Constipation is defined as hard poop that is difficult to pass. Irregular or infrequent bowel movements are not causes for concern unless they are accompanied by belly discomfort, bedwetting, or urinary tract infections. Children may “go” every day, but if it requires straining or poop is small or unusually large (think baseball), chances are your child is constipated. Significant gas pain episodes or requent soiling also indicate constipation.
Breast fed babies may go as often as every feeding or as infrequently as once a week. As long as the poop is soft, there is no concern. Many babies and toddlers will strain or grunt, often reflecting an effort to retain poop rather than push it out. A change in diet (addition of formula or cereal) will result in a temporary change in the consistency of the BM but will resolve over time. Adding some extra water to the diet may help the transition (4-8 oz/day).
Soy formula, rice cereal, applesauce, bananas, and potatoes are all binding. Some older babies may respond to diluted apple or prune juice. Pear nectar or juice is great stool softeners. Oatmeal, strained peaches, plums, and apricots may replace more binding foods and increase the fiber in a baby’s diet.
Rectal stimulation with the little finger or the tip of a rectal thermometer may cause a reflex BM. Glycerin suppositories (Babylax or half an adult suppository) may help but prevention is better than treatment.
Constipation occurs for a variety of reasons: potty training, change in diet or environment, heat, or illness. First be certain that no other problem is causing the lack of BM (Lack of food or water intake, dehydration, abdominal pain, or obstruction). Occasional constipation can be relieved by a glycerin or ½ Dulcolax suppositories. Cheese, too much milk, or high starch diet will be binding. Limit dairy to about 16 oz per day, temporarily limit cheese, increase fruits and fiber to relieve infrequent constipation. Yogurt labeled “digestive health” with probiotic or fiber is also good. High fiber cereals, cooked vegetables, dried fruit, peaches, and apricots may add more bulk naturally. Pear juice is also a natural laxative.
Miralax, Glycolax, Benefiber, or other over the counter bulking agents are very safe and may be used for long periods, in conjunction with diet. Reliance on suppositories and laxatives should be avoided. Use these only by recommendation of your doctor. Remember that it took months to get to this point so treatment must be maintained for months afterward. Give in evening to allow these products to work overnight.
IF CONSTIPATION PERSISTS OR IS ACCOMPANIED BY OTHER CONCERNS, PLEASE CONSULT YOUR DOCTOR FOR MORE AGGRESSIVE INTERVENTION.