Episode Transcript
Dr. Cindy Gellner: Today, I'm going to give you the poop on poop. I'm Dr. Cindy Gellner, and that's today on The Scope.
Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.
Dr. Cindy Gellner: I get asked about constipation a lot, like, at least several times a day. There are a lot of parents that are really worried about their children's bowel movements. Are they normal? Are they not normal? Are they too hard? Are they too soft? How many days can you go between a bowel movement?
Newborn & Baby Constipation
The bottom line is it depends on your individual child. A breastfed baby can poop anywhere from several times a day with every feeding to once a week with a huge blowout. Formula fed babies can poop every single day to once every three to four days. Some babies poop like toothpaste. Some babies poop like water. The bottom line is everyone's digestive system is a little bit different, but it's one thing that consistently comes up. Every single day somebody has concerns about poop, and especially they have concerns about constipation.
What Is Constipation in Kids?
Constipation means that a child is not pooping as frequently as they should or the stools are really, really hard. Sometimes, you'll even see blood on the toilet paper or on the stools themselves. That's true constipation.
Going for a day or two even without a bowel movement is not unusual. Usually, kids who are constipated will strain really hard. They'll be in a lot of pain.
Dyschezia
Let me tell you, babies have something called dyschezia, and that literally means painful pooping. Babies cannot coordinate the muscles that need to get the poop out, so they grunt, they turn red trying to get it out. That's not constipation.
Babies usually will do that and then you'll have a normal bowel movement in their diaper. Babies can't create enough pressure to get the poop out unless they make all those noises and everything. By the time they get to be about a year old they figure out how to do it without all that noise.
That's usually nothing to worry about unless you notice that the baby has hard rocks in their diaper or there's blood. Either of those things you need to talk to your pediatrician about.
Older kids, there are a lot of reasons why older kids may not poop like you think. One of the biggest ones I hear is the kids don't want to poop at school. It's kind of weird to poop in a strange toilet that's not at your house.
A lot of kids will actually hold it. Holding your bowel movements is not a good thing. That actually creates more constipation. The longer the stool sits in the large intestine, the more time it has for water to come out of it, the more hard your stool gets. The more hard your stool gets, the harder it's going to be to get out.
Some kids actually get backed up so much where there's so much hard stool in their colon that the soft, liquidy stool that hasn't made it yet to the large intestine will actually seep around the hard rock stool and come out as liquid. Your child may think they have diarrhea. You may be thinking that they have skid marks or they're having accidents in their pants.
The bottom line is they're actually super constipated, and usually your pediatrician is going to be able to pick that up with just feeling their belly. If need be, they can do an X-ray of their belly to see just how full they are. That will help determine how aggressive they need to get a clean out.
If you have a child who is having hard stools, blood in their stools, their belly is hurting, they're not going for three or more days, what can you do?
Constipation Treatment
The first thing you can do is make their stool softer. For babies over the age of two months old we recommend juice. The best juices are pear and prune. The thing is you're going to want to talk to your pediatrician about how much prune juice or pear juice to give. Usually, I will tell people that they can give about one or two ounces. I usually say you don't need to dilute it. You should just do that as needed. You shouldn't be doing that on an everyday basis.
Older kids, one of the biggest things you can do is help them take care of something called the gastrocolic reflex. Thirty minutes after you eat, the new food is trying to make its way on down, and your brain tells your large intestines okay, time to get the old stuff, time to poop. So, 30 minutes after you're done eating have your child go sit on the toilet. That's when your body is going to want to have a bowel movement.
Eat More Fiber, Drink More Water, & Juices That Begin With P
For older kids you're also going to want to increase the fiber in their diets and also increase how much water they're drinking. You may want to cut down on how much milk they're drinking, too. Milk and cheese and those kinds of products tend to have a constipating effect. The fruits that begin with P--peaches, pears, plums, and prunes--will make you poop. You'll never forget that again--peaches, pears, plums, and prunes will make you poop.
If you are continuing to have problems with bowel movements, or if you're noticing that there's a lot of blood that's on the toilet paper and your child keeps saying that their butt hurts, take a look. They might have something called an anal fissure. Those are very common in kids, and the main symptom is blood on the toilet paper. That's from constant irritation from hard stools.
That can be treated with making sure that they have soft bowel movements. They are little tears right in the very sensitive anal tissue. If they continue on and on they can cause problems later on, so make sure that you aggressively treat the constipation so that they're going on a regular basis.
Constipation Medicine
There are a lot of medications out there, too. Miralax is the one that I use the most and it's also the one that GI uses the most. That one, it kind of sounds really gross, but the best way to describe it is a chemical that you mix in with some water or juice--don't mix it with soda, it'll make a volcano--and you drink it.
You can adjust how much you take. It pretty much coats the large intestines. The stool pretty much slides on out. It doesn't have as much time to sit in the large intestine and get all the water taken out of it.
It is normal for your child to have some abdominal cramps if they're actually on medicine to try and get out the poop when they're constipated. That's their intestines trying to push that stool out. That's normal. Rub their belly. Let them sit and relax on the toilet for a little while. That's okay.
If you're continuing to have a lot of problems with constipation, talk to your doctor about it. We usually don't recommend enemas or suppositories unless they are really needed. Be sure that you talk to your doctor about ways that you can have your child's constipation managed.
It's a very common problem and I see it a lot. Usually, kids who are constipated from a young age are going to have constipation problems for the majority of their life. They learn how to get a handle on it early on it will help them out a lot.
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updated: July 9, 2018
originally published: January 8, 2014