Constipation is one of the common problems parents do often #AskThePaediatricians about. Constipation is the commonest cause of abdominal pain in children. So the goal of this post is educate parents about constipation, the likely causes, what to do when a child is constipated and more importantly how to prevent constipation.
What is constipation?
There are different ways to define constipation.
It can be defined as a delay or difficulty in defecation, present for 2 or more weeks; and sufficient to cause significant distress to the patient.
Due to lack of consistency in the different definitiona adopted, the medical community has what we call Rome criteria for categorically saying a child has constipation or not.
At least two of the following symptoms must be present for at least one month in infants and children up to age four years; and at least two months in children over four years of age:
⦁ Two or fewer bowel movement per week;
⦁ At least one episode per week of incontinence (involuntary passage of stools) after the acquisition of toileting skills
⦁ History of retentive posturing or excessive voluntary stool retention (over 4 years) or excessive stool retention (under 4 years);
⦁ History of painful or hard bowel movements or defaecation
⦁ Presence of a large faecal mass in the rectum (you can feel the stool in the tummy)
⦁ History of large diameter stools which may obstruct the toilet.
Constipation occurs in 5-30% of children
Various factors can lead to constipation in children. Common causes include early toilet training and changes in diet. Fortunately, most cases of constipation in children are temporary.
Encouraging your child to make simple dietary changes — such as eating more fiber-rich foods, fruits and vegetables and drinking more fluids — can go a long way toward alleviating constipation.
If your child’s doctor approves, sometimes constipation in children can also be treated with laxatives.
Why do we need to know about Constipation?
⦁ It increases the risk of recurrent urinary tract infections
⦁ Can worsen gastro-oesophageal reflux
⦁ Can cause painful anal fissures or tears
Most constipation in children are the functional types which occur from the vicious cycle of:
⦁ Painful, large stools – because of diet and poor water intake leading to
⦁ Fear of defecation then
⦁ Voluntary withholding of the stool then
⦁ Enlarging fecal mass in the rectum – then
⦁ Urge to defecate subsides then
⦁ Fecal loading and fecal soiling
Constipation however at times may be due to diseases or problems with the digestive tracts and such need to be taken more seriously.
The following symptoms and signs may help point to the worrisome type of constipation that require medical intervention and should be handled at the hospital. It is important to watch out for these red flags.
⦁ Early onset of constipation (as a baby)
⦁ Vomiting
⦁ Protrusion of anus
⦁ Wounds or ulcers around the anus
⦁ Severe abdominal swelling
⦁ Abnormal dimple at the back,
⦁ Weakness of the legs
These symptoms may point to diseases for which constipation is a major presentation. Examples of such diseases are Hirchsprung’s disease, Cystic fibrosis, Anal fissure, Intestinal obstruction and others. For such please see your Paediatrician urgently. There is no need to bore you with details! Sufficient to know that not all constipation is as a result of the child’s diet. There may be underlying problems for doctors to address.
How do we treat constipation?
Constipation must be treated because of the earlier reasons we gave above.
First thing is to educate the parents and indeed the entire family about constipation especially in those prone to chronic constipation. We explain how constipation occurs, the mechanism of fecal soiling and remove negative attributions. Parents are encouraged to maintain a consistent, positive, and supportive attitude in all aspects of treatment
Secondly, possible underlying disease conditions are ruled out by checking out for the presence of the red flags mentioned earlier.
If no red flags, the following initial treatment can be commenced:
⦁ Plenty of fluid intake…….as children increase in age the amount of water they must take each day increases….for example a 1 year old must take 1000ml or 1 litre of water every day….that is 4 glass cups of water daily!
⦁ Plenty of food rich in fibre especially fruits and vegetables. Some of these fruits are also rich in the laxative agent sorbitol like Prunes, apple amongst others.
⦁ Drugs that make it easy for the stools to come out (laxatives) can be given. There are different types and sometimes we need to combine them. Examples of such drugs include liquid paraffin, lactulose, sorbitol etc.
These treatments may need to be given for a while before we stop. Sometimes parents stop taking the drugs too early. Please be patient especially if the constipation has been present for months.
If the faeces have become so hard and big that even with drugs they are difficult to remove – what we call impaction; the doctors may have to remove the faeces manually like a minor operation.
For those who have underlying abnormalities or neurological diseases causing constipation, the underlying diseases will also need to be treated…for example Hirschsprung disease will need operation and so on.
