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	vomiting

CONSTIPATION

Constipation in children should be considered if there is a painful passage of stool even with straining. Infrequent stooling (such as going four (4) or more days between bowel movements) may or may not be a sign of constipation. Large, hard or infrequent stools would be a sign of constipation only if they are painful or difficult to pass. Babies less than six (6) months of age commonly grunt, push, strain or draw up their legs and become flushed in the face during passage of a bowel movement. This is normal if it does not result in prolonged crying.

You should call the office immediately if your child develops extreme pain or if pain becomes constant or persists for more than two (2) hours with stooling. If this is the case during or after hours call 345-3133.

Constipation is most often due to a diet that does not include enough fiber or includes too many constipating foods. Voluntary stool holding is another common cause in toddlers and older children. If your baby is less than four months and is constipated, we recommend adding apple juice, prune juice or white grape juice to the diet once or twice per day. You may give it straight or dilute it half and half with water and give one to two ounces per feeding. We do not recommend switching to low iron formula. If your baby is between 4-12 months old, in addition to the fruit juice, you may add strained apricots, prunes, peaches, pears, plums, beans or peas twice per day. Also decrease the naturally constipating foods such as bananas, rice cereal, applesauce and carrots. If your child is over 12 months of age, adding at least three (3) servings of fruits and vegetables per day is helpful. When your child is able to handle harder foods without choking, you can add raisins, celery and grapes. Most of the fiber in fruits and vegetables is found in the peeling. For the child over a year of age, an excellent source of fiber is found in bran, especially wheat bran. Sources of bran include bran flakes, bran muffins, shredded wheat, graham crackers, oatmeal, brown rice and whole wheat bread. For this age group, try decreasing the amount of constipating dairy products such as milk, cheese and ice cream. Limit milk to 16 ounces per day. Once these dietary measures have helped, then maintain this healthy diet to prevent recurrence of constipation.

If dietary measures do not prove helpful after three days, call our office at 345-3133 for assistance. We rarely recommend suppositories and enemas. These more drastic measures should be used only after all other measures have failed and only after consultation with our office.

Constipation due to voluntary stool holding, especially during toilet training, is more of a problem and warrants a visit to our office. For the already toilet-trained child who is having bowel movements in their pants, even if only small smears, it usually indicates stool holding with resulting constipation. These children should also be examined.

This advice on constipation is presented as general information and is not meant to be specific treatment for your child’s medical problem. If you need further assistance, call 855-9160 during regular office hours to speak with one of our Health Information Nurses.