It takes a newborn less than 24 hours to make a dirty diaper. New parents often find themselves changing multiple diapers a day, quickly become experts in their child’s voiding habits and patterns. Therefore, it should be no surprise that abnormal stooling can bring reasonable concern in the world of pediatrics.
Constipation is prevalent among children. In fact, it’s estimated to occur in approximately 30 percent of children. It can be identified through a variety of signs, ranging from infrequent bowel movements to hard/small feces to difficult or painful evacuation of large stools.
Infants have invariable bowel patterns, which is important to remember. If an infant strains while defecating, this doesn’t necessarily mean he/she is constipated. Some infants can stool up to seven times a day, while others might stool only once a week. Most infants will strain while stooling, but this is normal as long as stools are soft and mustard-colored. If your infant has hard, bloody or white stools, or didn’t stool in their first 24 hours of life, talk with your pediatrician. In some cases, administering juices containing sorbitol, such as prune or apple juice, can treat infant constipation.
The good news is nearly 95 percent of constipation (although a nuisance) is not rooted from a medical condition. This is called functional constipation, which is common amongst preschool age children and most children over the age of 1. Your pediatrician can diagnose functional constipation after a brief physical examination and discussion of history. Those with functional constipation often benefit from treatment interventions, but, unfortunately, delayed intervention can result in stool withholding behavior and psychosocial consequences as constipation worsens.
In older children, constipation can present itself through rectal bleeding, a sign that a large, passing stool may have torn the skin around the anus. Other signs might include severe abdominal distention, narrow stools (called “ribbon stools”), urinary incontinence, poor appetite and abnormal growth. If possible, create a five- to seven-day symptom and dietary diary for your pediatrician and record stool frequency, appearance and a pain scale.
Once your pediatrician diagnoses your child with constipation, treatment will typically depend on the age of your child and the type of constipation at hand. It can typically be managed through lifestyle changes, including an increase in water and fiber intake. Often, the transition from a baby food diet to a toddler diet is inadequate in amounts of fiber and fluid, causing constipation as a result.
For children and infants under 2 years of age, a reasonable fiber intake goal is approximately 5 grams per day. This will require multiple servings of vegetables, fruits and fiber-containing cereals. Most vegetables and fruits supply approximately 1 gram of fiber per serving, but prunes and peas can offer up to 2 grams. Rice cereal doesn’t have much fiber, whereas whole wheat, barley and multigrain cereals can offer 1-2 grams of fiber per serving. It’s also important to ensure your child isn’t consuming too much cow’s milk, as dietary intake of over 24 fluid ounces can contribute to constipation. Excessive consumption of whole cow’s milk (over 32 ounces per day) can slow down intestinal motility and satiate a child, therefore decreasing their appetite and subsequent intake of other foods that promote soft stools, such as water, fruits and vegetables.
If dietary modification doesn’t help treat constipation, your pediatrician might recommend a stool softener and, in rare cases, a laxative. In a small number of cases, constipation might require blood work or imaging.
In summary, constipation is a very common issue faced by young children and is often accepted as a normal variation in stool pattern that will typically resolve as children age. Always ensure your children are eating a healthy, balanced diet, and avoid too much dairy or carbonated beverages. If you suspect your child might be suffering from regular constipation, record a voiding diary and speak with your pediatrician to come up with the best solution for your child together.
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