Normal bowel habits vary tremendously and may range from three bowel movements (BMs) per day to the painless passage of a stool every two days in a toddler. Exclusively breast-fed infants on the other hand may go up to one week without a stool, and this should not be a concern as long as when the stool is passed it is soft and passed without blood. Babies may strain, grunt and push to achieve a bowel movement even when the stool is soft. This is usually normal behavior.
A child is constipated when he goes more than three days between bowel movements or the stool is hard or the pushing to stool excessive.
Chronic constipation is a common childhood problem often accompanied by chronic abdominal pain and sometimes a depressed appetite. Treatment requires a visit with your doctor.
Passage of a large dry stool can crack the delicate mucous membrane of the anal canal. This is indicated by bright red blood on the toilet tissue or the outside of the passed stool.
Constipation can often be relieved by adding certain laxative foods to the diet and by restricting some constipating foods.
Foods to Use to Help Relieve Constipation
- Aim at 5-6 glasses of water daily
- Juices - Prune, grape, apple or apricot. Drink 4-6 ounces daily.
- Fiber - Found primarily in bread and cereals. Substitute whole wheat or bran for white bread. Many new high fiber cereals are quite tasty. The fiber content is on the side of the box. Bran content is the most important. Infant foods containing fiber include cereals, prunes, apricots, plums, beans and peas. Graham crackers are also a good source of fiber. The amount of fiber needed is the child's age in years plus five.
- Vegetables - Three or four servings per day are recommended
- Fruits - Dried fruits such as raisins, prunes, apricots and dates can help alleviate constipation. Other fruits include apples and pears with the peel. Oranges, tangerines, grapefruit, grapes and all berries may be helpful.
Foods to Avoid
Certain foods are constipating and should be given in limited quantities. These include dairy, particularly, cheese and milk, (children still need their normal requirement of these products), refined wheat including white breads, crackers, macaroni and other pastas and bananas.
Glycerin suppositories can help relieve constipation, but should not be used routinely. Use the infant type only for children under one year. For those over one year, use the regular adult type. They are easily inserted when softened with warm water or lubricated with Vaseline®. They take 30 to 45 minutes to melt and will lubricate the anal canal.
Constipation that does not respond to dietary management or is long standing needs to be discussed with your doctor.
Most constipation is functional or habit constipation from withholding. However, there can be other causes that involve abnormalities of the anal structure or nervous innervation and can sometimes be caused by metabolic or endocrine problems.
Functional constipation requires clean out, then a period of maintenance medication and then a weaning process that can take months. The clean out can be done from above with a medicine such as ethylene glycol or milk of magnesium or from below with enemas. Maintenance then requires the ongoing use of a laxative. Contact your doctor to find out what is the most appropriate program for your child.