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Parent’s Guide

Parent’s Guide: Constipation

Constipation is one of the most common problems in pediatrics. It usually isn't caused by a disease, but rather by diet, holding stool in, or a transition (like potty training).
This guide will help you get things moving again and know when to call the doctor.

1

🚨 When to Get Help

Call Doctor Now or Go to ER

  • Vomiting: Your child vomits repeatedly and their belly looks swollen/distended.
  • Pain: Severe stomach or rectal pain lasts more than 1 hour.
  • Age: Baby is less than 1 month old (and not pooping).
  • Muscle Weakness: Baby (<12 months) has a weak suck or seems “floppy” (signs of Botulism).
  • Bleeding: You see more than a tiny streak of blood on the wipe.

Contact in 24hrs

  • Leakage: Liquid stool is leaking into the underwear (this can be a sign of severe backup).
  • Refusal: Child is physically holding the poop in due to fear or pain.
  • Failure of Treatment: You have tried diet changes and they aren’t working.
2

❓Is it Actually Constipation?

Parents often worry if their child skips a day. However, “normal” varies by age.

What is Normal?

  • Frequency: Anywhere from 1-3 times a day to once every 2 days is normal for most kids.
  • Breastfed Babies: It is normal for breastfed babies over 1 month old to go 3–7 days without pooping, provided the stool is soft and they are not in pain.
  • “Infant Dyschezia” (The Grunting Baby): Young babies often turn red, grunt, and draw up their legs when pooping. This is normal. They are learning how to relax the anus while pushing with the belly. As long as the poop comes out soft, they are not constipated.

Signs of True Constipation

  • Pain: Crying or screaming when trying to poop.
  • Texture: Stools are hard, dry, or look like “rabbit pellets.”
  • Straining: Pushing for more than 5-10 minutes without success.
  • Duration: Going 3 or more days without a bowel movement (if not exclusively breastfed).
3

🏠 Action Plan: Babies (Under 1 Year)

1. The “P” Fruits (Diet) If your baby is over 4 month old, you can add fruit juice to their diet.

  • Juice: Pear, Apple, or Prune juice.
  • Dosage: Give 1-2 ounces per day in infants
  • Solids: If they are eating solids, offer pureed peas, beans, prunes, or peaches twice a day.

2. Physical Help

  • Bicycle Legs: Lie baby on their back and gently pump their legs/knees against their chest. This mimics squatting and uses gravity to help.
  • Warm Bath: A warm bath can relax the muscles around the anus.

3. Rectal Stimulation (Use Sparingly)

  • If they are straining, you can gently massage the anus with a warm, wet cotton ball for 10 seconds to help them relax.
4

🏠 Action Plan: Toddlers & Kids (Over 1 Year)

1. Diet Overhaul

  • Cut the Dairy: Limit milk, cheese, and yogurt to 3 servings a day. Too much dairy causes hard, pale stools.
  • Increase Fluids: Water helps soften the stool.
  • High Fiber: Add beans, berries, bran cereals, oatmeal, and popcorn (if >4 years).
  • Prune Juice: Give 2-4 ounces per day in toddlers/older children

2. The Toilet Routine

  • Scheduled Sits: Have your child sit on the toilet for 5 minutes
    after meals (especially breakfast). This takes advantage of the body’s natural urge to go after eating.
  • The Squat (Footstool): If their feet dangle, they cannot push effectively. Use a footstool so their knees are higher than their hips (squatting position).

3. Stop the Power Struggle

  • If this is happening during potty training, stop training. Put them back in Diapers or Pull-Ups.
  • If they hold the poop in because they are stubborn or afraid, forcing them will make it worse. Use rewards and praise, never punishment.

4. Medications (Stool Softeners)

  • If diet doesn’t work, doctors often recommend Miralax (PEG 3350) for children over 1 year.
  • Dose: 1–3 teaspoons mixed into water/juice daily. It draws water into the poop to make it soft.
  • Consult your doctor for the exact dosage and duration.


5

What to Expect

  • Diet: Changes in food usually take 2-3 days to work.
  • Maintenance: Once they are “unclogged,” keep them on a high-fiber diet to prevent it from coming back.
  • Recurrence: Kids who have had painful poops often hold it in out of fear, creating a cycle. Keeping stools soft is key to breaking this fear.

Medically Reviewed by Dr Michael Villadelgado
Disclaimer: This information is for educational purposes only. You assume full responsibility for how you use it. If you are unsure, always call your doctor.