Constipation is one of the most common conditions we see in childhood. The causes tend to be different at different ages, and treatments should be based on the cause. Untreated, constipation can progress from a mild discomfort to a serious health risk. Paying close attention to your child’s stooling patterns and acting early are the best ways to ensure a healthy and happy pooper.
Hard stools presenting in the first few months of life merit a visit to the pediatrician. Frequency of stools are less important at this age – there are many babies (especially breastfed) that stool only once or twice a week. Given their liquid diet, loose or pasty stools are expected, and small, hard balls of stool are never normal at this age. Causes that your provider will consider include congenital problems with the shape or function of the intestines, genetic conditions like cystic fibrosis, and food allergies/intolerances (most commonly an allergy to milk proteins). Careful monitoring of your baby’s weight gain, overall growth, and development are key to measuring the success of treatment for any of these causes.
Solid foods tends to produce more solid stools, and as your baby becomes a toddler and eats a more varied diet, their stools are likely to change. The most common causes of constipation (which can be hard, painful stools and/or decreased stooling frequency) in this age group include insufficient water intake, too much milk/dairy products, and lack of fiber. The first step to treating hard stools in the toddler years is to limit milk and cheese. Dairy foods are a good source of calcium and brain-boosting fats, but they are not the only way to get these nutrients. Check out http://www.choosemyplate.gov for great ideas of non-dairy sources of calcium, and recommended daily intake amounts for your child.
Next, try to increase water intake. Keep a cup of water in reach throughout the day, make it more appealing by adding ice or a special straw or sticker, or as a last resort, flavor the water with an ounce or two of juice to encourage them to drink more. While juice intake should be limited, when given it should be 100% fruit juice instead of the extra sugary blends like Sunny D or fruit punches. Juices made from fruits that begin with P (pear, prune, etc) tend to help the most with constipation. If you can also get your child to consume a high fiber diet with lots of fresh fruits and vegetables, even better – but this is notoriously hard to do with toddler appetites. If these diet changes don’t produce softer, regular stools, discuss fiber supplements and laxatives with your pediatrician. They are a safe and effective way to keep poop soft and painless.
School-aged and beyond
About the time your child gets to school age, you can reason with them a bit about the importance of fiber and water to make healthy stools. Busy schedules, pickiness, and hesitancy to use the school bathroom to go number 2 are all common causes of constipation in this age group. Help your child understand the importance of drinking enough water every day (keep track of how many bottles finished in a day if needed). Continue to encourage fresh fruits and veggies and other high fiber foods at meals and snack times. Help create a routine to try and enable stress-free pooping in the mornings or evenings, and work with the school to make sure pooping on the premises is as smooth a process as possible. By this age, stress and emotions can really affect stooling patterns, so watch for abdominal pain and stool changes that worsen before tests or other big events. They may even be the first hint of bullying. When all else fails, treating with fiber supplements, stool softeners, and laxatives are a much better option than missing school for pain or ending up in the hospital for severe constipation.
Poop is gross, but talking about it with your child and pediatrician is not. Help your child be comfortable talking about their body processes with you and their provider. I assure you, we have heard and seen it all before. We have lots of ideas for helping your child poop and can partner with nutritionists and gastroenterologists to ensure that even the hardest (pun-intended) cases are solved.
Anne Welch, MD is pediatrician in Boston, MA. She writes about pediatric health topics and parenting at her bloghttp://www.cactusinthecommonwealthpeds.com.