How to Treat Constipation in Infants and Children

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Constipation is a common problem for infants and children and is the reason for almost 3% of visits to a pediatrician. Constipation is usually defined as having infrequent bowel movements that are hard and painful. This is often the case with older children and adults, but the definition is slightly different in infants.

Infants who strain or groan when they have a bowel movement are likely not constipated if their stool is soft, even if they only have a bowel movement every 2 or 3 days. Many infants who are exclusively breastfed only have a bowel movement once every week or two.

Causes of Infant Constipation

It is often frustrating for parents to try to understand the causes of their child's constipation. Although some parents understand the role that too much cow's milk, a diet low in fiber, and not drinking enough fluids have in contributing to constipation, they may have other children with the same diet who aren't constipated.

In addition to your child's eating habits, the other main factor that contributes to constipation is infrequent bowel movements. This can occur after a child has had a large, hard, and painful bowel movement. Because they may associate going to the bathroom with pain after this experience, they will try to hold their stools.

This creates a vicious cycle. Bowel movements are painful, so the child holds them in, causing stools to be even larger and harder, which causes more pain when they finally pass. Another common cause of constipation and infrequent stools is having a bad experience with potty training.

Although rare, there are some medical causes of constipation, such as Hirschsprung's disease, cystic fibrosis, and hypothyroidism. Constipation is also often found in children with special needs, such as spina bifida, Down syndrome, and cerebral palsy, and it can be a side effect of many medications.

Warning Signs of a More Serious Condition

When these symptoms occur along with constipation, it can indicate a more serious condition:

  • Abdominal distention
  • Fever
  • Poor appetite
  • Poor weight gain
  • Vomiting
  • Weight loss

Constipation Treatments for Babies

Younger infants and newborns with constipation should be carefully evaluated by their pediatrician. Poor feeding can lead to dehydration and constipation, so an evaluation of your infant's feeding habits and weight is important. Infants who are exclusively breastfed rarely become constipated.

Remember, infrequent bowel movements do not mean constipation if your child's stools are soft when they finally pass. It's possible that your little one is using every bit of what they ingest to support growth, and they simply don't have anything left over to produce waste.

The American Academy of Pediatrics (AAP) suggests giving babies (who are over 1 month old) a small amount of apple or pear juice to loosen the stool and relieve constipation. They advise parents to offer 1 ounce for every month of life up to 4 months of age. Some pediatricians also suggest giving 1 to 2 teaspoons of corn syrup per day.

Always talk to your child's pediatrician before taking any action to treat constipation, especially in young babies. Once your baby has progressed to solids, giving them more vegetables and fruits (such as prunes) may help with constipation.

Constipation in Toddlers and Children

Frequency of bowel movements for children will vary based on the individual. Some kids have a bowel movement twice per day, while others go once every 2 or 3 days. Constipation is characterized by hard or dry stools that are difficult to pass. If your child is struggling to use the bathroom, the first thing to look at is their eating habits.

Incorporating more high-fiber foods and encouraging plenty of liquids (especially water) will help your child produce regular bowel movements. Some beneficial foods to add to your child's menu include:

  • Beans
  • Berries
  • Fruit with the skin (like pears)
  • Lentils
  • Oatmeal
  • Vegetables
  • Whole wheat breads and cereals

Children should get about 14 grams of fiber for every 1,000 calories they eat. If your child is not used to eating high-fiber foods, increase their intake gradually to minimize discomfort from gas or bloating.

Other choices that are good for kids with constipation include vegetable soups (because they contain lots of fiber and added fluid) and popcorn. Extra bran can also be helpful, including bran cereals, bran muffins, shredded wheat, graham crackers, and whole-wheat bread.

Constipation Remedies

Most cases of infant and childhood constipation can be improved with dietary changes. In certain cases, your pediatrician may advise the use of a stool softener or other treatment.

Avoid chronic use of stimulant laxatives, such as bisacodyl, ExLax or castor oil. An osmotic-type laxative, which works by drawing extra fluid into the colon to soften the stool, is usually safer for long-term use.

Commonly used constipation remedies for young children include:

  • Bisacodyl: Bisacodyl is a commonly used stimulant laxative available as Correctol and Dulcolax.
  • Docusate: Available as Colace and Surfak, docusate is a
    lubricating laxative. It is also available with a stimulant laxative in
    the combination medicine Peri-Colace.
  • Malt soup extract (Maltsupex): Maltsupex has an unpleasant odor, but is easily mixed with formula for younger infants.
  • Milk of magnesia: Milk of magnesia contains magnesium hydroxide, an osmotic laxative with a chalky taste that is not tolerated by all children. It may be helpful to mix with 1 to 2 teaspoons of Tang or Nestle Quik, or mix into a milkshake.
  • Mineral oil: Mineral oil is a colon lubricant that you can mix with orange juice. Mineral oil may cause leakage of stool and staining of underwear.
  • Polyethylene glycol (Miralax): Miralax is a tasteless and odorless powder that can be mixed with water. It is available without a prescription.
  • Senokot: Senokot is a stimulant laxative, available either as Senokot or Senokot S (which combines the laxative with a stool softener).

Other medications that are available by prescription include lactulose, an osmotic laxative. In addition to a stool softener, it may also help to increase fiber by mixing Metamucil, Citrucel or another bulk-forming laxative with 8 ounces of water or juice, or give fiber supplements. Many fiber supplements are now available as chewable tablets or gummy supplements for kids.

With any of these treatments, talk to your pediatrician first. Laxatives can be very dangerous for children and should not be used without a doctor's advice.

It's also important to discuss the duration of your child's treatment so you can provide it for the right amount of time that it's needed, rather than stopping too early and risking the same issue again. Medication may need to be cut down gradually.

Disimpaction Treatments

If there is a large, hard mass of stool that has backed up in your child's rectum, your child may need a "clean out" or disimpaction before dietary and maintenance therapy will work. This is usually done using an enema or suppository under a pediatrician's supervision. A disimpaction can also be done with high dosages of mineral oil or polyethylene glycol.

Avoid the regular use of an enema or suppository. They are sometimes necessary as a rescue therapy if your child hasn't had a bowel movement in three to four days, but if you need to use them regularly, talk to your child's doctor about increasing the dosage of stool softeners.

Behavior Modification

Once your child's stools have become soft and regular, it is important to encourage them to have regular bowel movements. This often includes having them sit on the toilet for about five minutes after meals once or twice a day.

Keep a diary or sticker chart of when your child tries to have a bowel movement and/or takes medicine, then offer a reward for regular compliance. Don't try to force them to sit until they have a bowel movement.

In addition to pain, constipation can lead to more serious conditions if left untreated. Addressing the issue early with natural and less invasive methods is preferred.

Although constipation is a chronic condition that is often difficult to treat, having painful bowel movements is not something that your child has to learn to live with. In time, with proper dietary and medical interventions, your child should be able to have regular soft bowel movements.

If your pediatrician is unable to help treat your child's constipation, then you may want to seek additional help from a pediatric gastroenterologist. A referral to a specialist is also a good idea if your child has any warning signs of a more serious condition or if isn't improving with your current therapies.

A Word From Verywell

Constipation in infants and children is very common and is often related to eating habits or the withholding of stool when constipation causes discomfort. Treatment may require a combination of strategies and can take many months. That said, there are many options available to tackle this common problem.

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