Stephen J. Schueler, M.D.

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Hard Stool Children

Home treatment for constipation in children mainly involves general measures and diet changes. Medications such as laxatives or enemas are usually not necessary.

General Measures

  • Avoid foods that seem to give your child constipation. Some cheeses, white flour, and white rice can trigger constipation.
  • Avoid straining on the toilet, this can cause hemorrhoids and complicate things further.
  • Encourage drinking plenty of water.
  • Encourage regular activity and exercise.
  • Encourage your child to use the bathroom when the urge occurs.
  • Give your child a high-fiber diet every day.

Care for Constipation with Rectal Pain
For constipation with rectal pain consider the following treatments:
  • Have the child soak in a tub of warm water with 2 ounces of baking soda per tub. This can help the child to relax and release a bowel movement.
  • If the above is not successful, try one or two glycerin suppositories to smooth the way.
  • Try 10 seconds of gentle rectal stimulation using a lubricated rectal thermometer.
  • Fleet enema (normal saline enema) should only be administered with physician approval.

Care for Infants Under 1 Year
  • Infants younger 2 months: give one teaspoon of Karo syrup per day.
  • Infants older than 2 months: give 2-4 ounces of fruit juices (e.g. grape, pear, cherry, or apple) per day. Prune juice can be tried last. Orange juice and citrus juices are not as effective (contain lower levels of sorbitol).
  • Infants older than 4 months: try adding higher fiber baby foods such as peas, beans, cereals, apricots, prunes, pears, and spinach.
  • No enemas in children under 1 year of age.

Care for Children Over 1 Year
  • Make sure your child eats more fiber. The easiest way to do this is to include more fruits and vegetables in the diet.
  • Raw, un-peeled fruits and vegetables are best. Fruits include prunes, figs, dates, raisins, pears, peaches, apricots, and bananas. Vegetables include broccoli, cauliflower, peas, beans, and cabbage.
  • Bran is a natural stool softener and is high in fiber. Consider oatmeal, bran muffins, shredded wheat, graham crackers, and whole wheat bread. Popcorn is also high in fiber for those children who are over four.
  • A normal saline or Fleet enema may be considered in children over 2 years of age with your doctor's consent. Do not give an enema to any child with abdominal pain.
  • Anal fissures are a common problem associated with straining. They can also contribute to constipation. Symptoms include pain with defecation as well as blood on the surface of the stools.
    • Treat anal fissures with 20 minute sitz baths in a warm, saltwater tub three times per day. Apply a non-prescription 0.5% hydrocortisone cream to the fissure three times per day (after soaking).
  • Stool softeners can be considered if a change in the diet is unsuccessful. These medications can be given with dinner every night for one week.
    • Examples of stool softeners used in children include Colace, Haley's M-O, Metamucil, Citrucel, and mineral oil (1-2 tsp or 5-10 cc)
  • Stimulant laxatives are generally avoided in children. Your doctor may recommend one of these when diet and stool softeners are unsuccessful. These medicines work by irritating the intestinal lining of the intestines.
  • Popular stimulant laxatives include:

Enemas
Enemas are occasionally used in cases of constipation or to prepare the bowels for an x-ray. An enema works in two to fifteen minutes. One of the most commonly used is Fleet Enema, which contains sodium phosphate. Great care should be taken when giving enemas, since the nozzle could damage the anal canal.

Most commercial enemas contain phosphate compounds. Use in children may lead to toxic levels of phosphorus in the blood. Children should use no more than 1 ounce per 20 pounds of body weight. Pediatric Fleet enemas contain 2.25 ounces, while an adult Fleet contains 4.5 ounces. Mineral oil enemas come in 4.5 ounces. Children 2-6 years old can be given 2 ounces, while those older than 6 can be given a full, 4.5 ounce enema.

Instructions for a Fleet enema:
  • Place the child in a comfortable position on the left side with the knees bent.
  • Remove the protective shield from the enema tip.
  • Gently insert the enema tip into the anus. K-Y jelly may be used for lubrication. Slight bearing down as if having a bowel movement may help. Do not force the enema tip as this may cause injury.
  • Gently squeeze the bottle until the liquid has entered the rectum.
  • Remove the enema tip.
  • Retain the enema as instructed or for 10-15 minutes if possible.
  • Have the child drink plenty of fluids to avoid dehydration.

Continue to Hard Stool Dietary Fiber

Last Updated: Dec 8, 2010 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Hard Stool References
  1. Bleser S, Brunton S, Carmichael B, Olden K, Rasch R, Steege J. Management of chronic constipation: recommendations from a consensus panel. J Fam Pract. 2005 Aug;54(8):691-8. [16061057]
  2. Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P, Talley NJ. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol. 2005;100 Suppl 1:S5-S21. [16008641]
  3. Clayden G, Keshtgar AS. Management of childhood constipation. Postgrad Med J. 2003 Nov;79(937):616-21. [14654570]
  4. Lembo A, Camilleri M. Chronic constipation. N Engl J Med. 2003 Oct 2;349(14):1360-8. [14523145]
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