Let's Talk About Poop, Constipation, and How to Avoid or Treat it!

Infant & Child Poop

Most parents know (and new parents will soon learn) that poop all of a sudden becomes a normal topic of conversation when it comes to our little ones.

So let's dive right in and talk all about poop: what's normal, what's not, when to be concerned, and what to do about problems.

Newborn Poop

Your baby’s first stools will be black and sticky, like tar. This is called meconium and is normal. This will change once he/she feeds more and will eventually become more yellow with small chunks in it that resemble seeds or grains. Newborn stools are usually very loose and may resemble diarrhea. This is normal. It is also normal for your baby to have several poopy diapers a day, especially if your baby is breastfed. However, some babies may not poop daily and this can also be normal.

Consistency and frequency of stools can vary in newborns depending on several factors. But what is most important is that your baby's stools are soft, even if your baby does not poop every day. Signs of constipation may include a hard belly that seems painful to touch, fussiness or crying with stooling, or small hard balls for stools. If your infant is experiencing constipation, your child's doctor may recommend small amounts of prune or other high fiber fruit juice or may give your child a rectal suppository. Be sure to consult your child's doctor to find out how to correctly and safely help your baby.

You should notify your child's doctor if you notice red stools or anything that looks like blood in your baby's stool, stools that are completely white (acholic), or if you are concerned that your baby may be constipated. In newborns, blood in stools can be a sign of a milk allergy or of constipation if your baby's stools are also hard. White stools can be a sign of liver disease or a problem with your baby's metabolism and ability to process foods correctly.

Infant & Toddler Poop

Once your child starts eating baby foods or solid foods, their poops will change. At this stage, stools may change in color, frequency, and consistency. They can range in color from shades of yellows, greens, browns, or oranges, depending on what your child eats, and may become more formed. Most important, again, is that your child's poops are soft. There is usually no cause for concern unless you see anything that looks like blood in your child's stool or your child is showing signs of constipation.

At this stage, blood in stools can be a sign of a food allergy or of constipation if your baby's stools are also hard. Signs of constipation at this age may include a hard belly that seems painful to touch, fussiness or crying with stooling, or small hard balls for stools. You should still notify your child's doctor if you notice red stools or anything that looks like blood in your child's stool or if you are concerned that your baby may be constipated. Your doctor may test your baby's stool to determine if the redness is actually blood or may just be food-related.

Now that your baby is eating solid foods, you can try offering high fiber foods, such as pureed pears or prunes. You can also give your baby water to drink (up to 4 ounces per day if your baby is at least 4 months old or up to 8 ounces per day if your baby is at least 6 months old).

If this does not help your baby poop or your baby still seems constipated, talk to your child's doctor. Your child's doctor may recommend small amounts of prune or other high fiber fruit juice or may give your child a rectal suppository. Be sure to consult your child's doctor to find out how to correctly and safely help your baby.

Preventing constipation in babies

Here are some tips to help prevent constipation in your baby.

Know what foods constipate. Know that some of the baby foods that are common favorites or starter foods can often lead to constipation, such as rice cereal, apples, and bananas. Some foods, like apples, that are generally a good source of fiber, lose their fiber when they are processed into most store-bought baby foods.

Choose high fiber baby cereals. Opt for higher fiber options for cereal, such as whole wheat, oatmeal, or quinoa baby cereal and offer cereal on a spoon, rather than in your baby's bottle, unless your child's doctor has recommended otherwise.

Choose high fiber baby foods. Make sure to incorporate plenty of high fiber foods into your baby's diet when you start solid foods.

Make baby food at home. If you are making your baby's food at home, keep the skin on any fruits before pureeing to incorporate more fiber (this makes apples a great option when they're cooked at home). A good rule of thumb for fruits is that if you can eat the skin, it is usually high in fiber. This makes pears, prunes, peaches, plums, and berries great options. However, mangoes, pineapple, and papaya are good options too. For vegetables, green vegetables, such as peas, green beans, and spinach are rich in fiber. Sweet potatoes, avocado, squash, carrots, and beets also contain plenty of fiber and make great baby foods. Check out my post on "How to Make Baby Foods: Easier Than You May Think" for more specific ideas.

Read labels. If you are buying your baby's food, read the labels for fiber content. Your baby's foods should have at least 1 gram of fiber per serving. If your baby has some favorites that do not contain much fiber, mix them or offer them in combination with something that contains more fiber (for example, apples and prunes, bananas and mangoes, or rice cereal and squash).

Big Kid (and Adult) Poop

Once your child is eating mostly table foods and/or is potty trained or older, you will notice that their stools are more formed. Again, color may vary but you mainly want to monitor for signs of constipation.

