Infant with hard stools

Symptoms, Treatment and When to Call a Doctor

Nationwide Children’s Hospital

Constipation (con-sta-PA-shun) in infants can worry parents. Most of the time, your baby is not really constipated. They may not have developed a routine for pooping yet. Some babies do not develop a bowel movement (BM) pattern for a while.

An infant’s BM pattern can change if their diet changes, like switching from breastmilk to formula, starting solid foods, or drinking less formula than usual. If your baby’s stool (poop) is not soft or easily passed, then they may be constipated.

In rare cases, constipation may be caused by a lack of nerves going to the intestines or by a problem with the way the intestine formed at birth. Your baby can be tested for these conditions if your health care provider feels it is needed.

Signs of Constipation

less stools than their usual pattern
straining more than normal to have a bowel movement
a change in how the stool looks from soft and mushy to:
- small, hard pebbles, or like a large, round golf ball
- loose and watery
abdomen (belly) bloated or swollen with gas
painful cramps

Treatment

If your baby is not eating baby food yet, you may give 1 to 2 ounces of 100% fruit juice (pear, prune, cherry, or apple) once a day. Stop the juice if their stools become too loose.
If they are old enough to eat baby foods, feed them pureed pears, peaches, or prunes instead of giving them juice.
If your baby eats cereal, it may help to give oatmeal, wheat, or barley cereal. Rice cereal can cause constipation in some children.
Sometimes giving your baby a warm bath to relax them or exercising their legs, like riding a bicycle, will help stimulate the bowels to move (Picture 1).
If it has been a few days since your baby has pooped and the juice or pureed food has not worked, then you can try a glycerin suppository. Place your baby on their back. Gently push the suppository into their anus (bottom). Suppositories are meant for occasional use.
Contact your baby’s health care provider before giving them laxatives, baby mineral oil, or enemas to treat constipation.

Medical Therapy

Your child’s health care provider may order the following treatments:

Give your child medication.
Check your child’s temperature using a digital, rectal thermometer. Put a small amount of petroleum jelly (Vaseline®) on its tip before inserting into the rectum. Taking a rectal temperature may stimulate the baby to pass stool.

When to Call the Health Care Provider

Call the health care provider if any of the following occurs:

Your baby is irritable and seems to be having stomach pain. Infants will pull their legs up to their stomach and cry when they are in pain.
Your baby has constipation and develops vomiting, and their belly looks like it is bloated or filled with gas.
You see blood in their stool.
Their constipation does not get better with treatment.

If you have any questions or concerns, call your baby’s health care provider.

Constipation: Infant (PDF), Spanish (PDF), Somali (PDF), Arabic (PDF), Nepali (PDF)

Constipation in infants and children: MedlinePlus Medical Encyclopedia

Constipation in infants and children means they have hard stools or have problems passing stools. A child may have pain while passing stools or may be unable to have a bowel movement after straining or pushing.

Constipation is common in children. However, normal bowel movements are different for each child.

In the first month, infants tend to have bowel movements about once a day. After that, babies can go a few days or even a week between bowel movements. It's also difficult to pass stools because their abdominal muscles are weak. So babies tend to strain, cry, and get red in the face when they have a bowel movement. This does not mean they are constipated. If bowel movements are soft, then there is likely no problem.

Signs of constipation in infants and children may include:

Being very fussy and spitting up more often (infants)
Difficulty passing stools or seeming uncomfortable
Hard, dry stools
Pain when having a bowel movement
Belly pain and bloating
Large, wide stools
Blood on the stool or on toilet paper
Traces of liquid or stool in a child's underwear (may be a sign of fecal impaction)
Having less than 3 bowel movements a week (children)
Moving their body in different positions or clenching their buttocks

Make sure your infant or child has a problem before treating constipation:

Some children do not have a bowel movement every day.
Also, some healthy children always have very soft stools.
Other children have firm stools, but are able to pass them without problems.

