Baby Constipation

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CONSTIPATION

Constipation is a very common problem that occurs throughout childhood and is often accepted as “the norm” that will go away as children get older. It is important to catch constipation early on, even in infancy, to combat further health problems down the road. Baby constipation and childhood constipation will be discussed in this article.

ANTICIPATORY GUIDANCE

At well visits for your child, you should discuss any issues your child may be experiencing with dietary and bowel habits. This goes for children of all ages. Constipation is common and likely to occur in certain time periods of your child’s life. If education is given and treatment is had, future episodes can be prevented and resolved. The main reason constipation should be addressed is because if the issue is not solved, painful bowel movements will occur, which leads your child to not want to go to the bathroom. The times when constipation is often to occur includes: the introduction of solids or cow’s milk, toilet training, beginning school.

The TRANSITION TO A SOLID DIET

The transition to a solid diet is a very common trigger of constipation. This occurs because the diet often includes inadequate amounts of fiber and fluid. Mild constipation that only occurs occasionally may be easily treated by adding more fluids and fiber into the diet of your little one. If your child has chronic constipation, this will not be adequate treatment.

When your child is less than 2 years old, approximately 5 grams of fiber should be consumed per day. An easy way to add this into your child’s diet is by making sure that they eat several servings per day of pureed vegetables, fruits, and a fiber filled infant cereal. Most fruits and vegetables have 1 gram of fiber per serving. Prunes are an exception, as they contain 2 grams of fiber! Rice cereal contains very little fiber. It is best to give your baby a cereal that has whole wheat, barley, or multigrain listed on the label, as these have 1-2 grams of fiber per serving. Make sure your baby is drinking enough fluid. As long as they are peeing clear to very light yellow, you are okay. There is no need to add excess fluid to their diet as long as they are not dehydrated.

If your child appears to develop constipation when transitioning from breast milk or formula to cow’s milk, try to limit their cow’s milk intake to about 24 ounces per day. This should help. Make sure that your child is also consuming enough fiber.

Constipation can also develop from anal fissures, which are basically breaks in the skin emanating from the anus. This can be from withholding bowel movements, too much wiping during diaper changes, or from passing hard stool.

POTTY TRAINING

Constipation occurs in this age group of children for a few reasons. Sometimes children keep stool within them as toddlers may not know when to have a bowel movement, or by sitting on a large adult toilet, they may not be able to get the leverage to get out their stool. If children show signs of withholding, it is often necessary to use laxatives or hold off in toilet training for a short period of time.

In children between 2 and 5 years of age, they should be consuming between 7 and 15 grams of fiber per dat. Be sure not to give your child too much fiber or this can lead to something called stool impaction (basically a piece of hard stool gets stuck in the rectum) in someone with a history of constipation.

SCHOOL ENTRY

Some children develop constipation when beginning school because they are afraid of using the bathroom at school, or their schedule interferes with their potty use. Parents should ask their children about school and their daily routines to figure out if any of the aforementioned problems may be causing the constipation. Also, make sure your child is intaking enough fiber. A child that is 6 years old should be getting between 11 and 16 grams of fiber per day.

ACUTE CONSTIPATION

It is important to intervene in children with constipation to make sure that they do not develop further constipation. Make sure that the constipation does not persist for more than 2 weeks. The intervention should include a plan to make sure that constipation is prevented in the future.

TODDLERS AND CHILDREN

Make sure that your child is getting the proper amount of fiber and fluids in their diet. Then, Miralax, or a sorbitol containing juice (such as apple, prune, or pear) should be administered. You can dose your child with Miralax according to the bottle on the label, but it is always smart to run drugs past your child’s primary care provider to make sure you are not doing any harm to your little one. Several ounces of the juice can be given daily. The juice method is less effective than Miralax, but it is effective. If your child does develop an anal fissure, you can apply petroleum jelly to the area. The dietary measures above should be used to prevent constipation.

If your child cannot have a bowel movement for days on end, and no stool is passing,  they may have a fecal impaction. This is usually fixed by administering a sodium phosphate enema and administering 2 doses of laxitives. This method of correction should be prescribed and discussed with your child’s primary care provider. A fecal impaction is usually something that requires medical attention to rule out other possible causes of the issue at hand.

INFANTS

For infants who have not yet begun solids, you can add sorbitol containing juices (apple, prune, or pear) gradually increasing the amount given to induce a bowel movement daily. For infants that are four months or older, 2-4 ounces of a 100% juice is a reasonable starting dose. Once an infant has begun solids, a sorbitol containing puree can be substituted. Multigrain or barley cereal may be substituted for rice cereal as well.

Glycerin suppositories or rectal stimulation (lubricated rectal thermometer tip is gently inserted very minimally into the anus) may be used occasionally if there is hard stool in the rectum. This should not be done frequently, as tolerance may develop.

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