Clinical Reference Systems: Pediatric Advisor 10.0
- Painful passage of bowel movements: The most reliable
sign of constipation is discomfort with the passage of a
- 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)
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 psychological pressure.
(See Toilet Training Basics .)
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 happen again.
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 chew
- 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
- Decrease the amount of constipating foods in your
child's diet. Examples of constipating foods are
milk, ice cream, cheese, yogurt, and cooked carrots.
- Increase the amount of fruit juice your child drinks.
(Orange juice will not help constipation as well as
- 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 pull-ups.
- Stool softeners
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 daily.
- 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 habit-forming.
- Relieving acute rectal pain
If your child has acute rectal pain needing immediate
relief, one of the following will usually provide quick
- sitting in a warm bath to relax the muscle around the
anus (anal sphincter)
- 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 bulb syringe.
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 nonconstipating diet.
- You are using suppositories or enemas.
- You have other concerns or questions.