Constipation means hard bowel movements which are difficult and at times painful to pass. It does NOT mean infrequent bowel movements. There is a great deal of normal individual variation in how often we move our bowels, and as long as the stool remains reasonable soft and easy to pass the length of time between movements should not cause concern. On the other hand, even regular daily bowel movements which are too hard may represent a problem. In young children the discomfort associated with this can lead to a justified fear of moving the bowels, causing them to try to hold it in rather than push it out when they feel the urge to go. This in turn results in even harder stools the next time, and thus a vicious cycle is set up. The child withholds more and more stool inside, the intestine dilates and begins to function less efficiently, and the eventual endpoint can be uncontrolled soiling (encopresis), urinary accidents or frequency, abdominal pain and can even lead to nausea and symptoms of acid-reflux. Maintenance of normal stool consistency is important, especially in the early years of childhood.
Almost everyone experiences occasional self limited bouts of constipation. These can be the result of a dietary disruption, emotional stress, or acute illness. Don’t worry, no one has ever “burst” from constipation. While uncomfortable, it is not an emergency. It is best to avoid both stimulant laxatives and “rectal assaults” in young children. Both can be dangerous and do more harm than good. In particular, “rectal assaults” such as enemas, suppositories, and manual disimpaction are quite frightening and impossible to adequately explain to a young child. They may be very emotionally damaging. Stimulants can induce dependence. What CAN be done? Try the plan below, but remember none of them can be expected to work immediately – some patience will be necessary:
- In an infant (less than 1y) try light Karo syrup 1 tablespoon mixed in 4 oz. formula or breast milk once or twice daily. If the baby has been started on pureed or solid foods, cut down on cereals and increase fruits – particularly peaches, prunes and pears. Cut back on cheese, yogurt and simple carbohydrates such as breads, crackers and pasta.
- For older children, try Mineral Oil orally twice a day in a dose of:
1 teaspoon for ages 1-2
2 teaspoons for ages 2-4
1 tablespoon for ages 4-8
2 tablespoons for ages 8 and over
While Mineral Oil is tasteless, it does feel slimy so children are reluctant to take it. This can be minimized by keeping it cold in the refrigerator and having food or drink handy to wash it down. It can also be disguised by mixing with a semi-solid food such as yogurt, ice cream, oatmeal, jelly or a small amount of cocoa powder.
- Prevention is best achieved by increasing dietary fiber. It is the rare child who can do this by eating green vegetables, however. Buy high fiber cereals and breads, encourage prunes and raisins as snack food, and try to have your children develop a taste for Bran muffins. A very useful product in this regard is “Unprocessed Bran”, available in the grocery store. This can be added to many recipes – ranging from any kind of baked goods to hamburgers, meatloaf, and casseroles – without changing the taste.
If you have given the above measures a fair trial (at least several days) and have not met with success, please call. More aggressive treatments are available but really require close medical supervision.
Finally, some children are prone to repeated or chronic constipation. This tendency often runs in families. It is also sometimes the first sign of an underlying serious disease – especially if the tendency first shows up during early infancy. Children with chronic constipation deserve a thorough medical evaluation and an individualized long term treatment plan. If your child falls into this category, please schedule them for an extended consultation.