The most important thing in management of Constipation is PREVENTION!
1. FLUIDS – plenty of it especially water.
2. DIET – Adequate fibre-rich diet from fruits and vegetables. Sorbitol, found in some juices such as prune, pear, and apple juices are also very good in preventing constipation.
3. BEHAVIOUR MODIFICATION
• Regular toilet habits (retraining of the bowel)
• Unhurried time on the toilet after meals is recommended (scheduled toileting)
• Diaries of stool frequency
• Rewards system (positive reinforcement)
• Advise daily physical activity
• Also avoid too much of the pastries and junk foods which are deficient in fiber which can also lead to constipation.
In conclusion, though constipation is common, it can be easily prevented. Additionally where red flags are present, do not hesitate to see your doctor.
My almost 5months old baby always has to push a little harder before passing out stool.though her faeces is not hard because she is exclusively fed. Do u think my diet could be affecting her
No! There is nothing wrong with her. The “push” is not constipation as long as the stools are not hard. Most babies do groan and push because they are quite aware of any movements within their body but it does not mean they have constipation or anything is wrong with them
Hi Dr, thanks for all your help.
Please my baby of 11 weeks didn’t pass stool for about 3 days(for the first time). Within the 3 to 4 days, sometimes he will strain and push, but nothing or very little stool comes out. So today he passed stool after much strain, and I noticed a very thick pasty stool followed by normal ones…. The thick one was very thick but not as hard as a pellet, and when i was cleaning him up I noticed his anus was a little red( though he has diaper rash) and was paining him(because he was crying)… No blood, no wound…. Please, is that constipation? Help me out…this is my first time seeing that.. We are on EBF.
He is very active and sucks well, his tummy is soft, no vomiting. Sorry for the long note.
This is normal for babies on EBF. It is nothing to worry about. For the diaper rash, use appropriate diaper cream eg sudocream
Good morning Dr, my baby is 3months old and she hardly poo. I’m very worried because she’s not on exclusive breastfeeding, she takes formula. She hardly poo in a week, what can I do to help, I’m worried
Babies on formula needs to take plain water after the formula feeds and you also need to ensure that you constitute the formula as recommended by the manufacturer – right amount of scoops to right amount of water. Save yourself the stress and just breastfeed exclusively…breast is best for your baby!
Good day may God reward your labor of love, please I jus finished ebf I introduced cereal to my baby and self made ogi, he dint poo for two day and later pooed the third day now it’s over 4 days now dat the hasn’t pooed, I have stopped feeding him and back to my breastfeeding, please how can I help, he doesn’t accept water much cos it’s his first time. So worried
Hi Mum…Breast milk is no longer sufficient for your baby after 6 months. You should continue the complementary feeding. However, it should not just be ereals. You should add fruits (which can be pureed) and vegetables as well. Let it contain at least 4 classes of food at each feeding. That will help reduce and prevent the constipation. You also ensure the baby drinks water. Give water in a non-threatening way randomly throughout the day – a sip or two at a time. All the best. If no improvement, kindly see a Paediatrician physically for further assistance.
Good day doctor, please my baby of 15 months poo is always strong and sometimes comes out in tiny bits. He takes a lot of fluids and his on pap and (family milk) oldenburger milk. Just yesterday he’s poo came out with blood stains, Am very worried please help.
Wow Evelyn….you should see a Paediatrician for further evaluation of the cause of the chronic constipation. Kindly treat as very urgent.
Tanx for ur time always,just finish EBF for my boy of 6 months n 6days just introduced cerelac at baby milk but he doent like taking water n is poo always hard,wat are d other fluid to introduce tanx
Unfortunately Tosin, there is no alternative fluid to WATER!!! You should give water often not necessarily during or after feeds but let the child drink water randomly throughout the day. Try fancy sippy cups, use of straws and give the water in a non-threatening way. You should also give fruits as well….that will help also to avoid the constipation.
Still breastfeeding my baby of 10months and am pregnant. Can I stop the breastfeeding or it should stop???? Thanks in anticipation
It is your choice really. if you are able to cope you can continue breastfeeding. However if you are unable to cope you can stop and give age-appropriate formula in addition to the complementary feeds as your baby still need milk.
