Coping With Constipation

Constipation happens to all of us at some time or another. And it can be a frustrating and painful experience for kids and their caretakers.

Unpleasant as it can be, there are ways to get through an episode of constipation, says Prasanna Kapavarapu, MD, an attending physician with the Division of Gastroenterology, Hepatology and Nutrition at Children’s Hospital of Philadelphia.

Citing evidence-based data, Dr. Kapavarapu answers some common questions about constipation, as well as tips for treating it.

What are the symptoms of constipation?

Going a day or two without a bowel movement is usually normal and not cause for alarm, but your child may be constipated if:

• They have two or fewer bowel movements per week (for children of developmental age of at least 4 years)
• Their bowel movements are hard, dry or painful, or do not pass easily.
• They feel the need to have a bowel movement but are unable to.
• They experience at least one episode of incontinence per week after toilet-training.
• They have a history of passing stools large in diameter, to the point that stools clog the toilet.

What causes constipation?

While constipation is rarely caused by a major medical issue, kids become constipated for all sorts of reasons. Your child may become constipated if they:

• Haven’t been eating enough high-fiber foods, such as fruits and vegetables
• Have been drinking or eating too many dairy products
• Have been repeatedly waiting too long to go to the bathroom
• Haven't been drinking enough non-dairy fluids

Constipation can also have an emotional cause. For example, stressful transitions or changes in routines — such as traveling, starting a new school or issues at home or with friends — can bring on constipation.

How can you treat constipation?

You can usually treat constipation at home with high-fiber foods and lots of fluids. Do not use any suppositories, laxatives or enemas without first consulting your child’s doctor or nurse practitioner.

But when deciding on a home treatment for constipation, the child’s age should always be considered.

For children younger than 4 months old, Dr. Kapavarapu suggests this mixture:

• 1 ounce of prune juice, apple or pear in 1 ounce of water, one or two times a day

For children 4 months to 1 year:

• High-fiber baby foods, such as cereals (mulitgran, barely, oatmeal), fruits (especially prunes), vegetables, spinach and peas.
• Fruits like prune, pear or apple and if needed the juice forms of these fruits are helpful.

For children 1 year or older:

• Feed them raw, unpeeled vegetables and fruits (peaches, apples and pears) at least three times a day.
• Increase the bran in their diet with graham crackers, bran cereal, oatmeal and whole-wheat bread.
• Decrease the amount of dairy products you give them.
• Increase their water and juice intake.
• Have your child sit on the child on the toilet for 10 minutes after meals, especially after breakfast or dinner, to encourage a regular bowel pattern.

When should you call the doctor about constipation?

While home treatments work most of the time, Dr. Kapavarapu says if the situation lingers, contact your child’s physician or nurse practitioner to consider alternatives.

At the same time, be aware of issues that require immediate medical attention. Those emergency situations include when a child:

• Experiences severe pain with bowel movements
• Passes blood in their stool
• Develops tears in the rectal area
• Has not had a bowel movement in five days