Dr. Robert Needlman
Specialist in pediatric behavior and development.
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 Ask Dr. Needlman
Constipation in a 14-Month-Old | | | QUESTION | | | Dear Dr. Needlman,
I have a 14-month-old grandson, who suffers from constipation. He strains and grunts to a point that he will lie on the floor. When he does have the movement it is so large and hard that he cries from the pain that such a large movement causes. I give him peas and some juice to try and relieve this problem. Then he seems to start having runny movements. However, his parents feed him a lot of crackers and bread type products. Any suggestions as to what we should do? Thank you from his Poppy.— Shelferj in Daytona Beach, Florida | | | ANSWER |
July 23, 2001 | | | Dear Shelferj,
For constipation of the sort you are describing where there are very large, painful stools, the first step of effective treatment is to remove the built-up, hard stool from the colon. The way the colon moves stool along is by squeezing, sort of like squeezing a tube of toothpaste. Having a mass of hard stool makes it impossible for the colon to squeeze, which leads to the stool building up more and more.
So, as I said, the first step is to clean the colon out. Until you do that, no other treatment is likely to be effective. It's probably best, when going about doing this clean out, to work under the supervision of a doctor who has done it many times. It's not that it's so difficult or complex, but it is possible to cause medical problems if you do it incorrectly (for example, by over-using enemas). The other reason to work with a doctor is that although constipation usually is not a sign of any underlying disease, there are rare conditions that can cause constipation, and a doctor (pediatrician or family physician) will know how to look for them.
Once the colon is cleaned out, the treatment involves diet changes to keep the stools soft and large, so that the muscles of the colon can push them along, and so that they can pass without hurting. There are many ways to do this. Some of the suggestions I have found to work best are:- To give plenty of fluids. Young children should have two to three cups of low-fat milk a day (milk constipates some children, but if you decide to cut out the milk, you need to talk with your child's doctor about other sources of calcium and vitamin D). In addition to the milk, a constipated child should have four to five more cups of juice or water, or more in hot weather.
- To give high-fiber foods: bran cereal and miller's bran (available at supermarkets, but you may have to ask) mixed into foods or sprinkled on peanut butter, or cooked into casseroles or desserts. Be creative. Try to sneak in 2-3 tablespoons per day. Be aware that fiber has to be given with extra fluids (as mentioned above). Otherwise it just "gums up the works" more. The crackers and bread you mentioned are OK, but it would be best to use whole-wheat bread, and crackers made with whole wheat or other high-fiber crackers; plain white flour isn't very helpful.
- To try the "P Fruits that make you poop": peaches, pears, plums, prunes, aPricots (well, it's almost a "p fruit") all in heavy syrup. Children love the sweetness, and the syrup tends to draw fluid into the colon, causing a soft stool.
Find more suggestions for constipation treatment in our constipation program.— by Robert Needlman, M.D., F.A.A.P. |
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