Home Treatments for Constipation
Sometimes constipation will resolve if the issues discussed in Why Constipation Develops
are addressed by changing diet, fluid intake, position, and behavior. Sometimes medication is needed for a short time. Sometimes medication is needed chronically. If your child is experiencing constipation, you can try to modify some of the factors discussed above. You should seek medical care for your child if they are severely constipated, having significant vomiting or abdominal pain, having blood in their bowel movements and/or not responding to your treatment efforts. If your child is very young (under 4 months) or if your child has complex medical issues or severe constipation; talk with you clinician. However if your child has mild to moderate symptoms and is over 4 months, you might consider some of these treatment options.
For Infants and Toddlers:
- Fruit juice: Prune, apple, or pear juices contain sugars which are poorly absorbed, pass through the intestine unabsorbed, and hold water in the poop. Other juices are helpful because their sugars are better absorbed. A baby or toddler constipated may be helped by giving 2-4 ounces of one these juice once a day and 4-6 ounces once a day for older infants. In the case of pear or apple juice, it is important that the juice be 100% fruit juice (not watered down) or the sugars are not in high enough concentration to do their job. Prune juice contains more unabsorbed sugars so with prune juice use less and water it down somewhat (e.g. start with 1 ounce and add 1 ounce of water for a total of 2 ounces). Some children may develop gas or bloating with this treatment and become fussy. Seek evaluation from your clinician if the juice is not helping or your child is not tolerating it. With the exception of prune juice, juice is not very helpful for older children (above age 2-3) because their intestines are more efficient and absorb most of the sugars.
- High-fiber foods: If your infant has started eating solid foods, you can substitute whole grain cereals for white or refined cereals (white rice cereal). You can also offer other high-fiber fruit and vegetable to your baby or foods including apricots, sweet potatoes, pears, prunes, peaches, plums, beans, peas, broccoli or spinach. Banana, applesauce and carrot baby food and baby foods thickened with tapioca can be constipating so reduce these foods in your child’s diet. For older children, dairy products can be constipating. If your toddler is eating excessive amounts of cheese, milk (>16-20 ounces per day), or refined carbohydrates; try to reduce these in the diet and substitute higher fiber alternative such as whole grain breads and cereals, fruits and vegetables.
- Formulas: Some formulas may be constipating. Formulas which are higher in casein and formulas that have been thickened with rice cereal can be more problematic. Consider changing formula if you baby is having a persistent problem with constipation. Iron in infant formula does not contribute to constipation.
- Mild osmotic laxative: may be recommended by your baby’s clinician if the constipation does not respond to these interventions.
- Not Recommended:
- Dark Corn Syrup: Dark Corn syrup has been used in the past but most modern preparations of dark corn syrup do not contain the osmotically active substances to treat constipation and will not work. Additionally, there has been some concern about the potential for carrying botulinum spores similar to honey.
- On occasion, using a glycerin suppository or providing some rectal stimulation may give your baby relief from constipation but these are not something that should be used frequently. If you have to use these frequently, discuss with your clinician.
- Mineral oil and stimulant laxatives should not be used in young babies.
- Diet recommendations: Include whole grain foods, fruits and vegetables in you and your child’s diet. Your child is more likely to accept these foods if your child sees them in your diet. While you can offer your child these foods, if they don’t want them, making them eat them will only increase their resistance. You should also reduce constipating foods in your child’s diet including excessive milk, other dairy products (e.g. cheese and ice cream) and refined carbohydrates such as white rice, white pasta and white bread. Some children must eliminate milk from their diet to get control of their constipation. These children will need to get calcium from other dietary sources or a calcium supplement and need to take a multivitamin or vitamin D supplement since milk is the primary source of these nutrients.
- Fluids: It is important for children to keep themselves well hydrated. If a child does not drink adequate fluids, he/she is more likely to get constipated. Beyond good hydration, excessive amounts of water are unlikely to resolve constipation.
- Probiotics: Some children benefit from probiotics although there is not conclusive evidence about their role in treating constipation. Probiotics may be given by feeding certain brands of yogurt high in probiotics or by giving the child probiotic supplements which can be purchased over the counter at most pharmacies and health food stores.
- Medications: Osmotic laxatives (polyethylene glycol and lactulose), stimulant laxatives (e.g. senekot, bisacodyl), mineral oil and fiber supplements may be recommended by your clinician if the above interventions are not resolving the constipation. Mineral oil should not be used in children with risk of aspiration.
- Encourage your child to poop: If you are toilet training and your child develops significant constipation, back off till the constipation is controlled. The most important thing is for your child to poop regularly even if that’s in a diaper. For older children, establish a bowel sitting program such as 10 minutes sitting on the toilet once a day. The best time to do this is within 30 minutes after a meal such as breakfast or dinner. If your child has a natural tendency to poop at a particular time that would be a good time to have his/her bowel sitting program. Give your child something to do during the bowel sitting so they are not bored or aversive to the program. If your child is afraid of the bathroom, help your child gradually overcome their fears. You may need to stay with the child in the bathroom if they are anxious.
- Proper Position: Insure good position on the toilet. This means the feet must be supported on the floor or a step stool.
- Special needs: Some children may need support for anxiety, sensory processing disorder, or other behavioral concerns. Some older children with feeding concerns use special formulas. Some of these formulas may be more likely to lead to constipation than others related to their protein and micronutrient content. Some formulas have fiber added which can be helpful for constipation in some children but can actually contribute to constipation in other children. Talk with your clinician or dietician about your child’s formula. For some children with developmental disabilities, specialized toilet seats may be necessary to provide adequate support. Finally, some children are on medications for other medical problems (such as certain seizure and pain medications) which may be contributing to the constipation and need to be adjusted.
Medical Evaluation of Constipation
Most children with constipation do not have an underlying medical problem (such as low thyroid or a bowel anatomic abnormality) however if a child has persistent problems with constipation, it is important for a health care provider to carefully consider any possible underlying problem. Most problems can be excluded by a history and physical exam. This includes a careful abdominal and neurologic exam and typically a rectal examination. Special tests are ordered only if there are concerns from the child’s history or exam that suggest an underlying medical problem.
Functional constipation (constipation which is not due to an underlying medical problem…..most constipation) is treated by modifying lifestyle as discussed in the section above, by cleaning out the bowel if the constipation has been long standing (with higher doses of laxatives and in some cases enemas) and then through the use of daily stool softeners and laxatives to keep the bowel movements soft and daily. When a child has had chronic constipation, it is very common for it to recur. This is particularly true for children with encopresis. Those caring for the child must be vigilant in keeping the stool soft through daily medication and insuring a daily bowel movement. The clinician will give the family an “action plan” to escalate treatment if the child starts having hard bowel movements or skipping days.
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National Institute of Diabetes and Digestive and Kidney Diseases
The American Academy of Pediatrics
North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)