Constipation is a common issue. The age at which your child experiences this problem will shape the discussion and approach we have to resolve the problem.
Newborns should pass a meconium stool in the first 24 hours of life. This will be followed closely and observed.
Breast fed babies will initially have a stool almost after every feed in the first 2-4 weeks of life. Later, at 1-2 months of age, they may go 1-5 days without a stool. However, when it passes after several days of watchful waiting, we recommend getting out of the way! It is not technically considered constipation when the stool is water or creamy, even if it has been 1-5 days since the last bowel movement.
Toddlers and older children will often have issues with constipation. In this age group, a child is considered constipated when having hard stools (this can be daily) or after not having a bowel movement for several days.
Note-Toddlers who are not ready for or resist potty training will often hold their stools in. This can be voluntary or involuntary. Your child may not realize that he/she is doing this. The stool withholding is often rooted in fear and apprehension about taking this big step.
It is common for children to experience any number of fears around potty training. This includes fear of letting the stool go, sitting on the potty/toilet and slipping or falling into the potty/toilet, splashing sensations while using the potty/toilet, sound of flushing the toilet or the overall sense of a loss of control.
This can create a cycle of stool withholding. Hard stools cause pain. Your child then develops fear of letting the stool go (even if it might be soft) because it may hurt again. Holding it in makes the stool more hard and so on. Please seek our advice on helping your child break this cycle.
In general, having soft bowel movements is all about fluids and fiber. Plenty of water and a fiber rich diet go a long way. This includes plenty of fruits and vegetables. For the picky eaters, we may recommend fiber gummies and benefiber as supplements while you work on increasing the variety in your child’s diet.
Super foods to help with softer stools-Kiwi (natural laxative), berries, watermelon, prunes, peaches, pears and plums.
Foods to avoid-bananas (especially if more ripe), white rice and applesauce. In general, processed foods that are low in fiber and nutrition will not help with constipation. These are treats and once in a while foods. Adolescents who drink caffeine need to be educated that it is a mild diuretic and can take fluids out of the body. It should be avoided in general if fluid losses are not actively replaced with water.
Depending upon the duration and extent of the constipation, we may recommend stool softeners and other digestive aids such as probiotics. Stool softeners are helpful while you encourage (or beg) your child with improving the intake of fruits, vegetables and water.
It is helpful with digestion in general to teach children to take advantage of the gastro-colic reflex. This is an amazing feedback loop in our bodies. When we eat and our stomachs are full, the happy stomach sends a signal to the brain. The brain then sends a signal to the colon to empty out. This is the body’s way of making room for the food to travel from the stomach, through the small intestine and then the large intestine or colon. In our busy lives, we often ignore this signal. Children would rather play than stop and go to the bathroom. This can cause the stool in the colon to hang out there too long, get more and more water removed from it and then get harder and smaller.
When constipation is an issue, it is best to ask children to try and sit on the potty about 10 minutes after each meal in order to empty out the colon. The proper way to sit is with the knees bent at a 45 degree angle. This will often require a small stool under the feet for younger children. Your child’s feet should comfortably plant on the floor or a stool. They should not extend out with legs straight. Sitting should not be with feet planted on tippy toes. This prevents your child from using the abdominal muscles to push the stool out.
Your child can sit and try for about 5 minutes. This should not feel like punishment and should be gently encouraged. Regularly emptying out the colon will decrease hard stools and improve your child’s sense of control over his/her body.