— Mariah, Georgia Constipation is a common concern for many parents. The frequency of bowel movements in infants varies greatly. Some infants will go after every feeding, others every four days. Both situations are normal. In general, most breastfed infants will move their bowels more often than formula-fed babies. However, if an infant has not had a bowel movement in more than four days, it is a good idea to let your doctor know, even though this can still be normal. Because there is so much variation in how frequently an infant has a bowel movement, it is often more helpful to diagnose constipation based on other findings. For example, an infant’s stool should be soft. Sometimes a hard stool may be painful for infants, and parents will report that their child is in discomfort when having a bowel movement. This is different than “straining,” which is actually very common in infants. If your child seems to be straining to have a bowel movement, but the stool is soft, it is unlikely that she is constipated. There are many different ways to treat constipation in an infant. One of the simplest methods is to give your baby water. Infants less than a month old should not be given water without speaking with the child’s pediatrician. Older children may benefit from drinking a couple of ounces of water in addition to their formula or breast milk — especially in the summer when they sweat more. I usually recommend one to two ounces of water once or twice daily for infants between two and five months old. Some pediatricians suggest adding a teaspoon of brown sugar per ounce of water to help with constipation. Others recommend mixing an ounce of water with an ounce of prune juice to ease more severe constipation. Children older than six months and eating solids can try prunes to help them avoid constipation. Foods like rice cereal and bananas, however, could make constipation worse. If your child’s constipation is not controlled with some minor diet changes, discuss the issue further with her pediatrician since there are some rare conditions that could lead to constipation. Good luck! Q2. My grandson is 8, and has been constipated all of his life. We have to give him different laxatives all the time. His bowel movements are very long and grayish- white. Should I be concerned? — Anita, Ohio Many children suffer from constipation. Typical constipation is associated with hard stools that are less frequent. Constipation may be associated with pain with straining, general abdominal pain, or large diameter stools. Constipation can even cause fecal incontinence. A low-fiber diet is thought to be the leading cause of constipation. Often constipation will improve with simple changes to a child’s diet, like increasing high-fiber foods (enriched cereals, fruits and vegetables) and decreasing foods that can cause constipation (bananas, rice, and pasta). Some children’s constipation is more persistent and requires behavioral medication, laxatives, stool softeners, or suppositories in addition to diet changes. Although constipation is usually a benign problem, it may be a sign of something more significant. You mentioned that your grandson has been constipated “all of his life.” If he was actually constipated the first few days of life, and did not have a stool until after two days of life, that would be concerning. A child should pass stool within 24 hours of life. If he does not, he could have problems with nerves in his colon. Many children are constipated in infancy, but rarely is a child constipated in the first few days of life. You also noted that your grandson’s stool is grayish-white. Rarely, white stools may be associated with a problems processing food that is eaten. If a child is not growing well, has blood in the stool, has vomiting, or urinary incontinence, the constipation certainly needs to be investigated further. A careful diet history and a stooling history can be very helpful in determining the cause of a child’s constipation. Although it is common for children to suffer from constipation, your grandson’s gray-white stools and his reliance on frequent medication would be reasons to seek the advice of a pediatric gastroenterologist. Q3. My six-month-old daughter has been constipated for over a month. She is on Similac Alimentum and twice to three times a day we feed her either sweet potatoes, peas, pears, or prunes. She also drinks about four to five ounces of water with brown sugar. Nothing seems to help her. Her stool is very hard and she strains but only a little hard piece comes. I have to give her glycerin suppositories to get her stool out. I am desperate for any advice! Alla, it seems like you are feeding your daughter the right foods to try to prevent constipation. Avoid foods like rice, potatoes, and bananas; give prunes, pears, and oatmeal cereal. Many pediatricians will specifically recommend prunes or water and brown sugar as dietary ways to control constipation. If your daughter is still constipated despite a diet high in fiber like you describe, she may need to take a medication that helps soften her stool. There are multiple medications such as MiraLax that can help soften stool if diet alone doesn’t work. Sometimes a suppository or enema in addition to a stool softener is needed. If a child is having significant constipation that requires medication, I often recommend that a parent try to soften the stool with a high-fiber diet and either mineral oil or MiraLax in addition to helping the child with a suppository to initially clean the bowels out. After this, the child usually can be kept regular with a balanced diet and stool softeners. Constipation is extremely common in children, however, it is sometimes — although rarely — a sign of a more serious issue. Your daughter should be fully evaluated by her doctor to develop a plan for how to best treat your daughter. There are lots of options that could work. Learn more in the Everyday Health Kids’ Health Center.
