Constipation is the passage of hard stools, that is painful to pass and associated with infrequent bowel movements. Occasionlly, bright red blood may be passed with hard stools.   This blood comes from a slight tear in the rectal area from the hard stool.

• Breast-fed babies rarely get constipated. They do commonly develop an infrequent stool pattern after 2 or 3 months of age. These older breast-fed babies may have one stool every 4 or 5 days, but they are soft and mushy and the babies do not seem uncomfortable.
• Newborns should pass their first meconium stool by 48 hours of age, if they do not, notify your physician. Once newborns who are a few days old are feeding well, they should be having 3 to 4 or more stools per day.  If they are not, this may be a sign that they are not getting enough milk.
• Constipation is very common in infants starting on solids.
• Some toddlers who are toilet training may become constipated.  They may then start to hold onto their stools and refuse to go to the bathroom and this will create further constipation problems. 

• Severe, constant pain for more than 2 hours
• The child is acting sick
• You suspect your newborn is dehydrated and not getting enough milk

• Your newborn under one or two months who is breastfeeding is not stooling at least 3 or 4 times a day and you suspect they are not getting enough milk or gaining weight
• You need direction in treatment because what you have tried is not working

Babies.  In babies under 3 or 4 months a rectal temperature will sometimes stimulate them to have a bowel movement.  Prune juice, diluted 1:1 with water may be used to treat constipation in babies over a month or two. In babies on solids, try using prunes, apricots, pears, beans, plums and decrease foods like rice cereal, bananas, applesauce, or rice. Occasionally, a change of formula may be helpful, but talk to your physician before making a change.

Toddlers. Toddlers who are resisting toilet training may become constipated.  Sometimes, they do not like using the toilet for bowel movements, but will urinate in the toilet.  This can become a behavioral issue and if they start to get scared that their bowel movements will hurt, they try to hold onto to the stool further.  Try to keep the stools loose with diet and sometimes with medications.   If you feel you have a behavior issue on your hands, discuss this with your physician.

Older children. Over a year, increase fresh fruits and vegetables. Prune juice may be used. Increase bran and use bran cereals or muffins. Decrease constipating foods like milk, cheese, ice cream, rice, bananas and applesauce. Increase water intake. Constipation is very common in the summer months, when children are not keeping up fluid intake to compensate for increased fluid losses from sweating in the heat.

Medications. A natural laxative is available over the counter called Maltsupex. Other laxatives, suppositories and enemas should be used only after your physician directs the usage.

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