Constipation
also see GI Bleeding

Definition:
- In a newborn: firm stools less than once per day
- in an older child: hard, compact stools, less than every 3-4 days
- at any age: hard, dry, painful straining
- abdominal pain, relieved by a large BM
- blood in or on the outside of stools
- soiling between BM
- Illnesses resulting in loss of appetite or activity may cause constipation.

Etiologies of Constipation

• Anatomic: anal or rectalstenosis,anteriorlydisplaced anus, small left-colon syndrome
• Neurologic: spinal cord injury,myelomeningocele,Hirschsprung’sdisease, intestinal pseudo-obstruction, functional ileusof newborn, Botulism, Infant
• Metabolic: hypothyroidism,hypocalcemia,meconium ileus,hypokalemia, diabetes mellitus
• Psychogenic: functionalmegacolon/encopresis, painful defecation, severe mental retardation, emotional disturbance.
• Miscellaneous: infant botulism, drugs (e.g., opiates), lead poisoning, dietary

Dietary changes
- Increase water intake
- in an older infant/child, limit milk intake to less than 24 oz/day.
- High fiber foods: prunes, apricots, plums, raisins, high fiber vegetables (peas, beans, broccoli), whole grain cereals/breads, bran, whole grain, raw fruit and vegetables (carrots, broccoli, prunes, apricots, figs, celery, pineapple)
- apples and bananas tend to have binding (constipating effects)
- regular exercise

Infants:
- prune juice 1-3 oz (to start) bid, tid until stools are soft
- plain water 1-2 x per day will help soften stools
Children
- Maltsupex (15-30 cc in 8 oz liquid qd or bid)
- Metamucil, Effersyllium, Fiberall, Naturacil - follow instructions on label
- Mineral oil - 15-30 cc bid

Avoid large amounts of
- Bananas, Rice, Apples, Toast
- Potatoes, Yams
- Cheeses
- Pastries, Sweets
- White or processed bread
Honey and Corn syrup (ie Karo) should never be given to infants.

Behavioral
- sit on toilet after breakfast every day, until BM or for 15 minutes.

Bowel movements in infants