well, it can be common for a baby that is exclusively breastfed to only have a bowel movement every one to two weeks. If the bowel movement is soft or watery, then it is not constipation, even if it occurs infrequently.
It can also be normal for infants (whether breastfed or drinking an iron fortified infant formula) to strain and groan when they have a bowel movement. Again, if the bowel movement is soft or watery, then it is not constipation, even if your infant has to strain or groan to have a bowel movement. And remember that the iron in infant formulas does not cause constipation. You should not switch to a low iron formula because your child has constipation.
If you do think your infant has constipation, then you can:
Increase fluids: Give 2-4 oz of water or diluted fruit juices (such as apple or prune) 1-2 times each day, or try switching to a soy formula.
Increase fiber: If your infant is over four months old and has constipation, you may also try feeding foods with a lot of fiber, such as cereals, strained prunes, apricots, or spinach.
Keep in mind, that although rare, the first symptoms of botulism in infants is usually constipation. If your infant has severe or difficult to treat constipation, especially if he also has other symptoms, like weakness and poor muscle tone, ask your doctor about botulism.
Diet Treatment for Children
Constipation in children is best done by making changes in your child's diet. Some things that you can do to treat and prevent constipation in your children include:
Increasing fluids: Increase the amount of water and fruit juices (minimum of 2-3 glasses) that your child drinks each day.
Increasing fiber: Increase the amounts of fruits and vegetables that your child eats. Raw, unpeeled fruits and vegetables (especially beans, sweet potatoes, peas, turnip greens, raw tomatoes and corn) have the most fiber. Popcorn also has lots of fiber in it. Give enough grams of fiber to equal their age in years plus 5 each day (check the nutritional label for high fiber foods and snacks with at least 3-4g of fiber per serving). Vegetable soups are especially high in fiber and also add more fluid to your child's diet.
Increasing bran in your child's diet by offering bran cereals, bran muffins, shredded wheat, graham crackers, or whole wheat bread.
Decreasing constipating foods: The foods most notorious in causing constipation include cow's milk, yogurt, cheese, cooked carrots, and bananas. Drinking too much milk (your child may only be drinking 2-3 cups a day, but it may be too much for his system to handle) is heavily associated with having constipation. Switching to soy milk has been shown to soften stools. If your child is unable to drink milk, then offer a daily multivitamin or other sources of calcium (such as calcium fortified orange juice).
Most of these medicines for constipation are available in the pharmacy over the counter and do not require a prescription. They include Metamucil, Milk of magnesia, Citrucel, or mineral oil.
Unlike laxatives in adults, they are generally not considered to be habit forming. You should use them once or twice a day and work up on the dose until your child is having a soft BM each day. If you child starts to have diarrhea, then you are giving too much and you should cut back on the dose. See the table below for dosing information for treatment of children with constipation.
Senokot is also often commonly used in children, but it is actually a stimulant laxative and not a stool softener, so you may not want to use it for long periods of time.
A newer medicine, Miralax, is available only by prescription to treat constipation, but is very effective.
Changing doses of Stool Softeners
Once your child is having 1-2 soft stools each day you should continue with the doses of the medicines that you are using for 6-12 months until he is accustomed to his new non-constipating diet. You can then gradually stop the stool softeners by slowly lowering the amount you are giving every 1-2 weeks.
If stools are too loose then cut back on the dose by one-third. If stools are still too hard then increase the dose by one-third. Avoid making changes in the medicines based on one bowel movement, or you will wind up ‘seesawing' with the doses.
Treatment for Acute Constipation
If your child has been constipated for a long time or he is having discomfort or significant pain with bowel movements then you may need to ‘clean out' backed up stool before the stool softeners will work by using an enema, a glycerine suppository or high doses of mineral oil. See your pediatrician for information on how to start begin this treatment for acute constipation.
You should encourage your child to have regular bowel patterns. Have your child sit on the toilet for about ten minutes after meals 1-2 times each day.
The use of simple rewards or a daily calendar with stars or stickers for days that your child takes his medicine and has a bowel movement may be helpful.
- Be patient. Constipation in children is a chronic problem that can take time to improve. Avoid embarrassing or punishing your child.
- Avoid the frequent use of enemas or suppositories.
- Call your pediatrician if your child's constipation is not improving in 2-3 weeks, if he is regularly needing to use enemas or suppositories, or he is soiling his pants because of leakage of stool (encopresis).