The term constipation refers to a change in daily bowel habits, particularly a decrease in the number or consistency of bowel movements, or pain or difficulty passing stools. By the end of their first year, most children have one comfortable bowel movement every day. If a usually regular child goes two or more days without a bowel movement, and then has pain or difficulty passing a large, hard stool, he is constipated.
Breastfed babies have fewer bowel movements than bottlefed babies. Because just about every drop of breast milk is very efficiently used, a breastfed infant has less waste to excrete. It's not unusual for a breastfed baby of two, three, or four months of age to have no bowel movements for several days in a row. If the child has a good appetite and is not uncomfortable, there's no need to worry. However, if your baby doesn't want to nurse, is vomiting, or has discomfort, consult your physician immediately.
Constipation is commonly caused by insufficient fluids and too little fiber in the diet. Without enough fluids and bulk, stool becomes hard and develops rough edges. These rough edges can cause a rectal fissure, a painful microscopic tear in the rectum. Too much emphasis on toilet training, emotional stress (such as a move to a new location), the introduction of new foods, or too much fat in the diet may also contribute to constipation, as can a lack of proper exercise.
Children can also become constipated as a result of holding back stool. An active child may not want to take the time to interrupt his play to have a bowel movement. When that happens, the retained stool becomes dehydrated and hard and is painful to pass. A painful passing in turn makes the child want to hold back as long as possible the next time, to avoid the pain.
Even babies learn to hold back stool to avoid pain. A diaper rash that burns and hurts when a bowel movement occurs can make an infant reluctant to go.
The most important factor in determining whether your child is constipated is his level of comfort when passing a stool. Even if your child has a bowel movement every day, a hard-to-pass stool may indicate constipation. Another indication is a stomachache. A constipated child's stomach may be firm and tender to the touch.
Increasing the amount of fiber and fluid in your child's diet is the best place to start when treating constipation.
A stool softener, such as docusate sodium, may be prescribed to soften the stool and help it pass through the intestines more easily.
A bulk-forming laxative such as Maltsupex or psyllium seed increases the amount of bulk in the intestines, softens the stool to make it easier to pass, and initiates peristalsis (the contraction of the intestines that pushes waste along). Either of these products should be taken with plenty of water.
Magnesium hydroxide (found in milk of magnesia), magnesium citrate (Evac-Q-Kwik), and phosphosoda (Phospho-soda, Sal-Hepatica) are bulk-forming laxatives that work by drawing fluids from the body into the intestine, increasing the contents of the intestines and thereby initiating a bowel movement. Magnesium hydroxide and magnesium citrate should not be given to a child under two years of age. Phosphosoda should not be given to children under six. No laxative should be used on a regular basis. Do not give your child any medication without discussing it with your doctor.
When to Call the Doctor About Constipation
A constipated infant who is vomiting or uncomfortable, and/or who doesn't want to nurse should be examined by a doctor.
If your child experiences severe pain when passing a stool, if there is blood in the stools, or if you notice a cut or tear near your child's rectum, consult your physician.
If your child develops chronic or persistent constipation, he should be examined by a doctor. In some cases, constipation may be a sign of an internal problem, such as an intestinal obstruction. Certain serious health problems, including lead poisoning and hypothyroidism, can also cause chronic constipation. Even if unrelated to an underlying problem, chronic constipation should be taken seriously because it can lead to a loss of muscle tone in the bowel, setting the stage for a lifelong problem.