Constipation

What is Normal?

Babies grunt, push, strain, draw up their legs and become red during a bowel movement. Their bodies are learning to coordinate this process. Breastfed infants after 6 weeks of age can have a bowel movement every 7-10 days. The bowel movement should be soft (even sometimes watery). The colour of newborn’s bowel movement can range from yellow to brown to orange to green.

 

The above symptoms are all normal. When to treat:

If your baby has hard, dry, small, pellet like stools

< 4 months: talk to your doctor
> 4 months: pureed prunes as needed, baby apple prune juice mixed half and half with water (maximum daily: 4 oz/day)

 

When to worry (not normal):Your baby’s tummy is very distended or your baby is having projectile vomiting and is not feeding or behaving normally. 

 

What is Normal?

Children should have soft stools with no pain or blood.

A child’s bowel routine can vary from 2 stools/day to 1 stool every 2 days.

Children should eat 5 servings of fruits or vegetables/day and drink plenty of water. Children after age 2 need a maximum of 125 ml of 2% milk 2 x a day in a cup not bottle.

Children should take their time having a bowel movement. Stool is like an iceberg in the bowel.

When to treat:

The most common symptom of constipation in children is abdominal pain after eating.

Children may also have decreased appetite.

The constipated child has gas pains as their colon squeezes on the “iceberg of stool”.

Hard large stools, blood in stool or dry pellet like stools are also signs of constipation. The blood is caused by a paper cut tear (rectal fissure) that will heal on it’s own when the stool becomes soft with proper constipation Rx.
Children that are learning to toilet train can develop constipation because they “withhold” (try to keep in) a stool that they think may hurt to come out. This stool retention (iceberg of stool) causes a vicious cycle as the next stool will be bigger and more painful.

 

What to treat:

Diet: if you are giving your child a lot of milk, STOP. Children from 1-2 years need maximum 500 ml of 3.25% milk/day.

Add bran and prunes to your child’s foods. Give your child lots water and 5 fruits and vegetables a day.

Limit fast foods and sweets

You can give your child Restoralax (check dose and duration with your doctor or pharmacist).

You can give mineral oil (2-4 tablespoons/day or lansoyl jelly as needed)

Please be reassured that these treatments do NOT make your child’s bowel lazy and they are NOT addictive or habit forming.

Do not give your child enemas or suppositories unless on the advice of a doctor.

You want your child to empty their rectum of stool (not just the tip of the iceberg). Encourage your child to sit on the toilet for 15 minutes, 15 minutes after they eat their biggest meal of the day to empty their iceberg of stool. Prepare to treat constipation for at least 2-3 months to establish a bowel routine. Your child’s stool should be very soft and passed easily with no pain or blood.

Keeping a regular bowel routine with your child is like brushing your child’s teeth.

Do not quit too early or constipation symptoms (cavities) will reoccur.

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Dr. Shudeshna Nag, MD, FRCPC Pediatrics, Fellowship Ped. Derm. (Sick Kids)

Pediatrician specializing in Pediatric Dermatology
The Pediatric Dermatology Clinic provides comprehensive consultation and care for children and teens with skin or related concerns. Referral from your doctor is required.

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