Constipation?! Ah, yes, we have to talk about it. It’s a BIG issue in our household and drives me and my husband crazy. As if a 3 year old’s obsession with the word “poop” isn’t enough on this subject.
Parent have to think about constipation from the beginning of their baby’s life. We document how many nursings and “soiled diapers” we have. We hear on the playground that “baby Sophie hasn’t pooped in 7 days- is this normal?” Then we move on to potty training, where constipation can be a real issue. Our Expert Pediatrician, Dr. Gilgoff discusses what we can do about constipation at all ages.
How To Deal With Constipation In Children by Dr. Hugh Gilgoff
I warmed up the crowd with some common newborn issues (please see old posts), and I somehow survived giving some advice on vaccines. Then we had a nice chat about asthma, so of course it only follows that we start talking about good old “number 2”. You should see the face on the young ones when I ask about their poop in the office. But stooling issues, and constipation specifically , is one of the most common issues that we deal with as both pediatricians and parents.
Constipation in the newborn:
I get so many calls about constipation in the first few months. Typically, the baby hasn’t stooled for over 24 hours, and they may be straining, twisting, and even turning red. Although this is tough to watch, this is common and often normal. The key issue is the consistency of the stool. Constipation is hard, well-formed stool. It can cause bleeding, as the hard stool can actually tear the fragile skin near the rectum, and it can indeed cause pain and discomfort.
But there are also normal phases of development that occur. The intestines are not fully mature in a lot of babies, and it takes a lot for a baby to learn how to break down their milk into amino acids, carbohydrates, fats etc. Quite often, the baby may also have a little bit of colic, and this adds to the fussiness of digestion. The bottom line is that straining and turning red, even when coupled with no stool for a day or two is rarely a cause for concern. Some breastfed babies even skip 5-7 days without pooping, and yet each time they stool it is soft and normal.
Treatment for the newborn:
That said, if the stool of a newborn is indeed hard and very well formed, there are some interventions that are safe and effective. I would start by giving one ounce of straight water, and if that doesn’t work after 4 hours, I would give one ounce of straight prune juice. If you still don’t get a result after 4 more hours, I would give 1 ounce of water AND one ounce of prune juice. If you still don’t get a result after 4 more hours, then I would give a pediatric glycerin suppository.
Of note, there are indeed some medical causes for constipation in the newborn. Low thyroid (hypothyroidism) can cause this, but ALL babies are screened for this in the newborn screen. And it is crucial to remember whether your baby had a stool in the first 24 hours of life, as a rare but serious condition called Hirschsprung’s, where there are no nerves in the rectum, can present with chronic constipation since birth.
Constipation in the child:
A very common time for constipation is toilet training. If too much pressure is placed on a youngster, they may rebel and hold their stool. This leads to more water absorption, and the stool only gets harder. The harder it gets, the more they hold, and so on. So whether your child is learning to use the potty, or a full grown teenager, encourage them to use the toilet at the first urge, and not to hold their stool.
Dietary interventions are always my first choice. Common offending foods are rice and bananas – neither of which should be eliminated, but perhaps not given each and every day. You want to increase the water as much as you can. You can give prune juice straight, or mixed with apple juice or water, and dried prunes or apricots are also great. Giving bran, in the form or cereal (ok – mix it with a favorite, even slightly sweetened cereal if you have to) or muffins (try low fat) helps a lot. And of course increasing the roughage and fiber in general helps.
Safe Medicines for children:
When it comes to medicine, we need to go with safe and effective options that won’t taste horrible. Mineral oil is a very safe lubricant, but shouldn’t be given to young ones straight, as they may choke and swallow it to their lungs. Milk of magnesia, senna, colace and others have been around for a while, and still have a role in certain cases. But without a doubt, miralax is the most common medicine used by pediatricians and gastrointestinal specialists alike. It’s a safe, effective and tasteless medicine that can be used as a quick cure, or a maintenance medicine. For the younger kids, we’ll use half of a capful of the powder, and older kids will get a full capful each and every day for weeks to months without side effects. You mix the medicine with 8 ounces of juice or water, and can titrate down if there are too many loose stools.
If I feel hard backed up stool in the lower left quadrant of the abdomen, this means that the child is completely backed up, and then we need to turn to pediatric glycerin suppositories or even pediatric fleets enemas. These are usually given nightly for 3 nights, and are without a doubt more effective than oral medications. So while there are indeed the potential for emotional issues with rectal medications, they are safe and effective when used appropriately.
Constipation is more common than you would think. While we all talk about colds, coughs, sleep issues and percent tiles, our child’s stooling habits is not the hottest topic in the playground. But if your child is suffering with hard painful bowel movements, this can cause considerable agony. So talk with your doctor immediately before the vicious cycle of pain and retention begins
Dr. Gilgoff is a pediatrician who is known for his balanced approach to medicine, combining a western training at top institutions with an alternative outlook shaped by a mom who is both a midwife and creator of Mother Nurture Inc. – a Doula company since 1987. Dr. Gilgoff worked in Manhattan for 11 years, and since 2007 practices with the LICH group on 185 Montague Street. Dr. Gilgoff is available for free prenatal consults, second opinions, and accepts new patients with all types of insurance plans.