Constipation occurs when the stool remains in the colon for too long. Too much water gets absorbed by the colon, leaving hard, dry stools.

Constipation may be caused by:

Ignoring the urge to use the toilet
Not eating enough fiber
Not drinking enough fluids
Switching to solid foods or from breast milk to formula (infants)
Changes in situation, such as travel, starting school, or stressful events

Medical causes of constipation may include:

Diseases of the bowel, such as those that affect the bowel muscles or nerves
Other medical conditions that affect the bowel
Use of certain medicines

Children may ignore the urge to have a bowel movement because:

They are not ready for toilet training
They are learning to control their bowel movements
They have had previous painful bowel movements and want to avoid them
They don't want to use a school or public toilet

Lifestyle changes can help your child avoid constipation. These changes can also be used to treat it.

For infants:

Give your baby extra water or juice during the day in between feedings. Juice can help bring water to the colon.
Over 2 months old: Try 2 to 4 ounces (59 to 118 mL) of fruit juice (grape, pear, apple, cherry, or prune) twice a day.
Over 4 months old: If the baby has started to eat solid foods, try baby foods with high-fiber content such as peas, beans, apricots, prunes, peaches, pears, plums, and spinach twice a day.

For children:

Drink plenty of fluids each day. Your child's health care provider can tell you how much.
Eat more fruits and vegetables and foods high in fiber, such as whole grains.
Avoid certain foods such as cheese, fast food, prepared and processed foods, meat, and ice cream.
Stop toilet training if your child becomes constipated. Resume after your child is no longer constipated.
Teach older children to use the toilet right after eating a meal.

Stool softeners (such as those containing docusate sodium) may help for older children. Bulk laxatives such as psyllium may help add fluid and bulk to the stool. Suppositories or gentle laxatives may help your child have regular bowel movements. Electrolyte solutions like Miralax can also be effective.

Some children may need enemas or prescription laxatives. These methods should be used only if fiber, fluids, and stool softeners do not provide enough relief.

Do not give laxatives or enemas to children without first asking your child's provider.

Contact your child's provider right away if:

An infant (except those who are only breastfed) goes 3 days without a stool and is vomiting or irritable

Also contact your child's provider if:

An infant younger than 2 months is constipated.
Non-breastfeeding infants go 3 days without having a bowel movement (Contact your child's provider right away if there is vomiting or irritability. )
A child is holding back bowel movements to resist toilet training.
There is blood in the stools.

Your child's provider will perform a physical exam. This may include a rectal exam.

The provider may ask you questions about your child's diet, symptoms, and bowel habits.

The following tests may help find the cause of constipation:

Blood tests such as a complete blood count (CBC)
X-rays of the abdomen

The provider may recommend the use of stool softeners or laxatives. If stools are impacted, glycerin suppositories or saline enemas may be recommended also.

Irregularity of bowels; Lack of regular bowel movements

Constipation - what to ask your doctor
High-fiber foods

Sources of fiber
Digestive system organs

Kwan KY. Abdominal pain. In: Olympia RP, O'Neill RM, Silvis ML, eds. Urgent Care Medicine Secrets. Philadelphia, PA: Elsevier; 2018:chap 19.

Maqbool A, Liacouras CA. Major symptoms and signs of digestive tract disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 332.

National Institute of Diabetes and Digestive and Kidney Diseases. Constipation in children. www.niddk.nih.gov/health-information/digestive-diseases/constipation-children/definition-facts. Updated May 2018. Accessed September 20, 2022.

Rutter P, Gastroenterology. In: Rutter P, ed. Community Pharmacy. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 7.

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Constipation in a child: what to do?

Constipation disrupts the functioning of the gastrointestinal tract. The main manifestation of constipation is a rare stool, difficulty in emptying the intestinal tract. If emptying occurs every three days, but there is no swelling and discomfort, and the feces have a normal consistency, this is not considered constipation.

