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Dr. Fred Piaser

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CONSTIPATION   Constipation is a common problem for children of all ages. The problem is treated differently depending on your childís age. To better understand the treatment, letís look at the definition of constipation as well as its causes.

 Constipation is the passage of hard, dry stool which can be painful during passage. The absence of daily bowel movements does not constitute constipation. The number of bowel movements that your baby normally has is the baseline, whether it is once every other day to several times a day. There is no normal number of bowel movements for your baby Ė only what is normal for him. More important is a change in the frequency pattern of an individual.

 Rarely do breast fed babies have problems with constipation. Something in the formula may be constipating for your infant. Constipation is often first seen with the introduction of solid foods. Rice cereal is low in fiber. Diets low in fiber and children that are not getting enough fluids are prone to constipation. Also, any decrease in the frequency of using the toilet may cause constipation. If a child has a hard and large stool and it is painful to pass he may associate bowel movements with pain and withhold his stool. Bad toilet training experiences may also inhibit the frequent use of the toilet and thus make constipation more likely. Both these things can increase the time the stool is in the large intestines. If the stool is in the large intestines for a longer amount of time, more water is removed from the stool and absorbed back into the body, making the stool harder.

 The type of treatment for constipation depends on your childís age. Donít start any new foods that your baby is not already on. For the infant, giving extra water or fruit (apple, pear and prune) juices will help. You could also add Karo syrup to your infantís bottle. Switch from rice cereal to barley or oat cereal, or add pureed fruits and vegetables. Increase the amount of fiber by adding a teaspoon of bran to the cereal. Cut down on constipating foods like cowís milk, rice, banana, yogurt, cheese and cooked carrots. Add foods such as pureed prunes, apricots or pears, when your baby is ready for these foods. Vegetables high in fiber include beans, sweet potato, peas, turnip greens and raw tomatoes. Vegetable soups, bran cereal, bran muffins, shredded wheat, graham crackers, and whole wheat brad are other foods with high bran content.

 For the older child, there are medications that will help until the dietary changes start to take effect. Bulking agents, increasing the size and water content of stools, include Metamucil, Fiberall and Citrucel. Magnesium hydroxide (milk of magnesia) is an osmotic laxative. Because of its chalky taste it is not tolerated by all children. Stool softeners/lubricants, which soften the feces for easier passage, include Colace and Surfax. Malt Soup Extract (i.e. Maltsupex), an extract of malt from barley grains, is a plant-derived bulk-forming fiber laxatives. It has an unpleasant odor but can be mixed with formula for infants. Mineral oil, a lubricant, can be mixed with orange juice but can cause leakage and staining of underwear. Extract of senna (Senokot) and Bisacodyl (Ducolax) are stimulant laxatives. It stimulates peristaltic muscle contraction of the intestines to help move the stool along.

In severe constipation, you may need to stimulate a bowel movement from below. Glycerin suppositories stimulate from below, help the baby pass a stool. This help should only be for a short amount of time.