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Constipation: In Infants and Children.

A. Infants

The infants can develop constipation at anytime after birth. There are two concepts of constipation. One is the situation where the infant does not have a BM for 1-5 days but the stool is soft and runny. The other situation is where the stool comes out hard or molding clay consistency and there is pain when moving their bowels. The infant stools should be apple sauce consistency for the first 6-9 months.

Where the infant does not have a BM for awhile and the stool has normal consistency, the problem is that the sphincter does not relax and let the stool out. If the infant is acting normal, then wait for the stool to come out on its own. If the infant is fussy, then stimulate the sphincter to relax in one of two ways. One is to take the temperature with a thermometer and lots of Vaseline. The other is to insert an Infant Glycerin Suppository inside the anus. You can purchase these suppositories in the local drug stores. You can use this method several times a week to keep the infant more regular and not get into a habit. It would only be habit forming if you are still doing this at 2 years old. Only do this if the infant is fussy. There are many babies (usually breast fed) who have one BM a week and are growing and happy.

The second situation of hard stool needs to be treated by diet. Infants are best treated with fruits and juices. It is safe to start juice as early as 2 weeks. Use Apple, Pear, or Prune. You may use adult juice but dilute it more i.e. 1 part juice to 3 parts water. We usually dilute the infant cans of juice half and half with water. Start with 1 ounce two times a day and increase to several ounces several times a day depending on how loose the stools are. Some babies need such a large amount of juice to keep their stools loose that the parents put juice into every bottle of formula. To have the formula at the correct dilution, during preparation of the Milk, use strength juice to add to the powder or concentrate formula. That way the formula is at the correct concentration but the juice is in the formula. Mix every bottle that way and then adjust how much juice is in the water that you add to the powder, and try all three types of juices. Find out which one works and keep it up all the time or they will become constipated again.

B. Children

In older children usually 1 to 6 years old, the constipation is hard stools rather than lack of stooling loose stools as we see in infants. I have not found fiber very helpful but it does not hurt to try. We still prefer fruits and juices. The stools should be mashed potatoes to molding clay in consistency like ours. If it hurts to have a BM, then they will start to retain their stool and if you are in that situation there is an article here about stool soiling (Encopresis) that you should read. To loosen the stools, one tries different fruits or juices: such as Apple, Pear, Grape, Prune. If giving them large quantities of this does not help, then you can give Miralax. It is not habit forming. Start with 1/2 capful a day a day and increase or decrease the amount as needed every 2-3 days. Some need more doses 2 times a day. 

Keeping the child from constipation will help potty train them if it does not hurt. Remember males train later than females. It is harder for the male to move their bowels than females. So have patience with training and potty times. We all get potty trained some day.  It is more important to work on vocabulary and discipline.

Dr. Knapp

See video on this:  Constipation