| A: It’s impossible to tell if this could possibly be serious from the information provided. An important first question for parents is, how do we know this is true constipation and not just a normal pattern?
For starters, is there straining, or is it that the infant has infrequent bowel movements, like every 3 to 4 days? Many parents often mistakenly think that going a few days without a bowel movement is constipation. By itself, just not having a bowel movement every day doesn’t mean constipation. A definition of constipation may be helpful.
Constipation is discomfort or painful straining when having a bowel movement—either because the stool is too hard or large to pass, or when there is inability to pass stool because of some physical abnormality.
If there is no straining and the stool is normal—it’s not constipation. Some normal children, and adults have only one or two bowel movements a week with no discomfort. I know that this can be difficult to accept, but it is true.
Constipation can be either acute (sudden) or chronic (long standing). The most common causes include:
- Dietary insufficiencies are the most common cause-too little fiber (bran, fresh fruits and vegetables) and water intake.
- Eating constipating foods in excess, like excessive cheese, yogurt and milk.
Another common cause is an anal fissure. Constipation may result when a hard stool stretches the anus causing a tear in the lining. The clue is pain and bright red blood streaked on the outside of the stool or toilet paper. The child becomes fearful of the pain, setting up a cycle of retaining even more stool. Sometimes this can lead to a fecal impaction or partial blockage, causing abdominal and rectal pain. This may be associated with overflow diarrhea (liquid stool leaking around the impaction). If blockage is suspected, an appointment is needed quickly for examination and treatment.
There are other more serious but much less common medical and anatomical causes of constipation that require prompt evaluation by your primary care clinician. Two examples are an under active thyroid condition (hypothyroidism, usually with associated symptoms like poor growth, intolerance to cold, and decreased physical activity), and a disorder called Hirschprung’s disease where there is a lack of nerve endings surrounding the rectum. The diagnosis of Hirschprung’s disease requires specialized diagnostic testing by a pediatric gastroenterologist; treatment is surgical.
As for treatment of non-medical constipation, dietary management is always strongly preferred.
- Increase fiber in the diet-serve bran cereals with added raisins or prunes, prune juice, fresh fruits and vegetables, and popcorn (not in toddlers-can cause choking).
- Avoid constipating foods like excessive cheese.
- Encourage regularly scheduled bowel habits and routine.
| -- Take Home Message -- |
| If your child truly has constipation, it will usually be temporary and of short duration. Dietary management is always preferred to medication. For a small minority of children, other treatment may be needed if improved diet doesn’t work. Before resorting to stool softeners, laxatives, or mineral oil always consult your primary care clinician for evaluation to rule out more serious causes, and for treatment advice.
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