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Constipation

constipation; baby; child; hard; poo; strain; laxative; nutrition. ;

Constipation is the passing of a hard bowel action (poo) with pain and discomfort. A baby is constipated if the poos (stools) are dry and crumbly or like pellets.

Contents

A breast fed baby is hardly ever constipated. After the first few weeks of life, breast fed babies may not have a poo for several days or up to a week, but when they do, the poo will usually be soft.

Many babies and children do not do a poo every day. If a baby or child does poo only once or a couple of times a week, this is not constipation unless the poo is also hard.

Alert!
Constipation which goes on for a long time can cause other problems for children, in particular soiling (leaking of poo into the pants). For more information about this see the topic 'Soiling'.

Constipation in babies

Causes

  • If a breast fed baby has hard, crumbly poo, the baby might not be getting enough milk. Check with your doctor or community child health nurse.
  • With bottle fed babies sometimes the baby's milk formula is not made up correctly, so there is too much formula powder for the amount of water. For example,
    • the formula may have been tightly packed into the scoop or heaped up (rather than the formula being scooped out of the tin and levelled off with a knife)
    • the wrong scoop used (different types of formula need different size scoops)
    • the powder may have been put in the bottle before the water, so not enough water is added.
  • Changing the milk formula, especially to 'follow-on' formula, or a thickened 'AR' formula, or cow's milk, or starting solids may cause constipation for a short while.
  • Sometimes a baby may not have enough drinks, especially on a hot day, or when the baby has a fever.
  • Sometimes a hard poo can cause a little tear around the anus and it hurts the baby. The baby seems to know it hurts to do poo, so holds on. Then the poo becomes harder, and then it hurts more next time.

Signs of constipation

  • A baby who has hard poo which causes pain and discomfort is constipated.
  • Many babies strain and go red in the face when doing a normal poo. This is not a sign of constipation unless the poo is also hard.

What you can do

  • If the baby is bottle fed, check the formula tin to make sure the formula is being made correctly. Measure the water first, then add formula powder.
  • Offer extra drinks (water).
  • Give brown sugar, one half to one teaspoon mixed in a small amount of water (30 mls) separate from milk at the beginning or end of a feed 3 or 4 times a day until there is a soft poo.
  • For babies 6 months and older, offer fruit juice (especially prune juice) 1 part juice mixed with 3 parts water.
  • For babies 6 months and older who are already having solids, give your baby stewed prunes, stewed apricots, or steamed vegetables.
  • For babies 9 months and older, offer your baby cereals which contain bran.
    • Note: sometimes diets which are high in fibre can cause tummy pain. If your baby seems more unhappy after you start giving him extra fibre, give him less.
  • Do not give medicines. You should only give these to babies if they are prescribed by a doctor.
  • If these simple treatments do not work, or there is blood in the poo, have the baby seen by a doctor.
  • Remember that some straining (going red in the face and grunting) is normal when babies do poo; this usually does not mean constipation.
  • Tummy massage (clockwise) may help.
  • A warm bath can help the muscles relax (your baby may do the poo in the bath, so be prepared).
  • If the constipation persists, seek advice from your doctor.

Note: Some research shows that using formula with LCPs, or with probiotics, may help babies to have softer bowel movements (poos) than ordinary formulas.

Constipation in children

Causes

  • Children may develop constipation if there is not enough fibre or bulk in their diet. This can happen when a child is drinking too much milk and not getting enough solids (other foods).
  • Pushing a hard poo out can cause pain and sometimes a small tear in the skin around the anus, so the child tries not to do poo again, leading to worse constipation.
  • Sometimes medicines can cause constipation, including some cough medicines.
  • Some children ignore the feeling of needing to go to the toilet because they are too busy playing and as a result the poo becomes harder and it is more difficult for the child to go later.
  • When children are being toilet trained, they may also hold back and so the poo becomes harder and more difficult to pass.
  • Some children do not want to use school or preschool toilets:
    • the toilets may be smelly
    • they may not be private
    • there may be no toilet paper
    • sometimes children are teased in the toilets
    • if children are not allowed by the teacher to go to the toilet when they need to go, they learn to hold on and may become constipated.
  • Constipation seems to be due to the way the bowel works in some people, and having firm poo only once or twice a week seems to be the normal pattern for these people.

