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when stools become hard and are difficult to pass. Some parents are overly
concerned about how often their child has bowel movements, because they have
been taught that a healthy child has a bowel movement every day. This is not
true. The frequency of bowel movements is not as important as whether the child
can pass stools easily. Your child is not constipated if his or her stools are
soft and pass easily, even if it has been a few days since the last bowel
Newborns younger than 2 weeks should have at least 1 or
2 bowel movements a day. Babies older than 2 weeks can go 2 days and sometimes
longer between bowel movements. It's usually okay if it takes longer than 2
days, especially if your baby is feeding well and seems comfortable. Breast-fed
babies are more likely to have frequent stools and may have a stool as often as
every feeding. Constipation is likely to occur when a baby changes from breast
milk to formula, especially if this change happens during the first 2 to 3
weeks of life.
As babies grow older, the number of bowel movements
they have each day gets less and the size of their stools gets bigger. A child
age 3 or 4 years may normally have as many as 3 bowel movements a day or as few as 3
It is important for parents to recognize there are many
"normal" patterns for bowel movements in children. Some children may appear to
have trouble passing a stool. The child's face may turn red, and he or she
may strain to pass stool. If the stool is soft and the child does not seem to
have other problems, this is not a concern.
Most children will
occasionally become constipated. The problem is usually short-lived and does
not cause long-term problems. Home treatment is usually all that is needed to
relieve occasional constipation. Causes of constipation include:
Constipation may occur with cramping and pain if the child is
straining to pass hard, dry stools. He or she may have some bloating and
nausea. There may also be small amounts of bright red blood on the stool caused
by slight tearing (anal fissure) as the stool is pushed
anus. All of these symptoms should stop when the
constipation is relieved.
For reasons that can't always
be identified, some children often develop constipation that does not get
better or go away with treatment (chronic constipation). The most significant
factor may be the painful passing of a hard, dry stool. After a while, the
child may be unable to resist the urge to have a bowel movement and will pass a
large mass of stool. The child may have to "push hard" during the bowel
movement, which may be painful. Passing the stool relieves the pressure and
pain until another mass of stool collects, and the cycle is repeated. Fear of
pain may cause the child to try to hold the bowel movement.
causes of chronic constipation may include:
The child may be unable or unwilling to pass the stool
regardless of its size. Liquid or loose stool may leak out, soiling the child's
underwear. When this occurs in a child who is past the age of normal toilet
training, it is called
Chronic constipation usually
requires several months of treatment and cooperation between the parents, the
child, and the doctor to overcome the problem. Don't be discouraged if the
problem comes back during these months. The rectum is made of muscle tissue;
when a child has had chronic constipation, the muscle becomes stretched. It may
take several months to get the muscle back into shape.
In rare cases, constipation in children may be caused by
other health problems, such as:
Check your child's symptoms to decide if and when your
child should see a doctor.
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Constipation can usually be treated
effectively at home.
Call your doctor if any of the following occur during home
A nonconstipating diet is the best way to
prevent constipation. If constipation develops, a nonconstipating diet will
help restore normal bowel movements.
For babies younger than 12
For children age 12 months and older:
Constipation sometimes becomes a
problem when children start toilet training:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your
doctor diagnose and treat your child's condition by being prepared to answer
the following questions:
August 2, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & David Messenger, MD
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