Good day Doctor, My son is 15months old. He his always constipated with hard stool. I have given him Liqiud paraffin and take alot of fluid too . but stil no way. he still finds it difficult to poo.and cries alot. Dont know wat else to do. Thank you Doctor. awaiting your reply.
Hi Ellah….It is time to see a Paediatrician since all the simple measures are not working. Also look into the diet…avoid too much pastries and biscuits…give fruits and vegetables as well as food high in fibre content as well. There are medical conditions that may make a child to be constipated as well and that is where the Paediatricians come in.
Please MA, what’s liquid paraffin and where can I get it
It is a drug and available in Pharmacies. Ask at your local pharmacy stores
thanks gat more info
You are welcome
Goodevening ma, thank you for all you do. Please my 1 month old baby struggles to push. He groans and sometimes cries before the poo finally comes out but he poos almost everyday.He is on breastmilk and formula. Pls what do i do? Could it be my meal?
You should breastfeed exclusively. If the poo is not hard then it is not constipation. It is not unusual for babies to make the grunting sounds when passing stools but if the stools are normal texture, it is nothing to worry about. We recommend getting a copy of the FTM Companion and FTM FAQ.
GET THE FIRST TIME MUM series of Courses and books including the FTM COURSE MANUAL) HERE
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Good day Maa, my 11weeks old baby who is on ebf didn’t pass stool for 7days and I took her to a pediatric ward in general hospital Asokoro and d Dr. is talking about giving her liquid paraffin, should I go ahead n give her or not, as d thing have started disturbing her today.
No please!!! An 11 week old on exclusive breastfeeding may not pass stools every day even up to 2 weeks and that is still normal.
Please do not give liquid paraffin…..Just keep breastfeeding and the baby will pass the stools when ready.
There is no need to worry!
please ma what are the onset symptoms of constipation in New born.am a first time mum and I notice my son of 8wewks old always moan to pass stool, most times I have to help out by putting run in the anus before the poo comes out.what do I do please
Please do not put anything in the anus…..Newborns may not pass stools every day. Newborns may not pass stools for up to 2 weeks and that is normal and not constipation! The moaning does not mean the stools are hard or anything! It is just that babies like to do that for anything moving in and out of their bodies at that age. Constipation is applied for hard stools not passed frequently. That does not apply in newborns. You do not have to do anything! The baby will eventually pass the stool when ready and it will still be normal stools!
Ma please my son of 4 is always constipated. It takes him about 4 to 5 days before he poos and that is after struggling with it. He takes snuff water and we started him with paraffin and once he takes it he poos. Ma what can I do about it? I know I havnt been regular with d parrafin.
Sorry he is 4 years.
You really should see a Paediatrician to know the cause of his frequent constipation so it can be addressed.
Ma,my kids of 5plus &4plus constipated Big & hard stool & complain of stomach ache .we have been to hospital treated infection théy drink a lot of water & fruit.Thinking of going back to healthcare.pls help
Yes you can go back. Let them also eat food rich in fibre and vegetables as well!
Good morning doctor, pls my baby of 6months 2 days has not poo for 9days, she started vomiting yesterday after breast feeding , she’s not having temperature and stomach is not strong. Is there any need to worry so far it’s not up to 2weeks?
If the baby is on exclusive breastfeeding till now, there is no need to worry. However since the baby is now over 6 months, kindly start complementary feeds – give especially fruits like fresh orange juice (diluted with water) or vegetables like Ewedu as well. This will help. For more information on complementary feeding click Infant feeding in the first 1000 days
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Good day Doctor. My son of 7 months has been passing frequent stools for the past 3 days. The frequency is like 5 to 6 times a day. The stool is watery and has mucus. Sometimes greenish. He strains a lot at each bowel movement. I feed him with pap that contains crayfish and also mix with his formula. Please, what should I do. Thanks.
You need to give ORS and oral Zinc and then see a doctor if the diarrhoea persists. Read more here home treatment of diarrhoea
Hello! Am breastfeeding exclusively but notice my 10days old has been constipated for days. I will have to stimulate his anus before he poo after hours of effortlessly straining to get it out. The stools ain’t hard after I get them out though.!
