Constipation is the painful passage of bowel movements, the inability to pass stools despite feeling the urge to defecate, having infrequent bowel movements or going 5 or more days without a bowel movement.  It is usually due to a lack of fiber or fluid in the diet or eating too many milk products.  It also can be caused by withholding stool.  If constipation begins during toilet training there may be too much psychological pressure being placed on the child.

Large or hard BMs without pain can be normal.  Babies less than 6 months or age commonly grunt, push, stain, draw up the legs, and become flushed in the face during the passage of bowel movements.  These behaviors remind us that it is difficult to have a bowel movement while lying down.  Also babies do not coordinate the pushing with the release of the voluntary external sphincter.

Expected course:  Changes in the diet usually relieve the constipation.  After your child is better, keep him on the non-constipating diet so that it doesn't happen again.

Treatment in infants less than 4 months:  As long as the stool is somewhat soft there is no need to do anything because the frequency is highly variable.  If they are hard like marbles, increasing the fluid intake by increasing the frequency of the feedings or adding 1-2 ounces of water or Pedialyte to the diet each day usually helps.  Also adding 1 teaspoon of dark corn syrup to 1 oz bottle 2-3 times daily may help.

4 months to 1 year:  If your baby is eating solids, add foods with a high fiber content twice a day.  These include apricots, prunes, peaches, pears, plums, peas, or spinach.  Avoid strained carrots, squash, banana, and applesauce.  You can also offer apple, pear, or prune juice twice daily.  Although not as effective you can also try the dark corn syrup.

Toddlers and older children:  Feed your child fruits or vegetables at least three times a day (raw unpeeled fruits and vegetables are best).  Some examples are prunes, figs, dates, raisins (if your child is older than 3 years), peaches, pears, apricots, beans, peas, cauliflower, broccoli and cabbage.  Be sure to avoid any foods that your child cannot chew easily.

Increase bran.  make sure that your child's diet includes a source of bran, such as one of the "natural cereals", un-milled bran, bran flakes, bran muffins, frosted shredded mini wheats, graham crackers, oatmeal, high fiber cookies, brown rice, or whole wheat bread.  Plain popcorn is one of the best high fiber foods for children older than 3 years of age.

Decrease constipating foods such as mild, ice cream, cheese, white rice, applesauce, bananas, cooked carrots, and foods high in sugar, such as candy.

Great snacks for the 3 year old and older:  trail mix with nuts, dried fruits, and bran cereal, JELL-O made with fruit, popcorn, fruits cut up in various shapes.  Vegetables can be grated and added to meatloaf, meatballs, casseroles, breads or muffins.

Increase the amount of water your child drinks daily.

Encourage your child to develop 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 do not do this.  If your child is resisting toilet training by holding back, stop the training for awhile and put him back in pull-ups or diapers.

DO NOT GIVE ANY ENEMAS, LAXATIVES OR SUPPOSITORIES WITHOUT THE ADVICE OF YOUR CHILD'S MEDICAL PROVIDER.

Call us during OFFICE HOURS if:

1.  There is no bowel movement after 4 days on this non-constipating diet.

2.  The anal area develops tears that won't heal.

3.  Your child soils himself with leaking BMs.

4.  This is a recurring problem.