Constipation
Just about everyone thinks their infant or child is constipated at one time or another. Ironically constipation occurs much less frequently in infancy and much more frequently in childhood than people might think.
Constipation is defined as hard and infrequent stools. An infant that has a normal textured stool every 3rd day is not constipated, no matter how much he/she seems to strain in the interval. Babies strain from time to time, this is normal even if stool does not come out. If your baby is fussy and you think constipation may be the reason, see the FAQ on fussy babies for more information about this. If the stools are truly hard (not just formed, but HARD) a couple ounces of pear juice per day or one tablespoon of Kayro syrup per day might do the trick. Having your infant evaluated is advisable, however, to make sure there are no physical problems.
There are a couple periods where we do see true constipation frequently. The first is when an infant switches from formula to whole milk. This situation is generally temporary and can be ameliorated by transitioning from formula to milk gradually (e.g. half and half for a few days before going strictly to whole milk). The other period is the preschool and grade school years. These children are prone to constipation for a couple reasons. One, they are notorious stool holders. Playtime is too important to interrupt for pooping! Two, they may be in a school or daycare where having a bowel movement may not be so easy. Bathroom privileges are not easily obtained, and the bathrooms themselves may be uncomfortable for the child (for example open toilets). The resultant stool holding leads to harder stools, the child becomes scared to have a BM anywhere, leading to more stool holding; and thus the vicious cycle is born. Interestingly these children may present to our office with complaints of diarrhea. "My child is having wet accidents in his underwear". This is called encopresis, and occurs when new stool slips around the hard rocks in a child's dilated rectum and ends up in the underwear. The child may not even feel it. If your child has this problem, have him/her seen for evaluation and treatment. The treatment process usually requires an initial clean-out, and then months of a gentle laxative. Withdrawing laxative therapy too soon commonly results in relapses. There is no risk of "lazy bowel" with this therapy.
The following are conditions that may be associated with constipation and should be medically evaluated;
1. Has your infant gone longer than 4 days without a BM? If so, have him/her seen within within a day.
2. Do you smell fecal matter in your infant or child's breath or in his/her vomit? If so, take him/her to the ER immediately as there may be a dangerous obstruction.
3. Has your infant or child had bowel surgery in the past? Has he/she gone 3 or 4 days without a stool and is now vomiting? Again, there may be a dangerous obstruction. Go to the ER immediately.
4. Is your infant or child exhibiting poor growth? There may be a hormonal problem, such as low thyroid. There may be a problem with the nerves in the intestines, called Hirschprung's disease. Or, there may be a formula/food allergy.
5. Has your child been gaining weight excessively? Is he/she excessively fatigued? Feels cold all the time? Losing hair? Again, low thyroid may be the culprit.
6. Has your child become reclusive? Has he/she made sexual comments or gestures? Has he/she voluntarily mentioned any inappropriate touching by anyone? Sexual or physical abuse can lead to constipation.