Definition: Constipation means that bowel movements are difficult or painful to pass and less frequent than usual. A child with constipation feels an urge to have a bowel movement (BM), has discomfort in the anal area but unable to pass a BM after straining and pushing. Going 3 or more days without a BM can be considered constipation, but can be normal in some children.

Your child is only constipated if the infrequent BMs are associated with hard stools that are difficult to pass. Some children have infrequent stools that are soft; this is normal.

Young infants less than 6 months of age usually grunt, push, draw up their legs, and turn red in the face during bowel movements. If the stool that they pass is soft then the above behaviors are normal and we should remember that it is difficult to have a BM while lying down. 

Breastfed babies also have a wide disparity in the amount of stools that they pass. Some breasted babies occasionally can go 5-7 days without having a BM. Unless your breastfed baby is having hard stools, he doesnt have constipation.

Cause: Constipation is often due to a diet that does not include enough fiber, drinking or eating too many milk products. Also, waiting too long to go to the bathroom and holding it in until the stool is so large and painful to pass can lead to constipation. Frequent painful passage of BMs can make young children hold in stool, worsening the problem.

Expected course: Changes in the diet usually relieve constipation. When your child is better, be sure to continue the non-constipating diet so that it does not happen again. If dietary changes do not relieve constipation, or children will not eat the foods needed to soften their stools then a stool softener can be used.

Anal fissure: Repeated trauma to the anal canal during constipation can cause an anal fissure (a small tear). If your child has an anal fissure you may find small amounts of bright red blood on the toilet tissue or the stool surface. This tear will heal quickly on its own once the stool is soft.

Home Care and Diet

Diet treatment for infants less than 1 year of age Give prune or pear juice (1 oz.) once or twice each day. If your child is over 4 months old, add strained foods with high fiber such as prunes, figs, dates, pears, cherries, plums, blueberries, beans, or peas twice daily.

Diet treatment for children over 1 year of age Feed your child fruits and vegetables at least 3 times per day. Good foods include prunes, figs, dates, peaches, cherries, pears, apricots, blueberries, beans, peas, cauliflower, broccoli and cabbage. Avoid uncooked vegetables to children less than 3 years of age due to the risk of choking. Increase bran in diet, which is a natural stool softener because it has high fiber content. Sources of bran include cereals, bran flakes, bran muffins, shredded wheat, graham crackers, oatmeal, brown rice or whole wheat bread and whole grain pasta.

© ABC Pediatrics of Kankakee County, S.C. 2015