Having a Hard Go

This week's guest columnist is Dr. Justin Pratt, a Family Practice resident at the University Hospital and Clinics here in Lafayette. "Something isn't right.  My baby only poops every three days, and all my friends' babies go every day.  What's wrong?" -First time mother of a four-month old in my clinic. Constipation is common: Whew!  You're not the only one with a constipated kid!  Almost one third of children have constipation some time in childhood.  The definition of constipation varies with age.  For the baby above, skipping three to four days between stools is normal.  Straining to poop may mean constipation, maybe not.  However, passing hard stools that hurt, that's constipation for sure. Besides not stooling for days, moms worry that when their infants strain and grunt, they're having a hard time (literally?).  However, if baby finally goes and it's soft, that's normal.  Consider this: babies must have bowel movements while lying down, so it's going to take some straining.  You probably haven't tried since you were that age, but it is! Older children can suddenly have constipation, after going regularly and easily. There's some times in life this commonly occurs.  The first is when one year-old's transition to solid foods and cow's milk.  The new toddler can get constipated from too much milk, which has no fiber, and not eating enough fiber-containing foods like fruits and vegetables.  Moms think: milk is good, give him all he wants.  This kills baby's appetite for other foods, and then comes the painful consequences.  Thus, at one year babies should only get three or four 4-ounce sippy cups of milk per day.  This lets them be hungry for more fibrous food. The next common constipation "milestone" is potty training.  When confronted with the unfamiliar potty, toddlers often get stage fright: "You want me to do that, there!?"  Sometimes they'd rather just hold it until you give up and put the diaper back on.  If this stubbornness goes on for more than two weeks, maybe she isn't ready yet, and should go back to diapers for another few months. "I"m really uncomfortable and haven't had a BM all week.  I started a new construction job, don't get to go in the morning, and can't use the homeowners' bathrooms.  I'm in the heat all day and probably don't drink enough water." -17 year-old in the Emergency Department. Another time children get constipated is when they start school.  They've been using their nice, private bathroom at home.  Now they have to get out of the house early, often skipping going.  Then at school, they have to share the bathroom with other kids.  Many aren't respectful of bathroom privacy, sometimes out of curiosity, sometimes to be mean.  Who could go in those circumstances? So these kids hold it all day, waiting to get back home. When you don't poop for a while and don't drink enough water, your body scavenges extra water from stool.  The rectum absorbs the water, poop dries up, and compacts. Then it hurts to pass. Fixing constipation depends on age and cause.  As above, babies who skip days pooping or strain, but it comes out soft, aren't constipated.  If baby has hard poops that hurt, the easiest remedy is fruit juice, an ounce or two twice daily.  It takes a few days to work, but the fruit sugar is a laxative, and after passing the last "rocks," baby should go smooth.  Babies over 4 months old can have strained foods with fiber, like cereals, vegetables, or fruits, to prevent constipation.  Also, breast milk prevents constipation compared to formula. Babies transitioning to cow's milk, like we said above, should get only three to four 4-ounce cups of milk per day.  More than that can constipate, and kills appetites for fiber-containing foods.  Kids should eat at least three fruit and vegetable servings per day, preferably more. For potty-training kids, if you're fighting to get your kid use a toilet, put him back in diapers and wait a few months.  Have foot rests for your adult toilet, or a toddler toilet.  It's harder to go without a little leverage! If your child is having hard painful stools, and you're thinking about a suppository or enema, talk to your doctor first.  She can help you pick more effective, less traumatic fixes for constipation.