Natick Pediatrics, PC

Dr. Lindeman,
My son seems to be straining to poop but nothing happens. How do I tell if he is constipated?

Constipation is defined as painful passage of stools or the inability to pass stool despite the urge to do so. No pain, no constipation.

Another definition may be the absence of stool for 4 or more days, except in breast-fed babies, many of whom pass large soft BMs at very odd intervals (up to one week is normal for these babies!).

Constipation may be caused by a diet without enough fiber. Other causes include waiting too long to go to the bathroom.

Small amounts of bright red blood may appear in the diaper or on toilet tissue in constipated children. This is normal and should not be cause for concern. It is caused by tiny tears in the anus by passage of large, hard stool.

Home Treatment

Constipation can often be treated through diet:

Less than 4 months old: Prior to a feed give an ounce of filtered or sterile water with a teaspoon of sugar. Repeat up to three times per day. If this does not work, try one ounce of non-pre-sweetened prune juice diluted 1:1 with water.
4-12 months: Try strained fruits twice per day. Avoid carrots, squash, bananas, or apples.
Over 12 months: Give fruits or vegetables three times per day. Avoid fruits that are not easily chewed! Increase the amount of water your child drinks. Avoid milk products and carrots as these foods may be constipating.
Toilet habits: Set up a regular time to sit on the toilet/potty for 10 minutes after meals, especially breakfast. If nothing happens, say nothing. If something does happen, provide age-appropriate positive reinforcement.
Stool softeners: If diet alone does not work, try a tablespoon of mineral oil after dinner. To make this therapy more tolerable, give the mineral oil with a tablespoon of chocolate or butterscotch sauce (that makes 2 tablespoons total). This therapy is not habit-forming.
Avoid suppositories as they can introduce small tears that may be painful and may make the constipation worse. Avoid laxatives unless suggested by the doctor.

Call us immediately at 508-655-9699 if

Your child develops severe pain
The pain becomes constant and lasts longer than 2 hours

Call during call-hour at 508-655-9699 if

The dietary changes listed above do not work after 3 days
The anus develops tiny tears that do not heal
Your older child soils him/herself (leaking stool)
Constipation occurs frequently
You have other concerns or questions

Lincoln Medical Building
61 Lincoln Street, Suite 210
Framingham, MA 01702

(508) 655-9699
(508) 655-2984 fax

Updated: 5/22/03

Dr. Lindeman,
My son seems to be straining to poop but nothing happens. How do I tell if he is constipated?

Constipation is defined as painful passage of stools or the inability to pass stool despite the urge to do so. No pain, no constipation.

Another definition may be the absence of stool for 4 or more days, except in breast-fed babies, many of whom pass large soft BMs at very odd intervals (up to one week is normal for these babies!).

Constipation may be caused by a diet without enough fiber. Other causes include waiting too long to go to the bathroom.

Small amounts of bright red blood may appear in the diaper or on toilet tissue in constipated children. This is normal and should not be cause for concern. It is caused by tiny tears in the anus by passage of large, hard stool.

Home Treatment

Constipation can often be treated through diet:

Less than 4 months old: Prior to a feed give an ounce of filtered or sterile water with a teaspoon of sugar. Repeat up to three times per day. If this does not work, try one ounce of non-pre-sweetened prune juice diluted 1:1 with water.
4-12 months: Try strained fruits twice per day. Avoid carrots, squash, bananas, or apples.
Over 12 months: Give fruits or vegetables three times per day. Avoid fruits that are not easily chewed! Increase the amount of water your child drinks. Avoid milk products and carrots as these foods may be constipating.
Toilet habits: Set up a regular time to sit on the toilet/potty for 10 minutes after meals, especially breakfast. If nothing happens, say nothing. If something does happen, provide age-appropriate positive reinforcement.
Stool softeners: If diet alone does not work, try a tablespoon of mineral oil after dinner. To make this therapy more tolerable, give the mineral oil with a tablespoon of chocolate or butterscotch sauce (that makes 2 tablespoons total). This therapy is not habit-forming.
Avoid suppositories as they can introduce small tears that may be painful and may make the constipation worse. Avoid laxatives unless suggested by the doctor.

Call us immediately at 508-655-9699 if

Your child develops severe pain
The pain becomes constant and lasts longer than 2 hours

Call during call-hour at 508-655-9699 if

The dietary changes listed above do not work after 3 days
The anus develops tiny tears that do not heal
Your older child soils him/herself (leaking stool)
Constipation occurs frequently
You have other concerns or questions

Natick Pediatrics, PC
Lincoln Medical Building
61 Lincoln Street, Suite 210
Framingham, MA 01702

(508) 655-9699
(508) 655-2984 fax

Updated: 5/22/03