Constipation
Written by Dr. Jennifer Gerlach
Many children have constipation at one time or another. Minor changes in daily routines may cause it. Being away from home, changes in eating, drinking, or activity may also cause constipation. It is very common for children to avoid having a bowel movement at school, which can lead to constipation. Most of these things will not last long, are easy to correct, and do not result in long-term health problems. However, constipation can be linked to stomachaches, decreased appetite or eating, feeling of beeing "full", small amounts of blood on the toilet paper or the outside of the stool, stool leaking on underwear (encopresis or soiling), and repeated urinary tract infections.
Toddlers often try to hold in their stool after having a painful bowel movement. They often cross their legs and become rigid. They are determined not to have another painful experience and can often hold their bowel movements for days. This of course leads to large, hard bowel movements. This experience convinces them that having a bowel movement is something to be avoided. They may sometimes seem to be trying to have a bowel movement when they are actually trying not to go. Fissures and other painful conditions of the anus can also lead to this problem.
Children who are going through toilet training may not want to take the time out from play to go to have a bowel movement. They may also be afraid to use a bathroom other than the one they are used to. Many children do not want to have a bowel movement at school or a new daycare. If you anticipate these problems and deal with them early, you can help resolve the constipation that results from holding in stool in these situations.
Some children have trouble learning to relax their bottom as they try to push stool out. These children may push and hold at the same time, making it difficult to pass stool. Children usually can’t hold in stool and blow at the same time. Having a child blow a pinwheel or party noisemaker while trying to stool can help them learn to relax their bottom.
How is constipation treated?
Mild constipation may be treated with diet changes and scheduled potty times. Children with soiling or more severe constipation usually require medication. However, making changes in your child’s diet at the same time may help wean them from medications more quickly.
Tips for Babies:
● If your baby is old enough to eat strained foods, you may give him or her fruits and vegetables.
● If your baby is not eating solid foods yet and is older than 2 months (consult your doctor if younger), you may give 2 ounces of fruit juices (prune, pear, white grape, or apple) per day (up to 4 ounces if older than 6 months).
● If your baby is eating rice cereal, it may help to switch to oatmeal or mixed grain cereal.
● Do not give your baby enemas, laxatives, or suppositories unless you are told to do so by the doctor. Chronic constipation is often treated with a combination of these things and should only be treated at the instruction of a physician.
Tips for Toddlers & Older Children:
● If your child is toilet trained, have him or her sit on the toilet for 5 minutes after one meal, every day. Let the child eat, then wait 20 minutes after the meal to have him/her sit. It should be the same meal every day. It is ok to have them sit after breakfast, lunch, and dinner. Or try to figure out what time of day your child usually stools and do the sit time then. Place a footstool under his or her feet. Do not let his or her feet dangle and have the child lean forward.
● Give your child praise and rewards (stickers, small toys, etc) just for sitting. This will help him or her to go on a regular schedule. Check the stool or bowel movement routinely so you will know what is normal and not normal for your child. The stool should be soft, like mashed potatoes or peanut butter, and not hard.
● Make sure your child eats fruits and vegetables and whole grain cereals every day. Adding a serving of high fiber cereal to their diet can be helpful.
● Make sure your child drinks extra water between meals. A serving of prune juice or prunes once a day may be helpful.
● Teach your child to come in from play every time he/she has the urge to go.
● Try to stay calm and not be too concerned if your child cannot have a bowel movement. Let him/her leave the bathroom and try again later in the day.
In general, if your child has been dealing with constipation or struggling for a period of time greater than two weeks we would recommend scheduling an appointment in the office to discuss further and examine your child and to come up with a treatment plan.