One definition of constipation is a prolonged interval between passage of stool. Constipation can be classified in the following ways:
- Mild Constipation —> passing of stool every 3-4 days. Children who have a bowel movement every three days often tend not to have symptoms, but they easily drift into periods of 4 – day intervals with symptoms.
- Moderate Constipation —> passing of stool every 4 days. Children who have a bowel movement every 4-5 days tend to have pain with passage and prolonged straining.
- Severe Constipation —> passing of stool every 5 days or longer. Once children are on a regular diet (age 1 year), the normal range for stools is 3 per day to 1 every 2 days. Passing a stool should be free of discomfort. Any child with pain or crying during stool passage or prolonged straining at least needs treatment with dietary changes.
Reassurance & Education:
Most forms on constipation can be treated at home with diet changes. Most constipation is from a recent change in the diet or waiting too long to use the bathroom.
- Breastfed Babies —> Between 4 and 8 weeks of age, some breastfed babies change to normal infrequent stools. They can pass 1 large soft stool every 4 to 7 days. The reason for this is complete absorption of breastmilk. The longer they go without a stool, the larger the volume that is passed. These large stools are passed easily without pain or crying. —> newborns under 4 weeks old need to be checked to be sure they are getting adequate breastmilk.
- Dietary Changes —> Changes in an infant`s diet can result in changes in their stooling pattern. This is especially common in breastfed babies who start to take more formula as moms start to wean. Formula is more constipating than breast milk. Therefore, it will usually change the frequency of stools. Stooling patterns can also change as solids are introduced at around 6 months of age or when whole milk is introduced at 1 year of age. Remember, it`s normal for all babies to grunt, turn red in the face, and strain for short periods of time to pass a stool. This doesn`t necessarily mean there`s a problem.
Treating Constipation with Dietary Changes:
- Diet for Infants under 1 Year —> For infants over 1 month old only on breast milk or formula, add fruit juices 1 ounce (30ml) per month of age per day. Pear or apple juice are OK at any age. (Reason: using it to treat a symptom) For infants over 4 months old, also add baby foods with high fiber content twice a day (peas, beans, apricots, prunes, peaches, pears, plums). If on finger foods, add cereal and small pieces of fresh fruit.
- Diet for Children over 1 Year Old —> Increase fruit juice (apple, pear, cherry, grape, prune) *Note: citrus fruit juices are not helpful. Add fruits and vegetables high in fiber content (peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes, dates) 3 times or more per day. Increase whole grain foods (bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread. Limit milk products (milk, ice cream, cheese, and yogurt) to 3 servings per day. Avoid bananas, applesauce and rice as these foods can be constipating.
- Warm Water to Relax the Anus —> Warmth helps many children relax the anal sphincter and release a stool. For prolonged straining, apply a warm wet cotton ball to the anus and move it side to side. Another option is to help your baby sit in a basin of warm water.
- Flexed Position to Help Stool Release —> Help your baby by holding the knees against the chest to simulate squatting (the natural position for pushing out a stool). It`s difficult to pass a stool while lying down. Gently pumping the lower abdomen may also help.
- Stop Toilet Training —> Temporarily put your child back in diapers or pull-ups. Reassure him/her that the poops won`t hurt when they come out. Praise your child for the release of stools. Holding back stools is harmful. Use rewards to help your child give up this bad habit. Avoid any pressure, punishment or power struggles about holding back poops, sitting on the potty or resistance to training.
- Encourage sitting on the toilet (If Toilet Trained) —> Establish a regular bowel pattern by sitting on the toilet for 5 to 10 minutes after meals, especially breakfast. This time is not meant to be a punishment. Try providing your child with a book to read while sitting on the toilet.
Usually, it takes about a week for the baby`s system to adjust to the introduction of new formula (or milk) and/or solids. Improvements in the diet usually relieve constipation. After your child is better, be sure to keep him/ her on a high fiber non-constipating diet so that it doesn`t happen again. Sitting on the toilet on a daily basis and at a regular time also prevents recurrences.
Call Your Doctor If:
Your child cries with stooling or strains over 10 minutes. Mild constipation continues more than 1 week after making dietary changes, there is blood in the stool or if your child becomes worse.
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