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Constipation, Age 11 and Younger

Constipation, Age 11 and Younger

Topic Overview

Constipation occurs when stools become hard and are difficult to pass. Some parents are overly concerned about how often their child has bowel movements, because they have been taught that a healthy child has a bowel movement every day. This is not true. The frequency of bowel movements is not as important as whether the child can pass stools easily. Your child is not constipated if his or her stools are soft and pass easily, even if it has been a few days since the last bowel movement.

Newborns younger than 2 weeks should have at least 1 or 2 bowel movements a day. Babies older than 2 weeks can go 2 days and sometimes longer between bowel movements. It's usually okay if it takes longer than 2 days, especially if your baby is feeding well and seems comfortable. Breast-fed babies are more likely to have frequent stools and may have a stool as often as every feeding. Constipation is likely to occur when a baby changes from breast milk to formula, especially if this change happens during the first 2 to 3 weeks of life.

As babies grow older, the number of bowel movements they have each day gets less and the size of their stools gets bigger. A child age 3 or 4 years may normally have as many as 3 bowel movements a day or as few as 3 a week.

It is important for parents to recognize there are many "normal" patterns for bowel movements in children. Some children may appear to have trouble passing a stool. The child's face may turn red, and he or she may strain to pass stool. If the stool is soft and the child does not seem to have other problems, this is not a concern.

Most children will occasionally become constipated. The problem is usually short-lived and does not cause long-term problems. Home treatment is usually all that is needed to relieve occasional constipation. Causes of constipation include:

  • Changes in diet, such as when a child starts eating more adult foods. Constipation may also occur if your child drinks too much cow's milk. This happens most often in children younger than age 2.
  • Not drinking enough fluids. Sometimes the normal amount of fluid a child drinks is not enough, such as when the weather gets hot or the child increases his or her physical activities.
  • Not taking the time to have a bowel movement. A child may be so interested in play that he or she ignores the need to have a bowel movement.
  • Reluctance to use the bathroom. A child might become constipated when he or she is in a new environment, such as when traveling.
  • Changes in daily routine, such as when traveling or after starting school.
  • Medicines. Many medicines can cause constipation.

Constipation may occur with cramping and pain if the child is straining to pass hard, dry stools. He or she may have some bloating and nausea. There may also be small amounts of bright red blood on the stool caused by slight tearing ( anal fissure ) as the stool is pushed through the anus . All of these symptoms should stop when the constipation is relieved.

Chronic constipation

For reasons that can't always be identified, some children often develop constipation that does not get better or go away with treatment (chronic constipation). The most significant factor may be the painful passing of a hard, dry stool. After a while, the child may be unable to resist the urge to have a bowel movement and will pass a large mass of stool. The child may have to "push hard" during the bowel movement, which may be painful. Passing the stool relieves the pressure and pain until another mass of stool collects, and the cycle is repeated. Fear of pain may cause the child to try to hold the bowel movement.

Other causes of chronic constipation may include:

  • A crack (fissure) around the anus, which can make bowel movements painful and cause the child to resist passing stools. Fissures are a common problem that gets worse every time the child passes a large stool.
  • A brief illness with poor food intake, fever, and little or no physical activity, which may upset normal bowel habits.
  • Emotional problems or toilet training problems, which can lead to voluntarily withholding stools. A child may have fought the toilet training process, been pushed too fast, or been punished for having accidents. Struggling with parents for control may cause a child to hold stools back as long as possible.
  • Change in environment. At school, children may withhold stools because they are afraid or embarrassed to use school bathrooms, their schedules are too busy for them to take time for a bowel movement, or school activities interrupt their normal bowel movement time.

The child may be unable or unwilling to pass the stool regardless of its size. Liquid or loose stool may leak out, soiling the child's underwear. When this occurs in a child who is past the age of normal toilet training, it is called encopresis .

Chronic constipation usually requires several months of treatment and cooperation between the parents, the child, and the doctor to overcome the problem. Don't be discouraged if the problem comes back during these months. The rectum is made of muscle tissue; when a child has had chronic constipation, the muscle becomes stretched. It may take several months to get the muscle back into shape.

In rare cases, constipation in children may be caused by other health problems, such as:

Check your child's symptoms to decide if and when your child should see a doctor.

Check Your Symptoms

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Home Treatment

Constipation can usually be treated effectively at home.

