- Pain or crying during the passage of a stool (bowel movement or BM) OR
- Unable to pass a stool after straining or pushing longer than 10 minutes OR
- 3 or more days without a stool (Exception: Breastfed and over 1 month old)
Imitators of Constipation: Normal Variations
- If breastfed and over 1 month old: Infrequent stools every 4-7 days that are soft, large and pain-free can be normal. Before 1 month old, infrequent stools usually means an inadequate intake of breastmilk.
- Grunting or straining while pushing out a stool is normal in young infants. (Reason: difficult to pass stool lying on back with no help from gravity) Infants commonly become red in the face during straining.
- Brief straining or pushing for less than 10 minutes can occur occasionally at any age.
- Large stools - Size relates to amount of food consumed and stool frequency. Large eaters have larger stools.
- Hard or dry stools are also normal if passed easily without excessive straining. Often relates to poor fiber intake. Some children even have small, dry rabbit-pellet-like stools.
- High milk or cheese diet
- Low fiber diet
- Postponing stools
- Slow intestinal transit time (genetic differences)
See More Appropriate Topic (instead of this one) If
WHEN TO CALL YOUR DOCTOR
Call Your Doctor Now (night or day) If
- Your child looks or acts very sick
- Persistent abdominal pain over 1 hour (includes persistent crying)
- Persistent rectal pain over 1 hour (includes persistent straining)
- Vomiting over 3 times in last 2 hours
- Age under 1 month old and breastfed
- Age under 12 months with recent onset of weak cry, weak suck or weak muscles
- You think your child needs to be seen urgently
Call Your Doctor 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 anal fissures (tears)
- Needs to pass stool BUT afraid to release OR refuses to go
- Child may be "blocked up"
Call Your Doctor During Weekday Office Hours If
- You have other questions or concerns
- Leaking stool
- Suppository or enema needed recently to relieve pain
- Infrequent stools continue after dietary changes (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
- Constipation is a recurrent chronic problem
Parent Care at Home If
- Mild constipation and you don't think your child needs to be seen
HOME CARE ADVICE FOR CONSTIPATION
- Normal Stools:
- Once children are on a regular diet (age 1 year), the normal range for stools is 3 per day to 1 every 2 days.
- The every 4 and 5 day kids all have pain with passage and prolonged straining.
- The every 3 day kids usually drift into longer intervals and then develop symptoms.
- Passing a stool should be fun, or at least free of discomfort.
- Any child with discomfort during stool passage or prolonged straining at least needs treatment with dietary changes.
- Diet for Infants Under 1 Year:
- For infants over 1 month old only on breast milk or formula, add fruit juices 1 ounce (30 ml) per month of age per day. Pear or apple juice are OK at any age. (Reason: treating a symptom)
- For infants over 4 months old, also add baby foods with high fiber content twice a day (peas, beans, apricots, prunes, peaches, pears, plums).
- If on finger foods, add cereal and small pieces of fresh fruit.
- Diet for Children Over 1 Year Old:
- Increase fruit juice (apple, pear, cherry, grape, prune) (note: citrus fruit juices are not helpful).
- Add fruits and vegetables high in fiber content (peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes, dates) 3 or more times per day.
- Increase whole grain foods (bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread. 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: Temporarily put your child back in diapers or pull-ups.
- Reassure him that the poops won't hurt when they come out.
- Praise him for the release of stools.
- Avoid any pressure, punishment or power struggles about holding back poops, sitting on the potty or resistance to training.
- Sitting on the Toilet (if toilet trained): Establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially breakfast.
- Warm Water for Rectal Pain: Warmth helps many children relax the anal sphincter and release a stool. For prolonged straining, have your child sit in warm water or apply a warm wet cotton ball to the anus. Move it side to side to help relax the anus.
- Flexed Position:
- Help your baby by holding the knees against the chest to simulate squatting (the natural position for pushing out a stool). It's difficult to have a stool while lying down.
- Gently pumping the lower abdomen may also help.
- Call Your Doctor If:
- Constipation continues after making dietary changes
- Your child becomes worse
And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 11/14/2011
Last Revised: 11/14/2011
Content Set: Pediatric HouseCalls Symptom Checker
Copyright 1994-2012 Barton D. Schmitt, M.D.