One thing that pediatricians have noticed about our society is that we pay a great deal of attention to our bowels. We are frequently asked questions regarding size, frequency and color of our children’s bowel movements. One of the most common questions we encounter is in regard to the frequency of stooling, and at times, a perceived lack thereof. It is no surprise that constipation continues to be one of the most frequently discussed patient issues at pediatric visits.

What is constipation? Basically, it is defined by a combination of three factors: frequency, consistency and discomfort. Constipation is a very common frustration encountered by parents and children. In fact, it is estimated that approximately 5% of all outpatient visits to pediatric health providers and up to 25% of visits to pediatric gastroenterologists revolve around constipation. There are age appropriate norms for stool frequency (e.g., 4-6 per day in the first week of life, to 1-2 per day by the age of two). However, it is imperative to note that each child has her/his own patterns which are their baseline. Therefore, any changes in their stooling patterns have to be compared accordingly. For instance, it is not uncommon for breastfed infants two months of age and older to comfortably pass a soft, large, normal appearing bowel movement every 2-6 days. Infants also may exert considerable effort into passing reasonably soft BMs with no associated facial grimace or discomfort; this is a reminder that it is somewhat challenging to move one’s bowels when lying down.

There are a variety of causes of constipation, but it is most commonly due to a relative lack of fiber in the diet. As well, significant quantities of dairy products (e.g., milk, cheese, etc.) and carbohydrates (e.g., rice, pasta, cereals, etc) can work together to cause constipation in a significant number of people (adults are likely affected as often as children are). Not surprisingly, the treatment plans and strategies for relieving constipation are based in part on one’s age.

If your child is under 2 months of age: it is best to first call our office before implementing any “game plans,” as we like to be certain that it truly is constipation and not straining due to their position while passing a bowel movement.

For babies greater than 2 months of age: it is appropriate to offer a trial of prune or pear juice, 1-2 ounces twice daily. Some children respond more briskly than others, and you may need to decrease the amount if this "works too well."

For those infants 4 months of age and older who have already started eating cereals and stage 1 foods: avoidance of bananas and applesauce is often sufficient to resolve constipation. Some infants require changing from rice to barley cereal, as well as increasing the content of other fruits and vegetables in their diet.

Children greater than 1 year of age: we recommend 3 or more servings of fruits and vegetables per day (e.g., prunes, dates, pears, peaches, peas, broccoli, so long as your child is able to chew these foods. As well, the addition of bran to the diet is often helpful in easing constipation (bran is found in bran muffins, bran flakes, oatmeal, brown rice, graham crackers, whole wheat bread). Popcorn is a good source of fiber, so long as your child is over the age of 4, so as to minimize the risk of choking. If possible, reducing the content of dairy products in your child may also be of benefit to them.

NEVER give an infant (i.e., less than 12 months of age) honey, as there is a risk of botulism in this age group.

We are often asked by parents if they should take their child’s temperature rectally, as this maneuver may stimulate the passage of a stool. This is true, it may well result in a bowel movement, but it is generally discouraged as a routine part of a child’s treatment plan, as it is preferable to not have rectal manipulation become a regular intervention. This is especially true when children are in the process of toilet-learning. By instrumenting their rectum (e.g., thermometer, suppository) to “cure” constipation, this has the potential to backfire, ie, the child may become less likely to use the toilet.

If despite these basic measures your child is still experiencing constipation, please feel free to give Kids First Pediatrics a call at (704) 542-5540, and a member of our clinical staff will be happy to discuss other treatment options with you.