If your child is constipated, a specialist should be consulted. Initially, you should seek help from a gastroenterologist. The First Children's Medical Center employs the best pediatric gastroenterologists in Saratov: here you can get qualified medical care! nine0003

Symptoms of constipation

The main symptoms of constipation include:

infrequent bowel movements;
if the child pushes hard trying to go to the toilet;
if there is pain during bowel movements;
stools look like balls.

When the baby is breastfed, he can empty himself up to seven times a day, after each meal. During the first week, the frequency of emptying is three times a day. nine0003

When the baby is one month old, the stool will be daily. At two months of age and when complementary foods begin, stools can be once every two days. If the baby has a soft stool, he feels good, but at the same time he defecates once every few days, this is the norm.

Signs of constipation include: discomfort during bowel movements, moodiness, very hard stools. If this situation persists, you should contact your pediatrician.

It is important to adjust the feeding regimen. Do not overfeed the child, do not transfer to artificial feeding if the mother has little milk. The first step is to try to fix the situation. A nursing mother should drink more fluids, stop eating foods that cause flatulence, reduce intestinal motility. Only in extreme cases should be transferred to artificial mixtures. nine0003

If the baby is formula-fed, he should empty himself once a day. The main mistake in this case is that parents often change mixtures, try others. Mixtures should be adapted, sour-milk, which contain probiotics and prebiotics. It is also necessary to strictly follow the instructions, properly dilute the mixture, taking into account all proportions. The introduction of complementary foods should be on time. The diet should contain foods that contain a large amount of fiber. nine0003

After the introduction of complementary foods, the stool becomes formed, hard, less frequent. Until the age of three, bowel movements should be daily. After three years, the frequency of defecation should be at least three times a week.

Why constipation occurs

There are two types of constipation - organic and functional. The causes of organic constipation are:

Hirschsprung's disease;
anomalies in the development of the gastrointestinal tract;
violations of metabolic processes.

In a newborn child, this symptom may indicate a narrowing, lengthening or expansion of the intestinal tract.

The causes of functional constipation include:

psychological problems, such as being in an unfamiliar environment;
lactose deficiency;
lack of fluid in the body;
errors in the diet; nine0014
negative reaction of the body to taking antibacterial drugs, drugs for the treatment of anemia, anticonvulsants;
congestion of bile in the gallbladder and its ducts;
Intestinal worms.

In newborns, the nervous system is immature, it is just being formed. Therefore, children are unable to control the movements of their muscles during bowel movements. You can help them by gently bending the legs, pressing them to the tummy. With these movements, the pelvic muscles relax, the bowel is released much faster. nine0003

How the therapy works

The treatment of constipation requires a holistic approach. Treatment is prescribed in each case individually, depending on the cause of constipation.

To ensure the normal functioning of all organs, it is necessary to adjust the stool in children. You will need to adjust your diet and lifestyle, do not abuse laxatives, as they help only temporarily.

The main principles of therapy include:

Diet correction. Requires elimination of foods that can cause constipation. Among them are fermented milk products, rice, muffins, bakery products, pasta. The menu is recommended to include vegetable fiber, which is found in fresh fruits and vegetables. You should also abandon fast carbohydrates - flour products, sweets. You need to add to the menu more foods that contain potassium, for example, figs, dried apricots, prunes.
Observe the drinking regimen. It is important to drink clean drinking water. During the day, the child should drink at least 40 milliliters of water per kilogram of his weight. nine0014
According to the doctor's prescription, the baby should be given medicines, homeopathic remedies. These include drugs for the outflow of bile, drugs that restore the intestinal microflora. You can use antihelminthics, laxatives, drugs with lactulose in the composition. Your doctor may also prescribe medications that contain polyethylene glycol. They retain moisture in the intestines, thin the stool.
In case of prolonged constipation, the child can be given a glycerine suppository, a microclyster as a stimulant. nine0014
Undergo physiotherapeutic procedures prescribed by the doctor, massage, do therapeutic exercises.
Provide a calm environment, help the baby psychologically so that he is not afraid to empty his intestines. You can read fairy tales, play with your child.
Train the intestines, after eating, put the child on the potty for a few minutes.