Signs of constipation in a potty-training or older child may include:

• Streaks of blood on wipes or toilet tissue or blood seen in stool

• Stomach pain (which can be severe and is a common cause for emergency room visits)

• Rectal, anal, or stomach pain with stooling

• Withholding stools (young kids learn quickly NOT to poop if pooping hurts)

• Soiling underwear once fully potty-trained (often due to softer or liquid stool spilling around a larger, hard ball of stool stuck in the rectum)

• Infrequent stools (while stooling daily is not an absolute requirement, stooling only once or twice a week is a sign of a problem in an older child)

• Hard stools that present as small balls or very thick or very long pieces (or a child that often clogs the toilet)

• Having to push excessively or strain to stool or a child who is in the bathroom for extended periods of time while stooling (not including time spent just on cell phones or tablets)

Preventing constipation in older children

Here are some tips to help prevent constipation in your older child.

Know what foods constipate. Know that many of the common foods in American culture are big culprits for constipation. Excess meats and starches, such as in most fast foods, junk foods, and packaged foods contain little fiber (or nutrition in general) and lead to lots of constipation. Your child's meal should contain mostly (half of the meal) fruits and vegetables with only a quarter of the meal consisting of meats or other proteins (like eggs, beans, or tofu), and only another quarter of the meal consisting of starchy foods (like rice, potatoes, corn, or pasta).

Don't let your child drink TOO much milk. Excess milk consumption in kids can also lead to constipation. While infants diets' consist mainly of milk in the form of breastmilk of formula, after age 1, the need for milk significantly decreases and your child should be consuming more solid foods than milk:

• After age 1, your child should drink 16-24 ounces of whole milk daily but no more than 24 ounces (2.5 tall sippy cups or 4 short sippy cups)

• After age 2, your child should drink no more than 16 ounces of lower fat (2%, 1%, skim, or any milk alternatives, such as almond or soy milk) milk daily (1.5 tall sippy cups, 1.5 standard-sized kids cups, 2 tall glasses, or 4 short glasses)

Offer high fiber fruits and vegetables. Make sure to incorporate plenty of fruits and vegetables into your child's (and your) diet. A good rule of thumb for fruits is that if you can eat the skin, it is usually high in fiber. This makes pears, apples (with skin on), peaches, plums, raisins, prunes, and all types of berries great options. Other fruits that are high in fiber include mangoes, oranges, and pineapple. For vegetables, green vegetables, such as peas, green beans, spinach, kale, broccoli, and any dark leafy greens are rich in fiber. Sweet potatoes, squash, carrots, and beets also contain plenty of fiber. (check out my post on "How to Get Your Child to Eat Veggies (even if they don't know it)").

Juice does not count (even "100%" juice). Know that store-bought fruit and vegetable juices are NOT a substitution for fresh fruits and vegetables. Much of the fiber is lost during processing to make most commercial beverages. Opt to juice or make smoothies at home from fresh fruits and vegetables to retain fiber as an alternative to eating the fruits or vegetables directly.

Offer other high fiber foods. Incorporate plenty of other high fiber foods into your child's diet, such as whole grains and high fiber proteins. Opt for whole wheat bread rather than white bread, brown rice rather than white rice, or other healthy grains such as quinoa, oats, and chia. Avocado, beans, peanuts, peanut butter, and other nuts are also great fiber- (and protein-rich) foods to eat plenty of.

Encourage lots of water. Make sure your child is drinking plenty of water:

• After age 2, your child should be drinking at least 16 ounces of water daily (1.5 standard-sized kids cups, 2 kids-size bottles of water, or 1 regular-sized bottle of water)

• By age 4, your child should be drinking at least 24 ounces of water daily (2.5 standard-sized kids cups, 3 kids-size bottles of water, or 1.5 regular-sized bottles of water)

• By age 9 and into adulthood, your child should be drinking at least 64 ounces of water daily (4 tall glasses or 4 bottles of water)

Read labels. Read labels for fiber content to learn what foods are high or generally low in fiber! If a food or beverage contains less than 1 gram of fiber per serving, this a food that can lead to constipation or at least won't help with it, especially if eaten in excess and/or without other higher fiber-containing foods.

Make it routine. High fiber foods should be ideally consumed not just on a daily basis, but with every meal!

Avoid fiber supplements. Avoid fiber supplements in children. Natural fiber that they get through foods is the best way to prevent constipation as fiber supplements can sometimes lead to overly bulky stools that can actually make constipation worse in children.

Yogurt is your friend. Incorporate yogurt into your child's diet on a regular basis. Yogurt and it's natural probiotics (healthy bacteria) are great for bowel health and can prevent both diarrhea and constipation.

If after changing some of these things in your child's diet, your child is still showing signs of constipation, talk to your child's doctor. Your child's doctor may recommend medication to help, typically a stool softener that is safe in children. Rectal suppositories and enemas should only be used as a last resort in severe cases that do not respond to treatment by mouth or that are causing severe pain. Most older children (and adults) will fight anything being introduced into their rectum making this a difficult, traumatizing, and unpleasant experience for everyone, which is best to avoid when possible.

Good bowel health is a goal we all strive for and desire, especially for our children. Following some of these tips will help to create long-term bowel health for your child.

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