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             -- David Frost

Hand In Hand Pediatrics
725 River Road, Suite 208,     Edgewater, NJ 07020  |  tel: 201.840.8055
(We are located next to Trader Joe's)

      Constipation in Children
              By Dr. George Chai MD

Constipation in children is a very common problem. Constipation is defined as hard, stools that are difficult or painful to get out. It is not so much about the frequency per day, but the consistency and difficulty accompanying a bowel movement. On average children has 1-2 BM per day, but some children can go 2-3 days without problems.

Common causes of constipation are not medical but dietary and behavioral. From a dietary perspective, a child doesn't take enough fiber or liquids. Behaviorally, some kids develop constipation because it is difficult and uncomfortable to poop and they start witholding it. Other reasons for witholding behavior are toilet training has been an unpleasant experience and they want to hold their stools, they don't want to stop playing and for older children, they don't have time to go or are afraid of public toilets. Unfortunately, the combination of the two causes, usually lead to a downward spiral of pain with stooling leading to increased withholding and even harder stools and more pain. The longer a child holds stool, the harder it becomes.

The most important thing to do is change the diet. Increase the amount of fiber in the diet and decrease foods low in fiber. Encourage plenty of liquids. As a rule of thumb the number of grams of fiber your child needs is equal your child's age PLUS 5. For example, a 2 year old child will need 7 grams of fiber (2+5). Foods that are high in fiber are:

·         Whole-grain breads, cereals and pasta

·         Brown or wild rice

·         Dried fruits

·         Raw fruit with skin or membranes, such as oranges and grapefruit

·         Pears

·         Raw vegetables

·         Dried beans or peas

·         Baked beans

·         Seeds and nuts, and foods containing them

Food that are low in fiber and should be limited are:

·         Enriched white bread

·         White rice

·         Plain pasta, noodles or macaroni

·         Cereals with no more than 1 gram of dietary fiber per serving

·         Most canned or cooked fruits without skins, seeds or membranes

·         Raw fruit without skin or membranes

·         Fruit and vegetable juice with little or no pulp

·         Canned or well-cooked vegetables without seeds, hulls or skins, such as carrots, string beans and peppers

·         Tender meat, poultry and fish

·         Eggs

·         Milk

Additional ways to improve the stools is to encourage and develop a regular routine of stooling. If starting to toilet train, do not push the child until the child seems ready and interested, and make sure it is not an unpleasant experience.

If a child has abdominal pain with constipation, soiling in their pants, or constipation which occurred since birth, then your pediatrician should be consulted. In cases like these, medication made be required to clean your child out of hard stools or additional workup is necessary.

So what do you think? We would love to hear your experience of helping your child with constipation. Please share your stories with us. If you would like to consult Dr. Chai for your specific constipation problem, you are welcome to email us or call the office.

Article written by Dr. George Chai

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