First you need to get rid of constipation and only then potty training. If constipation is not treated in a timely manner, this will entail unpleasant consequences for the health of the child. nine0003

Pediatric gastroenterologist: where to turn for help?

To get rid of such a problem, it is necessary to visit a pediatric gastroenterologist. First you need to find out why constipation occurs, adjust the diet, after which, depending on the cause, competent therapy is prescribed.

Contact the First Children's Medical Center: we employ pediatric gastroenterologists who have experience working with children of all ages. We monitor the constant improvement of staff qualifications and offer the services of only highly qualified doctors. nine0003

You can sign up for a consultation from 8.00 to 20.00 by calling (8452) 244-000. Reception is by appointment.

Constipation in children. Prevention. Diet therapy

home

Articles

Health

Sabitova Vasily Ilyasovna Gastroenterologist

06/21/2019

Constipation is widespread among both adults and children (5-30% depending on the diagnostic criteria). Symptoms become chronic in more than 30% of patients, not only cause discomfort and pain to the child himself, but also disrupt the quality of life of his family. nine0003

CONSTIPATION - a condition manifested by an increase in the intervals between bowel movements (compared to the individual norm) or systematically slow, difficult and / or insufficient bowel movements. Constipation also includes stools with “gruel”, but after defecation was absent for up to 3 days.

Constipation can be related to functional or organic causes (abnormalities, inflammation). In children, 90-95% of constipation is functional. The peak incidence of functional constipation falls on 2-4 years, when they begin to accustom the child to the potty / toilet. nine0003

Main causes of functional constipation

Pain
Fever
Dehydration
Wrong diet of a nursing mother
Insufficient drinking regime of a child with artificial feeding
Insufficient drinking regimen of a breast-fed child with the introduction of complementary foods
Early transition of the child to artificial feeding
Fast transition of the baby from one mixture to another (less than 7 days)
Irrational nutrition of the child (for a long time the child receives food with a large amount of proteins, fats and insufficient dietary fiber, abuse of drinks containing a large amount of astringents - tea, coffee, cocoa)
Excessive use of baby hygiene products or the development of an allergic reaction of the skin of the perianal area
Consequences of perinatal injuries of the nervous system
Rickets, vitamin D deficiency
Anemia
Impaired thyroid function (deficiency - hypothyroidism)
Food allergy, especially cow's milk protein allergy
Forced potty training, period of adaptation to new conditions (nursery, kindergarten)
Physical inactivity - a sedentary lifestyle
Mental trauma or stress
Systematic suppression of the urge to empty the bowels, associated, for example, with the beginning of attending a kindergarten, school, etc.
Taking certain drugs
Constipation in family members

Frequency of defecation in children of different ages

nine0185

Age	Number of bowel movements per week nine0180	Number of bowel movements per day
0 – 3 months breastfeeding artificial feeding	5 - 40 5 - 20	2.9 2.0
6 - 12 months	5 - 28	1.8
1 - 3 years	4-21	1.4
4 years and older	3 - 14	1.0

In addition to the frequency of the chair, you should pay attention to its nature. For a more objective assessment, the “Bristol fecal shape scale” is convenient, since it is the shape of the feces, and not the frequency of the stool, that is more consistent with the time of intestinal transit. nine0003

Bristol stool scale

In accordance with this scale, 3 and 4 form of feces is regarded as normal, and 1 and 2 indicate delayed transit (constipation). Quite often, in practice, there are situations when a child has a bowel movement frequency within the normal range, but the stool is dense, fragmented, in a meager amount. These signs indicate incomplete emptying of the bowels and are considered as manifestations of constipation. nine0003

The consistency of the stool in newborns and infants should be mushy. From 6 months to 1.5 - 2 years, feces can be both formalized and mushy. From the age of two, the chair must be decorated.

