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Newborn and Infant Care

Infant constipation

07/16/2007

Question:

My 10 month old has a bowel movement every 4-5 days. When he does go he screams and cries and it is very hard and sometimes has blood on it.

Answer:

It sounds as though your baby has constipation, a condition in which stools are hard, dry, and difficult to pass. The hard stools often create tears at the anal opening, called anal fissures, that account for the pain when stooling as well as bright red blood in the stool. It is important to address the problem now, before it becomes a more difficult problem called encopresis (en-coh-pree-sis), during his toilet training years.

Encopresis occurs when children avoid stooling because of fear of pain with bowel movements, holding on to them for so long that an enormous mass of hard stool forms with liquid diarrhea stools seeping around it onto the underwear. These large masses of stool stretch out the bowel muscles, like an overstretched rubberband, and make it difficult for the bowel muscles to contract to aid in stooling. It can take up to a year to re-establish normal bowel function in severely affected children. 

Sometimes constipation occurs because the bowel muscles have not developed optimally. In this case the problem can one that your child will need to work to avoid throughout his life.

However, the most common reason that young children suffer from constipation is the lack of adequate fiber intake from food, inadequate intake of water, and lack of enough exercise to stimulate the gastrointestinal system. 

Fiber is most abundant in whole grain foods, fruits, and vegetables. It can also be prescribed as a supplement by the doctor. Whole milk is very constipating. The American Academy of Pediatrics recommends that infants should remain on iron fortified formula throughout the first year of life. So if you have moved your son to whole milk, it is a good idea to switch your son back to formula. Fruit juices, 100% juice only, can help prevent constipation. The best choices are pear nectar, prune, apple, and white grape juice - no more than 6 ounces per day.

Also, make sure your son has plenty of active play each day crawling, walking while holding on to objects, or walking and running if he is already walking independently. Of course, it is of great importance to make his play spaces safe by thoroughly childproofing your home. an excellent handout on this topic is available at http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDFDocs/women-in/infant/homsaf/ped Because it sounds as though this is a problem that has lasted for more than just a week,it is a good idea to visit your son's doctor and discuss ways to help your son have daily, soft, non-painful stools. This will help to avoid his developing the harmful pattern of stool withholding because of fear of pain.

I hope this information is helpful.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University