  • Make sure your child is drinking adequate amounts of fluids.
  • If you are switching from breast milk to formula, give your baby no more than 1 fl oz (30 mL) to 2 fl oz (60 mL) of water and no more than 2 times each day for the first 2 to 3 weeks. Be sure to give your baby the suggested amount of formula for feedings plus the extra water between feedings. Do not give extra water for longer than 3 weeks unless your doctor tells you to.
  • If your child is older than 6 months, add fruit juices, such as apple, pear, or prune juice, to relieve the constipation.
    • After age 6 months, give 0.5 Tbsp (7 mL) to 2 Tbsp (30 mL) of prune juice. Increase the amount slowly over time.
    • At age 9 months, add 1.5 Tbsp (22 mL) to 3 Tbsp (45 mL) of strained prunes per day.
  • If fruit juices do not help, add baby foods with a high fiber content twice a day. High-fiber baby foods include cooked dried beans or peas (legumes), apricots, prunes, peaches, pears, plums, and spinach.
  • For children age 12 months and older, add high-fiber foods. A diet with enough fiber (20 to 35 grams each day) helps the body form soft, bulky stool.
    • Give your child at least 1 cup of fruit a day. Choose whole fruit instead of fruit juice.
    • Give your child at least 1 cup of vegetables a day.
    • Increase the amount of high-fiber foods, such as bran flakes, bran muffins, oatmeal, brown rice, beans, and unbuttered, unsalted popcorn. Offer your child whole wheat bread instead of white bread.
    • Limit foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, if your child gets constipated easily.
  • Gently massage your child's belly. This may help relieve discomfort. You can also have your child lie on his or her back, legs flexed onto his or her belly, and rotate his or her legs in a clockwise direction.
  • If your child is having rectal pain because he or she is unable to have a bowel movement, try the following:
    • A warm bath in the tub. This may help relax the muscles that normally keep stool inside the rectum (anal sphincter) and help pass the stool.
    • If your child is age 6 months or older and the warm bath does not work, use 1 or 2 glycerin suppositories to lubricate the stool, making it easier to pass. Use glycerin suppositories only once or twice. If constipation is not relieved or develops again, discuss the problem with your doctor.
  • Do not give laxatives or enemas to children without first talking to your doctor. Children should not need an enema or laxatives to have a bowel movement.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • Constipation or changes in the stool persist after 48 hours of home treatment in a baby younger than 3 months.
  • Constipation persists after 1 week of home treatment in a child age 3 months to 11 years.
  • Rectal pain develops or increases.
  • Blood in the stool develops or increases.
  • Your child's symptoms become more severe or frequent.

Prevention

Diet

A nonconstipating diet is the best way to prevent constipation. If constipation develops, a nonconstipating diet will help restore normal bowel movements.

For babies younger than 12 months:

  • Breast-feed your baby. Constipation is rare in breast-fed babies.
  • Make sure you are adding the correct amount of water to your baby's formula.

For children age 12 months and older:

  • Make sure your child is drinking enough fluids. When the weather gets hot or when your child is getting more exercise, make sure he or she is drinking more fluid.
  • Add high-fiber foods. A diet with enough fiber (20 to 35 grams each day) helps the body form soft, bulky stool.
    • Give your child at least 1 cup of fruit a day. Choose whole fruit instead of fruit juice.
    • Give your child at least 1 cup of vegetables a day.
  • Increase the amount of high-fiber foods, such as bran flakes, bran muffins, oatmeal, brown rice, beans, and unbuttered, unsalted popcorn. Offer your child whole wheat bread instead of white bread.
  • Limit foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, if your child gets constipated easily.
  • Set a good example for your child by drinking plenty of fluids and eating a high-fiber diet.

Toilet training

Constipation sometimes becomes a problem when children start toilet training:

  • Encourage your child to go when he or she feels the urge. The bowels send signals when a stool needs to pass. If your child ignores the signal, the urge will go away, and the stool will eventually become dry and difficult to pass.
  • Set aside relaxing times for having bowel movements. Urges usually occur sometime after meals. Establishing a daily routine for bowel movements, such as after breakfast, may help.
  • Make sure your child has good foot support while he or she is on the toilet. This will help flex your child's hips and place the pelvis in a more normal "squatting" position for having a bowel movement.
  • Make sure your child gets plenty of exercise throughout the day. Set a good example for your child by following healthy routines of eating, exercising, and going to the toilet.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:

  • When did the constipation begin?
  • How often does your child normally have a bowel movement?
  • Are the stools hard or soft?
  • Does your child have a history of constipation?
  • Has prevention or home treatment helped relieve the constipation?
  • If your child has been toilet trained, has he or she had any leakage of soft or liquid stool that has stained his or her underwear?
  • Has your child had a recent change in diet, daily routine, or environment?
  • Has your child recently started taking a new prescription or nonprescription medicine?
  • Are you giving your child any new herbal remedies or vitamins?
  • Has your child been under any added stress recently?
  • Does your child have any health risks?

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer David Messenger, MD
Last Revised August 2, 2012

Last Revised: August 2, 2012

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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