Signs and symptoms of constipation

abdominal pain, often bursting, aching, sometimes colicky
bloating
change in the shape and consistency of the stool
unpleasant smell of flatus and stool
may have pain during bowel movements
straining to defecate
there may be blood in the stool - on the surface of the feces or in the form of traces on a napkin (indicates an anal fissure)

If you do not eliminate constipation and do not establish bowel movements, then there is a risk of coprostasis (formation of fecal stones) and fecal intoxication:

loss of appetite
lack of energy
general malaise
depression, irritability
nausea, vomiting
skin symptoms - dryness, rash, peeling
fecal incontinence, stool spotting
urinary retention and incontinence due to pressure from a crowded bowel on the bladder

The treatment of constipation involves the following goals:

1. Normalization of stool consistency (soft, painless stools)

2. Regularity of bowel movements (prevention of re-accumulation of feces)

The treatment of constipation is a sequential, complex, individual process and consists of several stages:

child and parent education
correction of nutrition and drinking regimen
elimination of existing coprostasis with the help of medications
maintenance therapy

It is necessary to exclude factors that provoke and contribute to constipation (normalization of motor and nutritional regimen, discontinuation of medications that can cause constipation, identification of a food allergen, exclusion or confirmation of neuromuscular disease, celiac disease, etc.). nine0003

Lifestyle normalization includes:

development of a conditioned reflex
active lifestyle
gymnastics
light abdominal massage training
for small children - laying out on the stomach, bending the legs to the stomach.

Education is the first step in the treatment of functional constipation. It must be remembered that episodes of fecal smearing and encopresis (fecal incontinence) are not arbitrary and should not be blamed on the child, who may already be frightened and disoriented. In some cases, when the intra-family situation is difficult, the help of a family psychologist may be needed. nine0188

It is important to understand that the treatment of functional constipation can be lengthy, based on trust, partnership and requires patience. Modern laxatives that are legal in children will not make the intestines “lazy”, will not cause “addiction”, they enter the bloodstream in minimal amounts or are not absorbed at all and are safe for long-term use.

Correction of the behavior of a child with constipation is based on the development of a routine of visiting the toilet, in order to achieve regular defecation. Defecation should be every time at the same time. The urge to defecate is based on the gastrocecal reflex, which manifests itself in the morning 1 hour after eating. A child with constipation needs to spend 3-10 minutes in the toilet (depending on age). It is necessary to plant the child on a potty or offer to visit the toilet after each meal. nine0003

A prerequisite for effective defecation is to provide a good support for the legs (a low bench on which the child can put his feet), which helps to increase intra-abdominal pressure.

If the defecation is not successful, the child should never be punished and vice versa. The daily frequency of bowel movements can be noted in a diary, which can be analyzed at a scheduled visit to the doctor.

Treatment of constipation should begin with lifestyle changes, which include dietary modification, drinking regimen and physical activity. nine0003

Calculation of fluid volume for healthy children

Children under 1 year of age should drink at least 100 ml of water per day.

For healthy children weighing 10 to 20 kg the water requirement is calculated using the formula:

100 ml (volume of water for children under 1 year old) + 50 ml per kg for body weight over 10 kg.

For example, with a mass of 12 kg: 100 ml + 2 x 50 ml = 200 ml.

A child weighing 20 kg should drink water: 100 ml + 50 x 10 = 600 ml

For children weighing over 20 kg the following formula is suggested for calculation:

600 ml (volume of water for a child weighing 20 kg) + 20 ml for each kg over 20 kg.

