Constipation is the infrequent passage of hard, difficulty to pass stool – that is the standard definition. Now for what we really see:
Normal infants can have stools with every feed or 1-2 times per week, so constipation in this age group is typically diagnosed when they start having pain with pooping or they develop tears around their anus. It is very normal for infants and toddlers to turn red or purple in the face and grunt or strain with pooping. Infants rarely have constipation under 1 month of age and poop (color, consistency, and frequency) is an indicator of how much milk they are getting. After 1 month, if your baby is having pain with pooping or infrequent, hard stools, you can give 1 oz of Pedialyte, prune juice, apple juice, or pear juice for every month of age (for example a 3 month old could get 3 oz of juice per day for constipation). I recommend giving 1 oz at a time, in between normal feedings until you get results (poop, in this case). Other methods include glycerin suppositories or enemas and a warm bath. If your infant is eating solid food, then giving a high fiber fruit daily helps (prunes, pears).
Toddlerhood is a very common time to develop constipation. It usually starts when potty training begins. Toddlers like to control when and where they poop. When we interfere, they fight back with holding in the poop. These children can hold in their poop for a VERY long time. When the rectum (bottom part of the colon) is holding onto hard poop, it gets bigger and loses its urge to push the poop out. They can develop frequent liquid stools (like diarrhea) that has to make its way around the large, hard poop. These children start to eat less and less, then complain intermittently of belly pain. Typically, the pain is around the belly button or on their left lower side. If your child gets to this point, back off on potty training and go back to diapers or pull ups. Unfortunately, it is very difficult to change a toddler’s diet. But, you can try and offer high fiber fruits and juice (4-6 oz per day). Suppositories and enemas also work in this age group, but there is also a very safe medication called polyethylene glycol (brand name Miralax) that has been used in children of all ages and is available over the counter. It works by pulling water into the poop, making it softer and easier to pass. You mix 1 capful of powder into 8 oz of fluid (I like to use juice). Most children only need 1-2 capfuls daily, but you will need to talk to your doctor specifically about your child’s dose. You need to treat your child with this medication daily, so it is easy and pain-free for them to poop, then go back to the potty training. It takes 6-8 weeks for the colon to go back to its original size, so this is a long term solution, not a quick fix.
School age is the next time constipation is popular. Trust me, no one likes to poop at school! Plus, parents no longer pester kids this age about their pooping habits. Symptoms are very similar to toddlers’, with decreased appetite, nausea, and sometimes vomiting. Belly pain is common and they usually complain in the morning (right before school), after meals, and even in the middle of the night. Treatment needs to be a bit more aggressive at this age. They may need an enema (Pediatric Fleet) to treat the immediate problem, then Miralax and a pooping schedule – have your child sit on the potty 2-3 times daily (morning, after school, and after dinner) for 10 minutes. Try to add high fiber food and juice to their diet, with lots of raw fruits and vegetables. But, even with changes in diet and treatment, it may take even longer to get your school age child regular and pain free, sometimes up to 6 months.
From the minute a baby is born, poop becomes a major concern in every parents’ life. Most people think that once a child is potty trained, the poop talk is over…but trust me, it never goes away!
Heather Joyce, MD