Today’s blog was written by Dr. Prakar Poudel, MB.BS, Medical Graduate, Future Pediatrician!

Is your child not passing stool ?

Many parents just like you visit the doctor when their child doesn’t pass stool for many days. But how many days are too many? How hard is too hard? How large too large? Should it hurt? Bleed?

You should suspect constipation if your child does not pass stool for about 5 days (unless they are a breast fed infant – they can average 2 weeks!). Constipated stool should be large and hard, sometimes painful, and sometimes have a little bright red blood from splitting the skin at the anus.

Around 30% of children below 5 years of age will experience constipation at some point, especially during their pre-school years. The causes of constipation in children can be confusing, but you can rule out a few common causes before a doctor’s visit.

Common Causes:

If your child drinks little fluid or a lot of milk, eats a lot of cheese or loads of highly processed foods, or eats few fiber rich foods, they can have difficulty passing stool daily.

Sometimes, they may also be hesitant to pass stool in a public toilet. Because of this nervousness, they also may not want to go at day-care or school. He or she may need patience and encouragement to ease their hesitancy in public toilets.

What is constipation?

So, how do you know if your child is constipated? The list below can help parents like you identify the problem. If:

• they pass stool less than 2 times in a week
• the stool is hard and thick.
• they cry while passing stool
• they take a long time in toilet
• the passed stool has bright red blood on it
• their belly hurts and is relieved by passing stool
• their belly is distended
• they pass foul-smelling gas

What to do?

All these signs are concerning, but can usually be resolved at home by giving your child an adequate amount of fluids and fiber-rich foods. Highly processed food should be minimized at this time, and limit dairy products. This is the only time your pediatrician will recommend sugary drinks, because sugar will draw water into the bowel. (White grape juice will match most carpets.)

As a parent, you should also be aware that children (and puppies!) will generally pass stool soon after they eat due to the gastrocolic reflex. This is very helpful in toilet training or with mild constipation. It is suggested that you keep your child for 5-10 minutes on the toilet after meals, even without any urge to pass stool. Keep special toys or books nearby that can only be played with while on the potty. We want this to be fun!

When to worry

Besides these common causes, medical causes like hypothyroidism, cystic fibrosis, celiac disease will always need a pediatrician visit. So, when should you visit a pediatrician with your child? Below are of some signs to guide that decision:

• If your baby does not pass stool within 48 hours after birth.
• If the baby is less than 1 month old
• If the stool is ribbon-shaped
• If a child is not gaining weight and height as per the growth chart
• If your child is also vomiting
• If a hair tuft or dimple is seen on the back of your child
• If your family history has Hirschprung disease or cystic fibrosis
• If the belly of your child is grossly distended
• if he or she is leaking liquid stool
• if they pass stools so large they clog the toilet

As always, if you have any questions, call your pediatrician. They love this stuff.

Pediatricians are weird.