Constipation

Hilliard Pediatrics, Inc. - Dr. Rob Snyder, MD

Introduction

Constipation is one of the most common childhood problems. Most parents deal with this sooner or later with their children. Children with constipation have stools (also called bowel movements or poops) that are hard and difficult or painful to get out. See below for information and helpful tips.

What is a normal bowel pattern?

Most children have a bowel movement 1 or 2 times a day, but for some children it may be normal to have a bowel movement every 2 days.

For infants, they typically have a bowel movement at least once a day, but may go 1-2 days between bowel movements. Many infants will grunt, groan, and strain with bowel movements. This is normal and should not be confused with constipation.

Common Symptoms

With constipation, most children will have crampy abdominal pain that comes and goes. They are generally still eating well and active. When they are experiencing abdominal pain, they may lay down for a little while, then be fine when the cramping passes. Stools are generally large and hard, but not always.

For older children, they sometimes will experience leaking stool, which can imply chronic constipation. If your child is experiencing this, please see our encopresis protocol. This is a condition that we manage differently, please give us a call during regular business hours to discuss further.

Treatment

Constipation can often be treated at home using one of the methods listed below. If this is a recurrent or chronic problem, please call our office on the next business day to schedule a visit or discuss a plan with one of our nurses.

Rectal Stimulation - Taking a rectal temperature can help to stimulate a bowel movement. To do this, put some petroleum jelly on a rectal thermometer and insert it into the anus. You will want to insert the thermometer about the distance from the end of your pinky to the first knuckle. Once you insert the thermometer, keep it about the same distance in, and spin/move it around a little bit for a minute. This will cause the child to bear down and often produce a bowel movement.
Glycerin Suppository - If rectal stimulation doesn't work, you can try an over-the-counter glycerin suppository. You will want to use either 1 infant suppository or 1/3 of an adult suppository. Place your child is a frog-like position with their knees up by their shoulders. You will then push the suppository in about the same distance as you did for the thermometer (about 3/4 inch) and then hold the baby's butt cheeks together for about 5 minutes. After 5 minutes, you can let go and the child will naturally push the remaining suppository back out. As a result of the suppository and the act of bearing down to push the suppository back out, it will often cause a bowel movement. If needed, you can repeat this process with another suppository in 30 minutes.
Offer Juice - For infants 4 months of age and older, you can offer them 1-2 ounces of prune juice daily.
Oral Medications
- If under 2 months of age, please call our office before trying oral medicines.
- Milk of Magnesia - for infants 2 months of age and older, you can give them 2.5 - 5 mL of milk of magnesia (MOM) daily. This will help soften the stool. MOM is not addictive, you can use it every day.

Increase Fluid Intake - Increasing how much water your child drinks will often be helpful. Apple, pear, grape and prune juices are all helpful to treat constipation; however, too much juice can damange the teeth and can become preferred over water.
Adjust Diet - Certain foods tend to naturally make constipation better or worse.
- Worse: milk and dairy products (especially cheese), carrots, bananas, and apples tend to constipate.
- Improve: oatmeal, bran, raisins or grapes, green vegetables, prunes, peaches, pears, and apricots tend to allow a softer, easier to pass bowel movement.
Oral Medications
- Milk of Magnesia - For toddlers, we recommend trying milk of magnesia (MOM) if diet and fluid changes are not helping. You can give your toddler 5-10 mL of MOM daily. Note, it will take 12-24 hours for MOM to work. If MOM improves your child's constipation, we recommend continuing it for a few weeks to keep your child regular and then slowly wean them off.
- Glycolax Power (Miralax) - You can also try glycolax powder (Miralax) for children 18 months of age and older (please call the office prior to giving to a child under 18 months of age). With Miralax, the dose will vary and may require some trial and error before finding the right dose for your child. A reasonable starting dose is 1/4 - 1 capful daily. Add the Miralax to 4-8 oz. of liquid. Stir until the crystals are dissolved.

Increase Fluid Intake - Increasing how much your child drinks will often be helpful. For older children, we recommend increasing the amount of water they are drinking.
Adjust Diet - Certain foods tend to naturally make constipation better or worse.
- Worse: milk and dairy products (especially cheese), carrots, bananas, and apples tend to constipate.
- Improve: oatmeal, bran, raisins or grapes, green vegetables, prunes, peaches, pears, and apricots tend to allow a softer easier to pass bowel movement.
Oral Medications
- Milk of Magnesia - For older children, we recommend trying milk of magnesia (MOM) if diet and fluid changes are helping. Note, it will take 12-24 hours for MOM to work. If MOM improves your child's constipation, we recommend continuing it for a few weeks to keep your child regular and then slowly wean them off.
  - Children 2-6 years of age: 5-15 mL/day of regular-strength liquid
  - Children 6-12 years of age: 15-30 mL/day of regular-strength liquid
  - Children 12 years of age and older: 30-60 mL/day of regular-strength liquid
- Glycolax Power (Miralax) - You can also try glycolax powder (Miralax) for children 18 months of age and older. With Miralax, the dose will vary and may require some trial and error before finding the right dose for your child. A reasonable starting dose is 1/4 - 1 capful daily. Add the Miralax to 4-8 oz. of liquid. Stir until the crystals are dissolved.

How to Prevent Constipation

First, lets briefly discuss how the body processes food. Our stomach grinds it up and the small intestine absorbs important nutrients. The waste that is left over is sent to the large intestine to be processed. Water is reabsorbed from the stool and eventually ends up in the lower part of the large intestine called the sigmoid colon.

The foods we eat and how they are processed influence how hard or soft the stool is. Dairy products like milk, cheese and yogurt tend to harden the stool. The same is true when taking in too many carbohydrates such as crackers, bread and pasta. Additionally, high fat foods in excess are hard to process and tend to worsen the situation. Most fruits (not bananas), veggies and high fiber foods tend to either soften the stool or add bulk making it easier to pass. Fruit juices like apple juice tend to create diarrhea. A great way to prevent consitpation is to control the foods that your child is offered. Also, drinking lots of water keeps us healthy and helps to prevent constipation.

What to Do When

When to go the Emergency Department (ED)

Severe abdominal pain - Constipation is almost never an emergency. The pain with constipation typically comes and goes, whereas problems like appendicitis will worsen over time. If your child is having intense pain, then an ED visit is warranted, mostly to assess for more dangerous causes of abdominal pain.
Blood from the rectum (no stool with it) - When a child passes a significant amount of blood from the rectum, this can be the result of several serious problems such as Meckel's diverticulum, intussusception, or malrotation with volvulus. These can also present with severe pain which will justify a trip to the ED.

When to Call the Doctor On Call

If you are trying to decide if you should take your child to the Emergency Department or Urgent Care, give us a call. We can review the symptoms your child is having and help you decide if you need to take them in or if it can wait. In general, if the pain does not stop after an hour, we will tend to recommend an evaluation.

When to Call the Office

If your child is experiencing any of the following, please call the office to discuss further options or the need to schedule an appointment. When you call, please press option 1 and leave a message with the child's name, DOB, a brief description of the situation and one of our triage nurses will call you back to discuss further.
- Rock hard or distended belly
- Inconsolable
- Has blood in the stool
- Not improving after trying the above recommendations
- Chronic constipation (greater than 3 months)
- Leaking stool - when the colon is unable to hold a child's stool as a result of frequent constipation it will leak. This is called encopresis and requires a detailed discussion.

Last Updated: 05/2022