Constipation

YOUR CHILD AND CONSTIPATION
Updated Fall 2001 by Joni Bosch, PNP
Center for Disabilities and Development

What is constipation?

When a person has hard or very infrequent bowel movements, the condition is called constipation . Constipation is a common problem for children and adults with disabilities. A variety of factors, including feeding problems and some medicines, can cause constipation.

Why should constipation be prevented?

Constipation can cause stomach pain, decreased hunger, and fussiness. Bowel movements can become painful. Pushing to pass a hard stool can cause hemorrhoids and bleeding around the rectum. Pushing can also force bowel tissue out through the rectum. If constipation becomes serious, the stool may become stuck. This blockage may require surgical treatment.

Ways to prevent constipation

Fluids - Drinking plenty of fluids is the best way to prevent constipation. One way to tell whether your infant is drinking enough fluids is to count the number of wet diapers. If you count fewer than 5 wet diapers each day, your baby needs more fluids. You should also give your child more fluids if the urine is dark yellow or has an odor. Ways to give your child enough fluids include:

• Give water or juices during the day, at meals and in between meals, too.
• Provide prune juice, a natural laxative, in small amounts (2-4 ounces) every day to help prevent constipation. Prune juice may taste better if mixed with another juice, such as apple, apricot, or cranberry juice. (Apple and apricot juice also help soften stools.)
• Freeze prune juice to make popsicles, which are fun for your child to eat.
• Don't mix honey with formula to treat constipation. In babies less than one year old, honey can cause a very serious illness called botulism. Karo syrup may also contain botulism spores that can harm young infants.

High-fiber foods - Fiber makes the stool softer and easier to pass. Increasing the fiber in your child's diet can help prevent constipation. To add more fiber to your child's diet, you can:

• Provide at least 2 servings of fruits each day. Fruits with the peel left on - such as plums, prunes, raisins, apricots, and peaches - have a lot of fiber. Give your infant strained prunes, up to 3 tablespoons each day.
• Provide at least 3 servings of vegetables each day. The skin from a baked potato has a lot of fiber.
• Provide cereals high in fiber, such as bran cereals, shredded wheat, whole grain cereals, oatmeal, and granolas. Avoid refined cereals, such as corn flakes.
• Provide whole wheat breads instead of white bread.
• Provide bran muffins, or blend bran cereal in a blender and add it to your child's regular cereal.

Limit high fat foods - Foods that are high in fat can cause constipation and should be limited. These foods include fried foods, lunch meats, bacon, cheese, and similar foods.

Exercise. The child whose activities are primarily watching TV and playing computer games will not get enough exercise, and this can lead to constipation.

What to do if your child becomes constipated

If your child is toilet trained and becomes constipated, have her sit on the toilet for about 5 minutes after each meal and try to have a bowel movement. This will be more comfortable, for a child whose feet don't reach the floor, if a footstool is provided. Reading a story or singing songs with you can help pass the time.

Laxatives - Your child may need to use a laxative to treat the constipation and prevent further constipation. Talk with your health care provider before you give your youngster a laxative. When you do, always start with the lowest dose. You may increase the dosage slowly if it isn't helping. Decrease the dose if the stools become loose.

You can get effective laxatives without a prescription that are safe to give to your child. These laxatives include:

Senokot - This laxative comes as a liquid, tablet, or granules. The granules can be mixed with food, such as applesauce or ice cream. Diarrhea or stomach cramps may occur if the dose is too high. Giving Senokot at night may reduce cramping. The amount of Senokot to give is:

• Child is one to 12 months old - 1/4 to 1/2 teaspoon liquid daily
• Child is older than one year - 1/2 to 2 teaspoons liquid or granules daily, or 1/2 to 2 tablets daily

Per Diem - This product provides both fiber and a laxative. There are two kinds of Per Diem, so be sure to buy the one that has senna in it. Fluid intake is very important when taking Per Diem. The amount of Per Diem to give is:

• Child is 7 to 11 years old - One teaspoon with at least 4-8 ounces of fluid at bedtime
• Child is older than 11 years - One to 2 teaspoons one to two times daily with 8 ounces (one cup) of fluid

Milk of Magnesia - This is a mild, fast-acting laxative. The amount of milk of magnesia to give is:

• Child is 2 to 5 years old - One to 3 teaspoons daily
• Child is older than 5 years - One to 2 tablespoons 1 to 2 times daily

Miralax - This prescription laxative is a tasteless powder. It can be disolcved in nearly any fluid, such as milk or juice.

Suppositories - If you have given your child laxatives for two or three days and the constipation isn't any better, you may need to use a rectal suppository to treat your child. The suppository should first be coated with a water-soluble lubricant, like K-Y Jelly, before inserting it into the rectum. Do not use Vaseline to coat the suppository; it is not water-soluble. A bowel movement will usually occur within 30 minutes of giving the suppository. Two good suppositories are:

Glycerin suppository (Babylax):

• Child is less than 2 years old - One infant-size suppository, inserted into the rectum
• Child is 2 to 6 years old - One child-size suppository, inserted into the rectum
• Child is older than 6 years - One adult-size suppository, inserted into the rectum

Bisacodyl suppository (Dulcolax):

• Child is less than 2 years old - 1/2 suppository, inserted into the rectum
• Child is older than 2 years - One suppository, inserted into the rectum

Enemas - Never give an enema to your child unless your health care provider -- your child's doctor, physician assistant, nurse practitioner -- has told you to do so. Giving enemas too often can be harmful.

Continue to give your child lots of liquids to drink if they are constipated.

When should I call my health care provider?

Call your child's doctor, physician, or nurse practitioner if the steps above haven't helped, and if your child:

• Has not had a stool for 4 or 5 days.
• Has a stomach that is hard and bulging.
• Has blood or mucous in the stools.
• Complains of a stomach ache.
• Vomits.
• Needs a laxative or suppository on a regular basis.
• Continues to have problems despite changing diet, drinking more fluids, and having a regular bathroom routine.

Please note -- Before using this information, please discuss it with your family health care provider.

Find more information about this subject in the online catalog of our Disability Resource Library.