Constipation - Children

• Pain or crying during the passage of a bowel movement (BM) OR
• Unable to pass a BM after straining or pushing longer than 10 minutes OR
• No BM after more than 2 days. (Exception: if breastfed and older than 1 month, infrequent BMs every 6-7 days that are soft, large and pain-free can be normal. Before 1 month old, infrequent stools usually means an inadequate intake of breast milk).

The following symptoms are NOT constipation

• Normal grunting and brief straining. This is because it is difficult to pass BM lying on back with no help from gravity.
• Pushing for less than 10 minutes can occur occasionally at any age
• Large BMs - size relates to amount of food consumed
• BMs passed every 2 or 3 days
• Hard or dry BMs are also normal if passed easily. Often related to poor fiber intake.

Normal BMs

• Once children are on a regular diet (age 1 year), the normal range for BMs is 3 per day to 1 every two days.
• Those kids who go every four and five days all have pain with passage and prolonged straining.
• The kids who go every 3 days drift into longer intervals and then develop symptoms.
• Passing a BM should be free of discomfort. Any child with discomfort during BM passage or prolonged straining at least needs treatment with changes in the diet.

Diet for Infants Under 1 Year

• For infants over 1 month old only on breast milk or formula, add fruit juices 1 oz./month of age twice a day. Pear, or apple juice are okay at any age.
• For infants over 4 months old, also add baby foods with high fiber content twice a day (peas, beans, apricots, prunes, peaches, pears, plums).

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).
• Increase whole grain foods (bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread. Popcorn can be used if older than 4 years old.)
• Decrease milk products (milk, ice cream, cheese, yogurt) to 3 servings a day.

Stop Toilet Training

• Temporarily put your child back in diapers or pull-ups.
• Reassure him that the poops won't hurt when they come out.
• Praise him for the release of poops.
• Avoid any pressure, punishment or power struggles about holding back poops, sitting on the potty or resistance to training.

Sitting on the Toilet (if toilet trained)

• Establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially breakfast.

Warm Water for Rectal Pain

• Warmth helps many children relax the anal sphincter and release a BM. For prolonged straining, have your child sit in warm water or apply a warm, wet cotton ball to the anus (the opening where the BM comes out).