DEFINITION
Constipation is best defined as the painful passage of stool or the inability to have a bowel movement (BM). A hard, dry stool that the child has difficulty pushing out typically causes constipation. Infrequent movements (more than four days without a BM), if accompanied by pain or difficult passage also can be considered constipation. However, some children, especially breast-fed babies, may have large, soft BMs several days apart normally. The key is that the BMs are soft, and the passage is not difficult or painful. Also note that most babies grunt, strain, draw up their legs and turn red in the face when having a BM. This only is considered a problem if accompanied by a hard, dry BM.

COMMON CAUSES

• Diets low in fiber
• Diets of excessive milk products
• Waiting too long to go to the bathroom
• A small tear in the rectum that makes stool passage painful.

These common causes of constipation can lead to further retention or holding of stools by the child. Stool retention can lead to a cycle of holding because of the pain associated with a large, hard BM, thereby increasing constipation.

TREATMENT
A change in diet usually relieves constipation. The following tips may also help.

• For babies younger than 4 months, try giving one to two ounces of fruit juice such as grape, prune or apple-prune twice daily
• For babies between 4 months and 1 year, try strained foods that contain high fiber such as apricots, prunes, peaches, plums, pears, peas or spinach twice a day. Avoid strained carrots, squash, apples and bananas as these may aggravate constipation
• For children over 1 year, encourage them to eat fruits and vegetables like those mentioned above at least three times daily. Also encourage other high-fiber foods such as graham crackers, shredded wheat, whole-wheat bread and bran cereal. Increase the amount of water your child drinks. You also may give your child peach, pear or apricot nectar
• Decrease the consumption of constipating foods such as milk, cheese, dairy products, cooked carrots, apples and bananas
• For potty-trained children, encourage regular bowel patterns by establishing a schedule of 10 minutes of "toilet time" after every meal
• A footstool for the child's feet can make stool passage easier. For safety reasons, remove the footstool after use.

These changes should help relieve the constipation. Occasionally, a stool softener may help. However, do not give any suppositories, stool softeners or enemas without consulting your doctor first.