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The Informed Parent

Constipation: A Parent’s Guide

by Lori A. Livingston, M.D., F.A.A.P.
Published on Oct. 29, 2012

At every well child exam, from birth to adolescence, I ask parents and children about bowel movements. “How are your poops? Are they hard poops or soft? Are they giant poops or painful?” These questions always elicit a giggle or embarrassed glance at the parent, but very frequently I find out that kids are constipated, and their parents had no idea it was a problem.

Constipation, by definition, is hard stool AND decreased frequency of stools OR very large stools accompanied by straining or pain with bowel movements. Some bleeding can often occur due to small tears in the perianal tissue or due to hemorrhoids from chronic straining to poop.

What is normal poop, you may wonder? Most newborns pass their first poop, called meconium, within 24 to 48 hours of birth. This black tarry stool usually changes to yellow, orange or brown loose stools within the first week of life. Most breastfed infants poop frequently, often after every feeding. Typically after 6-8 weeks, breastfed infants will poop less often, sometimes not even every day. Usually this in NOT constipation. As long as poops have been soft and your baby is eating well, it is unlikely your newborn is constipated. Formula fed babies usually poop less often, but at least once per day. Hard stools or infrequent stools before 6 months could be due to some formulas, but can also be a very serious disease called Hirshprungs. You should call your doctor right away if you suspect your young infant is truly constipated. 

Common constipation typically starts in infancy with the introduction of solid foods at six months old. However, most children don’t have problems until they become toddlers. This is usually due to a diet that is high in dairy and carbohydrates and not enough fiber or vegetables. As you can imagine, the first line of treatment is changing the types of foods your child eats.

The consequences of untreated constipation in infants, toddlers, and children include abdominal pain, decreased appetite, nausea, vomiting, frequent urination, urinary tract infections and encopresis (stool leakage/incontinence). Constipation is a potentially serious medical problem if not treated. Sometimes kids are hospitalized for severe constipation, stool impaction, abdominal pain and vomiting. This can all be avoided if parents pay attention to their child’s stooling habits and ensure a diet high in fiber, fruit and vegetables.

Treatment of constipation is usually straightforward, but requires constant monitoring since hard poops often return if treatment stops. The most common challenge is actually getting your young child to eat a proper diet to soften poops. Toddlers are notoriously picky about food, and often they like something one day but refuse to eat it the next. If these dietary strategies do not work, there are other options such as stool softener medication. It is best to talk to your pediatrician if you are having difficulty treating your child’s constipation.

Tips for softer stools:

  • Drink plenty of WATER throughout the day.
  • Limit milk to 24 ounces max per day.
  • Do NOT give your child bananas; they are notorious for causing constipation.
  • Limit cheese, apples and carrots since these can cause harder stools as well.
  • GIVE your child  more PITTED fruits and “P” foods such as peaches, plums, pears, peas apricots, mangos cherries, prunes etc. since these soften poops.
  • Fiber helps soften stools--beans (black, pinto, garbanzo, lentils, etc) whole grains, and bran are examples.
  • Typically pediatricians do not recommend juices since they are high in sugar, but with constipated children, JUICE can help. Pitted fruit juices such as plum, peach, mango, and pear are the best. 1-2 small cups per day should help.
  • Also, there are many supplements offered over the counter. Many parents ask about fiber supplements, probiotics, flaxseed oil, and others to help with digestive problems. It is best to discuss these options with your doctor since none of them have been well studied for constipation in children and proper dosing should be discussed.
  • Last, stool softeners such as polyethylene glycol (Miralax), lactulose, glycerin and enemas can be very helpful in children with restricted diets. These should be discussed with your pediatrician.

Most importantly, monitor your child’s stools. If they are older and independent, ask about daily poops. They may be embarrassed, but constipation is common and can be easily fixed if addressed early and healthy eating habits started from those first solid foods at six months old. 

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