- Pain or crying when passing a stool (bowel movement or BM) OR
- Can’t pass a stool after straining or pushing longer than 10 minutes OR
- 3 or more days without passing a stool (Exception: Breastfed and over 1 month old)
- High milk or cheese diet
- Low fiber diet
- Postponing stools
- Slow passage of food through the intestines. Most often, this type runs in families.
- Breastfed type: Change in diet, such as adding formula or baby foods
How Often is Normal?
- Once children are on normal table foods, their stool pattern is like adults. The normal range is 3 per day to 1 every 2 days.
- Kids who go every 4 or 5 days almost always have pain with passage. They also have a lot of straining.
- Kids who go every 3 days often drift into longer times. Then, they also develop symptoms.
- Passing a stool should be free of pain.
- Any child with pain during stool passage or lots of straining needs treatment. At the very least, the child should be treated with changes in diet.
Imitators of Constipation: Normal Patterns and Stools
- Breastfed and over 1 month old. Stools every 4-7 days that are soft, large and pain-free can be normal. Caution: Before 1 month old, not stooling enough can mean not getting enough breast milk.
- Grunting or straining while pushing out a stool is normal in young babies. It’s hard to pass stool lying on your back with no help from gravity. Babies also become red in the face during straining. This is normal.
- Brief straining under 10 minutes can occur at times at any age.
- Large stools. Size relates to the amount of food eaten. Large eaters have larger stools.
- Hard or dry stools are also normal if passed easily without too much straining. Often, this relates to poor fiber intake. Some children even have small, dry rabbit-pellet-like stools.
When to Call Us for Constipation
Call Us Now (night or day) If:
- Your child looks or acts very sick
- Stomach pain goes on over 1 hour (includes crying) after using care advice
- Rectal pain goes on over 1 hour (includes straining) after using care advice
- Vomits 2 or more times and stomach looks more swollen than normal
- Age under 1 month old and breastfed
- Age under 12 months with recent onset of weak suck or weak muscles
- You think your child needs to be seen urgently
Call Us Within 24 Hours (between 9 am and 4 pm) If:
- You think your child needs to be seen, but not urgently
- Age under 2 months (Exception: normal straining and grunting)
- Bleeding from anus
- Needs to pass a stool BUT afraid to or refuses to let it out
- Child may be “blocked up”
Call Us During Weekday Office Hours If:
- You have other questions or concerns
- Leaking stool
- Suppository or enema needed to get the stool out
- Infrequent stools do not get better after changes to diet. (Exception: Normal if breastfed infant over 1 month old AND stools are not painful.)
- Toilet training is in progress
- Painful stools occur 3 or more times after changes to diet
- Constipation is a frequent problem
Parent Care at Home If:
- Mild constipation
Care Advice for Constipation
What You Should Know:
- Constipation is common in children.
- Most often, it’s from a change in diet. It can also be caused by waiting too long to stool.
- Passing a stool should be pleasant and free of pain.
- Any child with pain during stool passage or lots of straining needs treatment. At the very least, they need changes in diet.
- Once children are on a regular diet, their stool pattern is like adults. The normal range is 3 per day to 1 every 2 days.
- Kids who go every 3 days often drift into longer times. Then symptoms start.
- Kids who go every 4 and 5 days almost always have pain with passage. They also have lots of straining.
Diet for Infants Under 1 Year Old:
- For infants over 1 month old only on breast milk or formula, add fruit juice. Give 1 ounce (30 ml) per month of age per day. Pear or apple juice are okay at any age. (Reason: Treating a symptom.)
- For infants over 4 months old, also add baby foods with high fiber. Do this twice a day. Examples are peas, beans, apricots, prunes, peaches, pears, or plums.
- If on finger foods, add cereals and small pieces of fresh fruit.
Diet for Children over 1 Yer Old:
- Increase fruit juice (apple, pear, cherry, grape, prune). Note: Citrus fruit juices are not helpful.
- Add fruits and vegetables high in fiber content. Examples are peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes, or dates. Offer these foods 3 or more times per day.
- Increase whole grain foods. Examples are bran flakes or muffins, graham crackers, and oatmeal. Brown rice and whole wheat bread are also helpful. Popcorn can be used if over 4 years old.
- Limit milk products (milk, ice cream, cheese, yogurt) to 3 servings per day.
Stop Toilet Training:
- Put your child back in diapers or pull-ups for a short time.
- Tell him that the poops won’t hurt when they come out.
- Praise him for passing poops into a diaper.
- Holding back stools is harmful. Use rewards to help your child give up this bad habit.
- Avoid any pressure or punishment. Also, never force your child to sit on the potty against his will. Reason: It will cause a power struggle.
- Treats and hugs always work better.
Sitting on the Toilet (if Toilet Trained):
- Set up a normal stool routine.
- Have your child sit on the toilet for 10 minutes after meals.
- This is especially important after breakfast.
Warm Water for Rectal Pain:
- Warmth helps many children relax the anus and release a stool.
- For straining too long, have your child sit in warm water.
- You can also put a warm wet cotton ball on the anus. Move it side to side to help relax the anus.
- Help your baby by holding the knees against the chest. This is like squatting for your baby. This is the natural position for pushing out a stool. It’s hard to have a stool lying down.
- Gently pumping the lower stomach may also help.
What to Expect:
- Most often, changes in diet helps constipation.
- After your child is better, be sure to keep him on high fiber foods.
- Also, have your child sit on the toilet at the same time each day.
- These tips will help to prevent the symptoms from coming back.
Call Your Doctor If:
- Constipation lasts more than 1 week after making changes to diet
- Your child becomes worse