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Constipation

Before we talk about what constipation is, let’s talk about what it is not. An infant who only passes stools infrequently is not necessarily constipated. The nutrients in breast milk (and to a lesser degree in formula) can be absorbed almost entirely, such that no waste is produced. Lucy’s stool pattern can change abruptly, from several stools in one day to none for ten days, and vice versa.

If Lucy’s stool pattern becomes infrequent, don’t resort to prune juice, glucose water, or rectal stimulation to activate her bowels; she’ll become more regular eventually. (On the upside, you’re saving on diapers and wipes.) Even when Lucy gets cranky and raises her legs, it doesn’t necessarily mean she’s constipated. It’s more likely just a normal episode of fussiness that you attribute to her lack of stools, for want of a better explanation. However, if the pattern persists for many months and her stools are abnormally large, you should mention it to your doctor, because this could indicate a rare condition in which the rectum is distended.

Now, let’s talk about what constipation is. For that, we’ll go to Webster’s, which defines it as “abnormally delayed or infrequent passage of usually dry hardened feces.” That about covers it, although it shows up somewhat differently at different ages

Constipation Before Solid Food


In formula-fed babies, stools can be hard because formula can be tougher to digest than breast milk. This is mild and will resolve with the introduction of solid food around 6 months.

Before settling on this diagnosis, however, let’s address another cause of hard stools in infants. Many parents are told to introduce cereals with a spoon or in a bottle around four months, but this additional nutrient often causes constipation. If this is true in your case, simply discontinue the cereals, and the stools will regain a softer consistency. Simply put, baby cereals are unnecessary [See: Cereals].

Now, if Lucy is not eating cereal, you can safely declare her constipated. While rare, this can happen even if she’s breast feeding, although the likelihood is slimmer, since breast milk is more laxative than formula. Constipated infants just have a predisposition to reabsorb more water, which leaves the stools drier and harder. Unfortunately, this can lead to pain and even a little bleeding from small tears on the rectum. You can ease the problem by giving Lucy a couple of ounces of prune juice daily in a bottle. If the stools are very hard, your doctor will prescribe a mild laxative until the constipation resolves, which usually happens naturally when she starts eating fruits and vegetables at six to eight months.

As I’ve noted many times, rectal stimulation is not advised.

Constipation After Solid Foods


Now the diagnosis becomes easy. In the vast majority of cases, kids become constipated at this age because they’re eating too much bread, potatoes, and cereals. Reduce the starch, and you’ll reduce the chance of constipation. Again, a couple of ounces of prune juice given in a bottle each day will help, as will a mild laxative, which your doctor may prescribe.

Constipation in Older Children


When Jimmy points to his stomach and starts bawling that he’s in pain because he can’t go number two, it’s too late for a laxative. It’s time for crisis intervention: an over-the-counter glycerin suppository that will produce relief within hours.

Okay, crisis averted. Now that he’s back to playing, let me have a word with you. Try not to make suppository relief a habit. Prevention is far better than cure. If Jimmy has a tendency to become constipated, do whatever it takes to change his diet so it doesn’t happen again. Too much starch is almost always what causes constipation. Starch means pasta, bread (white and brown), potatoes, crackers, cereals, rice, and beans. I can hear you saying “But that’s everything he likes!” That’s right; kids like starch because it tastes sweet, but the solution is simple: Lay off the starch, and you’ve solved the problem. Giving him a laxative to ease the problem won’t do any good in the long run, since the effects wear off over time. And there’s another, far scarier dimension to constipation: It can lead to stool retention, a situation in which a child becomes fearful of defecating, regardless of the consistency of the stools. If you have a few minutes, go ahead and read the stool-retention topic, and you’ll understand why you want to avoid starting that cycle at all costs.

Real questions from real parents
What if my child doesn’t overconsume starch?
Give even less starch until the stools become softer. There could be a gap between our definitions of how much is “too much.”

What can I give my child instead of starch?
Fish, meat, vegetables, fruit, dried fruit, eggs, tofu, yogurt . . .

What if he won’t eat anything?
The first day won’t be fun, but the second day will be a little better. The third day will be better still and so on [See: Picky Eater].

What if I give him more fluid?
That won’t fix the problem if you don’t decrease the starch.

How about if I add vegetables and fruits to his diet?
That’s good for general health, and they do have laxative properties; however, you must decrease the starch to alleviate his constipation.

What about milk? Will it contribute to constipation?
Rarely. But if you’ve decreased the starch and the constipation persists, ease off the milk for ten days and see if there’s a change.