Signs of constipation

  • Children may sometimes say that it hurts when doing a poo, or cry, and will try to do their poos less often.
  • Often they don't say anything.
  • They may show lots of signs of holding on, such as crossing legs, running around, crying or refusing to sit on the toilet.
  • They may complain of abdominal (tummy) pain which comes and goes, and is usually around the belly button (navel, umbilicus).
  • Some children will start to soil their pants (see 'Soiling').

What you can do
Hard poo hurts when it is passed, so it is 'normal' and 'logical' for a child to try to stop doing poo when she is constipated. Find ways of making the poo softer, so that poo does not hurt and the child is no longer afraid to do poo.

  • If your child's diet is low in fibre, give her more fresh fruit and vegetables, and offer cereals, rice, dried fruits, breads and biscuits with high fibre (eg bran, prunes, dates) in them.
    • Be careful not to give too much, as this can cause tummy pain.
  • Encourage children to have lots of drinks, especially clear drinks. Water is the best, although fruit juice helps some children (you could try apple, prune or pear juice).
  • Encourage them to exercise more.
  • If the toilets at school are a problem, try taking this up with the school.
  • Unless your doctor recommends laxatives, they should not be used for more than a few days. Laxatives which increase bulk and fibre in the gut may be the best. Ask your pharmacist which ones to use.
  • If the constipation lasts a long time or keeps coming back, get advice from your doctor.
  • When the constipation lasts a long time, laxatives which contain paraffin oils, or which increase fibre, are sometimes prescribed by a doctor. These should only be given after the child has been seen by the doctor and the cause of the problem worked out. The treatment may be needed for several months.
  • Behaviour modification programs and the use of 'star charts' usually do not work for young children because the reason for not passing poo is because the poo is hard, not because there is a behaviour problem.  Charts which show how often the child can do poo and whether the poo is soft, hard or painful, can show whether the problem is getting better or not.

Constipation in young people

Causes

  • A common cause is not enough fibre or bulk in the diet.
  • It can also be caused by not drinking enough, or not being active.
  • Some eating disorders (eg anorexia nervosa) may cause constipation but there will also be other problems.
  • Constipation seems to be due to the way the bowel works in some people, and having firm poo only once or twice a week seems to be the normal pattern for these people. This may be a family pattern.

Signs of constipation

  • Similar signs as for the child, ie having hard poo, and difficulty and pain when passing poo, and sometimes tummy pain.

What parents can do
This is the same as for the child. Work out ways to make the poo softer.

  • Try increasing the amount of fibre in the diet, eg fruit, vegetables, cereals, bread, etc and water, and increase the amount of regular exercise. If tummy pain increases, cut back a bit on the extra fibre.
  • Laxatives should not be used for more than a couple of days. Laxatives which increase bulk and fibre in the gut may be the best ones to try.
  • If the constipation persists, seek advice from your doctor.
  • For chronic constipation, laxatives are sometimes prescribed by a doctor after the person has been examined and the nature of the problem worked out. Sometimes an enema is needed when a large amount of poo is retained in the bowel. An enema is fluid which is squeezed into the rectum (lower bowel) through the anus. It stimulates the bowel muscles to push the poo out.
  • There is a topic called 'Constipation' on the Teen section of this site which could help older children or adolescents understand constipation and help them work out what to do to take control of their problem.

Health problems from constipation
  • There are no health problems from 'normal' constipation, but if the constipation becomes long lasting and a large mass of poo (faeces) is held in the gut, soiling may begin, and this can lead to serious social and emotional problems. (See 'Soiling')
  • There is no scientific evidence that toxins or poisons are absorbed from the large bowel when someone is constipated.

Prevention
  • Offer extra drinks especially in hot weather or a child is unwell. For babies who have started solids, give water; for children and young people, offer a variety of drinks to increase the amount they drink.
  • For older children and young people, encourage them to live a healthy lifestyle by eating cereal, bread, fruit and vegetables every day and getting regular exercise.

References

Gastroenterological Society of Australia 'Constipation information leaflet' 
 http://www.gesa.org.au/consumer.asp?id=46  

Barclay L, Lie D 'Common myths about constipation dispelled' Medscape Medical News 2005 

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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