Springdale Mason Pediatrics

Constipation (Age 6-21)

Definition

  • Can't pass a stool or pain (crying) when passing a stool
  • Can't pass a stool after straining or pushing longer than 10 minutes
  • Passes stools infrequently
  • Pass stools every 3 days or longer

Call or Return If

  • Constipation lasts more than 1 week after making changes to diet
  • You think your child needs to be seen
  • Your child becomes worse

About This Topic

Normal Frequency of Stools

  • The normal range is 3 stools per day to 1 every 2 days.
  • Kids who go every 4 or 5 days almost always have pain with passage.
  • Kids who go every 3 days often drift into longer times. Then, they also develop symptoms.
  • Any child with pain during stool passage or lots of straining needs treatment. At the very least, the child should be treated with changes in diet.

Normal Stools and Normal Behaviors

  • Brief straining under 10 minutes can occur at times at any age.
  • Large stools. Size relates to the amount of food eaten. Large eaters have larger stools.
  • Hard or dry stools are also normal if passed easily without too much straining. Often, this relates to poor fiber intake.

Causes

  • High milk or cheese diet
  • Low fiber diet
  • Postponing or holding back stools because of pain
  • Slow passage of food through the intestines. Most often, this type runs in families.

After Care Advice

Overview:
  • Constipation is common in children.
  • Most often, it's from a change in diet. It can also be caused by waiting too long to stool.
  • Passing a stool should be pleasant and free of pain.
  • Any child with pain during stool passage or lots of straining needs treatment. At the very least, they need changes in their diet.
  • Here is some care advice that should help.
Diet for Children:
  • Increase fruit juice (apple, pear, cherry, grape, prune). Note: Citrus fruit juices are not helpful.
  • Add fruits and vegetables high in fiber content. Examples are peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes, or dates. Offer these foods 3 or more times per day.
  • Increase whole grain foods. Examples are bran flakes or muffins, graham crackers, and oatmeal. Brown rice and whole wheat bread are also helpful. Popcorn can be helpful.
  • Limit milk products (milk, ice cream, cheese, yogurt) to 3 servings per day.
  • Give enough fluids to stay well hydrated. Reason: This keeps the stool soft.
Stool Softeners:
  • If a change in diet doesn't help, you can add a stool softener.
  • Miralax is a good one. Give it each day with dinner.
  • Dose: 2 teaspoons (10 mL) powder mixed in 4 ounces (120 mL) of water or fruit juice.
  • Stool softeners should produce soft stools in 1 to 3 days.
  • After 1 week, try to phase it out.
Encourage Sitting on the Toilet:
  • Set up a normal stool routine.
  • Have your child sit on the toilet for 5 minutes after meals.
  • This is especially important after breakfast.
  • Once he passes a normal size stool, he doesn't need to sit anymore that day.
Squatting Position to Help Stool Release:
  • The squatting position gives faster stool release and less straining. Reason: it lines up the rectum with the anus.
  • The squatting position means that the knees are above the hips.
  • For most children who sit on the toilet, a foot stool is needed.
  • It is an important part of treating constipation.
Prevention of Constipation:
  • Eat a high fiber diet. Drink plenty of fluids.
  • Sit on the toilet and pass a stool around the same time each day.
  • Don't ignore the signal of a full rectum.
What to Expect:
  • Most often, changes in diet helps constipation within a few days.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2020 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
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