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Constipation

Constipation

  • Pain or crying during the passage of a bowl movement (BM) OR
  • Unable to pass a BM after straining or pushing longer than 10 minutes OR
  • Three or more days without a BM (Exception: breastfed and older than 1 month)

Imitators of Constipation

  • Grunting, straining, and becoming red in the face while pushing out a BM is normal in young infants
  • Large BMs: Size relates to amount of food consumed and BM frequency. Large eaters have larger stools.
  • Hard or dry BMs are also normal if passed easily without straining. This is often related to poor fiber intake.

Frequency of BMs

  • If Breastfed and Older Than 1 Month: Infrequent BMs every 4-7 days that are soft, large, and pain free can be normal. Younger than 1 month, infrequent stools usually means an inadequate intake of breast milk.
  • Once children are on a regular diet (age 1 year), the normal range for BMs is 3 per day to 1 every 2 days.
  • The “every 4- and 5-day” kids all have pain with passage and prolonged straining.
  • The “every 3-day” kids drift into periods of 4-day intervals with symptoms.
  • Any child with discomfort during a BM at least needs treatment with dietary changes

Causes

  • High milk or cheese diet
  • Low fiber diet
  • Postponing bowel movements
  • Slow gastrointestinal transit time (genetic differences)

Glycerin Suppositories (Over the Counter [OTC])

  • Suppositories are wax-coated, 1 inch (2.5 cm) long, bullet-shaped medicines that are inserted round-tip first into the rectum and melt at internal body temperature. The glycerin in the suppository acts as an anus lubricant and mild osmotic stimulant. It is very gentle and has no proven side effects. Sometimes the insertion itself stimulates the release of the stool. The glycerin usually will produce a stool within 15-30 minutes. Babylax is a small squeeze bulb that contains 4 mL of glycerin solution and can be squeezed into the rectum (much like a small enema). Suppositories work for milk stool blockage. A severe blockage requires an enema.

Enemas (OTC)

  • Enemas are needed to relieve moderate to severe stool blockage. The only enemas that are completely safe in children are mineral oil and normal saline enemas.
  • Mineral oil enemas (OTC) can be purchased at a pharmacy.
  • Normal saline enemas must be made at home. Add 1 teaspoon of table salt to 16 oz (500 mL) of water.
  • Fleet’s phosphate enema’s (called saline enemas on the package) are also OTC, but ideally should only be recommended by physicians, nurse practitioners, or physician assistants. The dosage of phosphate enemas must be accurate (1 oz per 20 pounds or 10kg). If retained or given in overdosage, phosphate enemas carry the risk of hypocalcemia, tetany, and even cardiac arrhythmias.

Home Care Advice for Constipation

  1. Diet for Infants Younger Than 1 Year
  • For infants older than 1 month only on breast milk or formula, add fruit juices 1 oz/month of age per day. Pear or apple juices are OK at any age.
  • For infants older than 4 months, also add baby foods with high fiber content twice a day (peas, beans, apricots, prunes, peaches, pears, plums).
  • Increase fruit juice (apple, pear, cherry, grape, and 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).
  • Decrease milk products (milk, ice cream, cheese, and yogurt) to 3 servings per day.
  • Age 2-5: 1 teaspoon (5mL) per day in 2 oz (60mL) fluid.
  • Age 6-12: 2 teaspoons (10 mL) per day in 6 oz (120 mL) fluid.
  • Age 13 or older: 3 teaspoons (15 mL) per day in 6 oz (180 mL) fluid.
  • Reassure him that the poops won’t hurt when they come out.
  • Praise him for the release of BMs.
  • Avoid any pressure, punishment, or power struggles about holding back poops, sitting on the potty, or resistance to training.
  • Help your baby by holding the knees against the chest to stimulate squatting (the natural position for pushing out a BM).
  • Gently pumping the lower abdomen may also help.
  • Constipation continues after making dietary changes.
  • Your child becomes worse.
  • Constipation is a chronic problem (present >4 weeks)
  • If a warm water bath doesn’t work, use glycerin suppositories (OTC) to smooth the way. A suppository is inserted past the anal sphincter while the child is lying on his stomach. Dosage is based on age:
    • 6 months-1 year: ½ Babylax or ½ pediatric suppository cut lengthwise
    • 1-6 years: 1 Babylax or 1 pediatric suppository or ½ adult suppository
    • 6-12 years: 1 adult suppository
    • Older than 12 years: 2 adult suppositories
  • If unavailable, recommend gentle stimulation for 10 seconds using a lubricated thermometer (if younger than 3 years old).
  • If nothing is effective for RECTAL pain in a child older than 1 year, can give a mineral oil enema (Caution: do not give for abdominal pain).
  1. Diet for Children Older Than 1 Year
  1. Stool Softeners: For chronic or recurrent constipation, recommend Miralax (OTC) until seen.
  1. Stop Toilet Training: Temporarily put your child back in diapers or pull-ups.
  1. Sitting on the Toilet (if toilet trained): Establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially breakfast.
  2. 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.
  3. Flexed Position
  1. Call your pediatrician if
  1. Extra Advice for Acute Rectal Pain Due to Constipation
  • Dosage of mineral oil enema: 2-6 years: 2 oz (1/2 enema), older than 6 years: 4.5 oz (OTC)

 

Information on this site is intended for Angel Kids Pediatrics patients only. Always consult your doctor before beginning, modifying, or discontinuing any treatment plan.

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