For children over 3-5 years old you can use the calculation of the amount of water: 30ml / kg of weight

Principles of Dietary Therapy for Constipation:

meeting physical needs for nutrients and energy
exclusion of excessive consumption of proteins and fats, which can inhibit intestinal motility
enrichment of the diet with dietary fiber
normalization of intestinal microflora with pro- and prebiotics

If the child is breastfed, then the mother's nutrition is corrected (restriction of products that promote gas formation). With artificial feeding, special mixtures are shown. For constipation associated with an allergy to cow's milk protein, therapeutic mixtures are prescribed if the child is bottle-fed. If the child is breastfed, cow's milk and products based on it are completely excluded from the mother's diet. nine0003

After the introduction of “thick” complementary foods, boiled water is necessary for all children, regardless of the type of feeding.

For older children, it is recommended to eat foods rich in vegetable fibers. It is not recommended to “smear food”, puree, “snacks”, “eating on the go”. Food should be crumbly, meat / poultry / fish - “piece”. A “bulk” breakfast is required to stimulate the “gastrocecal reflex”.

The main source of coarse-fiber vegetable fiber, containing a large amount of dietary fiber, is cereal bran, rye bread, as well as a number of vegetables and fruits. According to the principles of evidence-based medicine, a statistically significant increase in stool frequency and improvement in its consistency was demonstrated with the use of fiber compared with placebo. nine0003

Bran, as the main source of vegetable fiber, is recommended to be added to the second and third courses, after pouring boiling water over it and settling for 20 minutes. Bran can also be used in between meals, drinking plenty of fluids. For school-age children, the total amount of fluid when taking bran should be at least 1.5-2 liters per day, otherwise they mainly act as sorbents, absorbing fluid from the intestines, thereby increasing constipation. The dose is selected individually, it is recommended to start with 1 teaspoon 2-3 times a day, with a gradual increase to 40 g per day. When the effect is achieved, the dose is reduced and limited to one dose. nine0003

The American Academy of Pediatrics (2009) recommends a fiber intake of 0.5 g/kg/day (maximum 35 g/day) for all children. Fiber intake below the minimum recommended value has been shown to be a risk factor for chronic constipation in children.

However, long-term intake of a large amount of plant fibers due to fermentation by intestinal microflora is naturally accompanied by bloating and flatulence.

Children with constipation are shown to take cool liquids on an empty stomach (drinking and mineral water, juice, compotes, kvass), to enhance the laxative effect, it is possible to add honey, xylitol or sorbitol. It is very beneficial for bowel function to increase the intake of juices containing sorbitol/sorbitol, such as juice from plums, pears, apricots, peaches and apples, nine0003

With “sluggish” bowel function (hypomotor constipation), cool mineral water of medium and high mineralization is used, such as Essentuki 17, Batalinskaya, Arzni, Donat Magnesium, etc.; with spastic constipation (hypermotor constipation, stool form more often type 1) - warm and low mineralization (Essentuki 4). Calculation of mineral water - 3-5 ml / kg per day.

It is necessary to limit milk in its pure form and in dishes, as flatulence may occur with the appearance or intensification of abdominal pain. It is better to replace whole milk with sour-milk products - kefir, acidophilus, yogurt, yogurt, etc. nine0003

The diet of children with constipation includes dishes rich in vegetable fiber - salads from fresh vegetables, greens 2-3 times a day, baked apples, stewed vegetables, diluted vegetable and fruit juices with pulp. Food is cooked mostly unground, steamed or boiled in water.

It is preferable to take raw vegetables and fruits (in the absence of contraindications). Especially recommended are tomatoes, zucchini, pumpkin, carrots, beets, lettuce, cauliflower, apples. Dried fruits (prunes, dried apricots, figs) are given in soaked form and as part of cooked dishes. White cabbage, young green beans, green peas are allowed with good tolerance. Parsley, dill, celery are good to add to various dishes and salads. nine0003

If after reading the article you still have questions or you do not understand how to apply the recommendations in your particular case, we invite you and your child to be examined by a pediatric gastroenterologist at the DDC. For the convenience of parents, you can make an appointment with a pediatric gastroenterologist at the Children's Diagnostic Center on a weekday and on Saturdays.