Parents can often become concerned over their child’s bowel habits. Constipation is one of the two most common complaints doctors hear from parents. Knowing what is “normal” can help ease parents' concerns. These are guidelines, not hard and fast rules. You know your child better than anyone, and if you are concerned call your doctor.
What is normal and when should I intervene?
Babies over 1 month of age who are breastfed can often skip bowel movements for 4 or more days. If the subsequent bowel movement is large and soft you can consider this normal. Breastfed babies under 1 month who are not having regular bowel movements should see the doctor. It could indicate that they are not getting enough food.
Babies can grunt and turn red while eliminating. This is normal because they are usually lying flat and don’t have gravity to aid them in passing stool. Also, size of the stool is related to size of the appetite of the child. A big eater is going to have a big stool, and this is normal.
Table food added to a diet will change a baby’s stool. Toddlers and children who do not eliminate regularly can experience pain while trying to pass the stool. Passing a stool should be pain free. Pain often triggers a “holding” response in a child. They become fearful of the pain and refuse to go. Adding extra fiber (fruit and fruit juices, vegetables) and water can help decrease the hardness of the stool, decrease the pain, and increase the urge the child will find harder to resist. If this does not immediately help the problem, you should see your doctor. Do not administer laxatives to children except under the supervision of a doctor.
Normal constipation and slow elimination can escalate over time.
Go to the Emergency Room if your child is vomiting green bile. Yellow vomit is normally just stomach juices. Bile is green.
Call your doctor immediately, regardless of time of day if:
- Your child is weak, vomits more than twice and has bloating or swelling of the stomach your child has abdominal pain that goes on for over an hour
- Your child is under 1 month old and not having bowel movements
- Your child is under 12 months and suddenly has a weak sucking reflex or muscle weakness. Children who look and act very sick should be seen immediately
Make an appointment the next day if:
- There is blood in the stool or visible in the diaper
- Your child refuses to go to the bathroom even though the need is obvious
- Your child is under 2 months of age and is showing more than a normal strain
Make a “next available” appointment if:
- Constipation is becoming a frequent issue
- There is leaking stool
- Changes in diet (adding more fiber and liquid) are not helping
- You are in the midst of potty training and your child is holding their stool
- You are concerned as a parent that something is wrong
Trust your instincts!
Children are not just miniature adults. Their illnesses and gastrointestional issues require a special touch and special training. GI Associates has a dedicated pediatric department specializing in the treatment of gastrointestinal disorders in children.
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