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Constipation is a common and very frustrating problem in children. It is defined as passing dry or hard stool or having painful bowel movements each couple of days.

 
Babies usually squawk and strain during bowel movements, which occur each two or three days. If the child’s stool is soft but not regular, it is not called constipation, it is infrequent bowel movements. 
 
Only if the stool becomes hard and painful can we talk about constipation. Straining could be normal but crying would definitely be a sign of constipation. 
 
Breastfed babies may have bowel movements once a week or even less frequent. This is because the mother’s milk completely digests. Babies on formula have more leftovers in their bowels and are more likely to suffer from constipation. 
 
First signs of constipation in infants are hard and dry stool and painful bowel movements. A child who suffers from constipation will fold his legs toward the stomach, squawk and make strange faces. There could be even some traces of blood. Small amount of blood should not scare you if the child suffers from constipation. The main cause of such blood is fissures caused by hard stool trying to squeeze through the narrow rectum.  

How does stool form?

When the food gets digested, it moves toward the bowels. Water and nutrients get absorbed and the waste becomes stool. In order to have soft stool, water needs to get back to the waste material and bowels’ and rectum’s muscles need to contract and relax to pass stool. 
 
Failure of any part of this mechanism (too little water or bad muscular movements) could cause constipation, which can become chronic.  The longer the child keeps the stool inside the bowels, the weaker the muscles get. While passing through the narrow rectum, hard stool can create fissures, which can then bleed. Expecting pain, the baby holds in the stool making it even harder and more painful to pass. This scares the baby and it doesn’t empty its bowels. 

Causes of constipation in infants

Reasons for constipation in infancy can be new food or switching from breastfeeding to formula and from formula to cow’s milk as well as too much cow’s milk or too little water. 
 
Additionally, when the child is upset, his intestines get upset too which can cause either constipation or diarrhea. 
It is also likely that the baby is not getting enough water or enough fiber. 

Nutrition (treatment) in infants with constipation 

An infant should get: 
 
* more fluids
 
* more fiber (from cereals in the first and second age of life)
 
* when the time comes, introduce vegetables such as peas, brocolli, beans, tomatoes and vegetable marrow
 
* juice rich in sorbitol (sugar that attracts water makes the stool mass that way). You should offer your child plum juice or plum, peach and apricot stewed juice. The amount of   juice should not exceed 120ml in the first year of age
 
* plum puree
 
* more frequent but smaller amounts of formula 
 
* corn instead of brown rice when introducing cereals. 
 
If constipation persists, talk to your child’s pediatrician about glycerol suppositories. These should not be given frequently. 

Constipation in toddlers

 
Constipation in toddlers can be pretty tricky and an unpleasant experience. Commonly it is emotionally acquired because at this age, children are going through so called “negative phase” in which they object to almost anything, including bowel movements. 
 
Some children eat too many fat foods (like crisps), lacking fiber in their nutrition, and drink too little water but too many juices or even sodas. Lack of physical activity due to constant TV watching and playing video games can even worsen the already bad habits.
 
Some children, when busy playing, don’t (re)act to the bowel movement stimuli (signs) or they just ignore it. The longer they ignore it and the longer they postpone the discharge, more water gets absorbed from the stool, the stool becomes harder and the child enters the magic circle in which defecation gets harder and constipation worse. 
 

Treatment

A child should have his meals at approximately same time every day.
They should go to toilet a few times a day, especially after breakfast. Remind him to go to the toilet every time he feels he’s having an urge. 
 
Pears, plums, peaches, apricots and bananas have laxative effects. They make passing of the stool easier. Bananas are important when it comes to constipation because they normalize functioning of the bowels. It is due to the presence of pectin that absorbs the water and creates the stool mass. 
 
Leafy vegetables such as cabbage, carrots, fresh and dried fruits (plums, grapes, dates, figs) contain natural cellulose. Celery is rich in fibers. To make use of fiber, a child (as well as an adult) needs to drink enough water to help stool passage. A toddler should be given fruits and vegetables with larger structures, brown bread (whole grain), cereals and potatoes. 
 
Foods that lubricate the digestive tract are: spinach, bananas, sesame, honey, pears, plums, peaches, apricots, apples, nuts, soy products, beet root, etc
 
Foods that aid bowel movements: cabbage, peas, coconut, asparagus
 
Foods that help maintain intestinal flora: dairy products, yogurts, kefir and others that contain Lactobacillus Acidophillus and Lactobacillus Bifidus. 
 
  • Mineral water that contains magnesium helps bowel cleanse. 
  • Vegetable soup is rich in fiber and a good source of fluid. 
  • Vitamin B is helpful with the bowel movements.
  • Marsh mellow tea is recommended. 
  • Physical activity is crucial in getting your bowels to work. 
 
As a parent you need to teach your children to recognize the signs that precede or signal bowel movement in order to avoid the nightmare called constipation.