He is NOT constipated!!! Babies on exclusive breastfeeding may not pass stools every day! Indeed they may not pass stools for up to 2 weeks and are fine as long as when the stools are passed, you will as you rightly observed will be normal stools and the baby is otherwise healthy. There is no need to worry or stimulate the baby’s anus at all! Read more about it here
Thank you Dr. I have been following your tips and responses. Pls i needed to share this for good advise. My wife usually feed our daughter of 20months old and another family son of about 2 1/2years with the same spoon and cup and i have been talking harsh about this but refuses to listen. Meanwhile, this boy and his elder sisters are equally nursing rashes on their body. About five months ago, my daughter developed this rashes turned scars similar to this other family. Can sharing same spoon have adverse effect on my daughter to the extend of causing rashes and or other related skin and health problems.
Thank you Owoh! It is very unlikely for spoon sharing to cause rashes on the skin. However it is not hygienic and the dentists warn against it. I guess you meant simultaneous using of the same spoon as against after the spoon has been washed and dried?
Good day Dr. Thanks for all your responses. My baby of 1 month seems unsatisfied all the time with breast milk. He only sleeps 10-25 mins after breastfeeding and wants more immediately he wakes up. Please what can I do?
Hi Cha.
You should watch the breastfeeding videos for more information. There are videos on how to increase your breast milk supply, ensure your baby is getting enough breast milk and more importantly attach your baby to the breasts. You can watch the videos on YouTube or check the Guide 1 on our Guides section of our Facebook group
Good day ma. My baby of 9months finds it very difficult to poop. She groans and has to push harder and water comes out of her eyes whenever she wants to poop even though her faeces is not hard. It’s been like that since she was a baby. What could be the issue ma?
If the baby is having chronic constipation, you need to see a Paediatrician for further evaluation to rule out medical conditions that often cause chronic constipation in children. There are many of them including Hirschsprung disease
Good evening ma Please
I recently gave birth after the fourth day my baby stopped pooing, I waited till day 12 took her to the hospital we run series of test and scan and everything was ok, they only complained that the baby is constipated, after that she poo very little the next day since then she hasn’t poo. Today makes it day 8 she pooed last since we left the hospital.
Her tummy isn’t strong she is on EBF and suck very well. Please help am confused cos I have done everything I need to do
Just keep breastfeeding exclusively. Babies on EBF may not pass stools every day and up to 2 weeks but as long as the baby is fine, there is no need to worry.
Good day ma, my son of 3 years old he don’t to stool everyday sometime it take week before he stool what can I do ma
Are the stools hard? If yes make sure you give lot of water, fruits, vegetables and food rich in fibre. If no improvement, then see a Paediatrician for further evaluation if no improvement.
My 5mnths old baby hasnt poo for a wk now bt during d wk after massaging her anus small poo came out after so much straining, the poo looks formed unlike her normal egusi like poo. Altho its not soo hard like pellets bt its formed like adult poo. And since then nothing came out again its been 4 days after d massage i gave her.she only pass smelly gas.she’s on formula n breastmilk
Those are normal stools and it is perfectly normal for babies on exclusive breastfeeding not to pass stools for days even up to 2 weeks and when they eventually pass the stools, they will be normal texture as you have discovered. There is no need to force her to pass stools. Babies on formula also need plain water after the formula feed and ensure the formula is constituted as advised by the manufacturers. We encourage you to breastfeed your baby exclusively.
Good evening doctor, Gid bless you for your good work. My son is 2years old Nd two months ago I noticed hard stool gandered on his lower abdomen. We went to a pediatrics and the popo was removed Nd the doctor also gave us a drugs to give him for three days Nd one was the one we inserted inside his Anus. But after some week, he started constipating again. Once I give him the drugs, he will popo but after a while, it will get hard. He takes allot of milo and milk, eats allot of biscuits, caprison, drinks more than 3bottle water a day and also eats fruit once in a while. What is the cause and what should I do?.
You should stop the junks and let the baby eats fruits daily and drink water a lot. Kindly also give food rich in fibre eg vegetables
Good evening ma. My 7months + baby poo 3 to 4 times a day but always push hard to defecate and it does come out strong and in bits. Should I be worried?
She may be constipated. You should give water, fruits and vegetables. Please read the article for more information on how to prevent constipation.
Good evening Dr, Thanks for all the time, pls Dr my baby of 2yrs old do pass strong stool for the past 1month now,some come out tiny like goat stool He normally drinks alot of water, though don’t like to take fruit which I do force him to take. Pls Dr should I be worried, can I give him liquid paraffin. Thanks
You should see a doctor and they can prescribe appropriate stools softeners.