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| Main > School Age > Common Problems
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Constipation
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| Constipation is a very common and frustrating problem in children. It is usually defined as the passage of hard and painful stools or going four or more days without a bowel movement. It is most commonly caused by a diet that is low in fiber, but can also be caused by drinking too much milk (more than 12-16oz/d), not drinking enough water or waiting too long to go to the bathroom.
Once a child becomes constipated and has hard and painful stools, he will then begin to hold in his bowel movements to prevent it from hurting again. This creates a cycle that makes the constipation continue and become worse.
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Treating Constipation
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| Constipation is best treated by making changes in your child's diet. Until the constipation has improved with a non-constipating diet, your child will most likely also be on stool softeners. The goal of treatment is for your child to have one to two soft stools each day. |
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Diet Treatment for Infants
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| Increase fluids: Give 2-4 oz of water or diluted fruit juices (such as grape or prune) 1-2 times each day, or try switching to a soy formula.
Increase fiber: If your infant is over four months old, you may also try feeding foods with a lot of fiber, such as cereals, strained prunes, apricots, or spinach.
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Diet Treatment for Children
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| Increase fluids: Increase the amount of water and fruit juices (minimum of 2-3 glasses) that your child drinks each day.
Increase fiber: Increase the amounts of fruits and vegetables that your child eats. Raw, unpeeled fruits and vegetables (especially beans, sweet potatoes, peas, turnip greens, raw tomatoes and corn) have the most fiber. Popcorn also has lots of fiber in it. Give enough grams of fiber to equal their age in years plus 5 each day (check the nutritional label for high fiber foods and snacks with at least 3-4g of fiber per serving). Vegetable soups are especially high in fiber and also add more fluid to your child's diet.
Increase bran in your child's diet by offering bran cereals, bran muffins, shredded wheat, graham crackers, or whole wheat bread.
Decrease constipating foods: These include milk, yogurt, cheese, cooked carrots, and bananas which can make your child more constipated. Drinking too much milk (your child may only be drinking 2-3 cups a day, but it may be too much for his system to handle) is heavily associated with being constipated. Switching to soy milk has been shown to soften stools. If your child is unable to drink milk, then offer a daily multivitamin or other sources of calcium. |
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Stool Softeners
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| Most of these medications are available in the pharmacy over the counter and do not require a prescription. They include Metamucil, Milk of magnesia, Citrucel, mineral oil or Senokot. Unlike laxatives in adults, they are generally not considered to be habit forming. You should use them once or twice a day and work up on the dose until your child is having a soft BM each day. If you child starts to have diarrhea, then you are giving too much and you should cut back on the dose. |
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Changing doses
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| Once your child is having 1-2 soft stools each day you should continue with the doses of the medicines that you are using for 6-12 months until he is accustomed to his new non-constipating diet. You can then gradually stop the stool softeners by slowly lowering the amount you are giving every 1-2 weeks.
If stools are too loose then cut back on the dose by one-third. If stools are still too hard then increase the dose by one-third. Avoid making changes in the medicines based on one bowel movement, or you will wind up ‘seesawing' with the doses.
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Treating Acute Constipation
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| If your child has been constipated for a long time or he is having discomfort or significant pain with bowel movements then you may need to ‘clean out' backed up stool before the stool softeners will work by using an enema, a glycerine suppository or high doses of mineral oil. See your pediatrician for information on how to start begin this treatment. |
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Behavior Modification
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You should encourage your child to have regular bowel patterns. Have your child sit on the toilet for about ten minutes after meals 1-2 times each day.
The use of simple rewards or a daily calendar with stars or stickers for days that your child takes his medicine and has a bowel movement may be helpful.
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Important Reminders
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- Be patient. This is a chronic problem that can take time to improve. Avoid embarrassing or punishing your child.
- Avoid the frequent use of enemas or suppositories.
- Call your pediatrician if your child is not improving in 2-3 weeks, is regularly needing to use enemas or suppositories, or is soiling his pants because of leakage of stool.
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