CONSTIPATION PROTOCOL

 

1.     BOWEL TRAINING:

Sit on the toilet for 10 minutes after a meal with a glass of water. Pick a time of day when the household is not in the “Rush Mode”. Do not insist that the patient has a bowel movement; this is a time to allow the body to relax. If this sitting time is done every day for 1 week, eventually the bowels will be conditioned to relax and pass a stool at that time.

 

2.     DIET for Infants  < 1yr of age:

·      Infants >1mo of age who are fed breast milk or formula exclusively:  add fruit juices* – 1oz./month of age/day.

·      Infants >4mo of age:  add baby foods with high fiber content 2 times/day, (see food list below).

*Prune, apple and pear juices are beneficial to give because they contain carbohydrates which are poorly absorbed by the body, causing soft stool.

 

3.     DIET for Children >1yr of age:

·      Increase fruit juice (apple, pear, prune, cherry grape); citrus juices are usually not very helpful.

·      Add fruits,vegetables and whole grain foods which are high in fiber content (see food list below).

·      Decrease milk products to 3 servings/day

·      Increase water consumption

 

4.     FIBER REQUIREMENTS per age per day

·      2 -3 yrs = 19 grams

·      4 – 8 yrs = 25 grams

·      9 – 11 yrs:  female = 26 grams; male = 31 grams

 

 

5.      FIBER FOOD SOURCES (if age appropriate):

 

  Bran flakes


  Shredded wheat

  Figs

  Dates

  Prunes

  Raisins

  Raw Carrots

  Other Raw Vegetables

  Dried Apricots

  Peaches

  Pears

  Peas

  Beans

  Broccoli

  Cauliflower

  Cabbage

  Popcorn (>4yrs of age)

  Oatmeal

  Brown rice

  Whole wheat bread

 


 

6.      Foods to decrease:

   


       Milk

       Ice cream

       Yogurt

       Cheese

       Rice

 Cooked carrots

 

 


 

 

 

MEDICATIONS FOR CONSTIPATION:

 

Over The Counter:

 

CITRUCEL  (Bulk forming fiber laxative)

Promotes elimination by providing additional bulk (fiber) to the diet. The patient will usually have a bowel movement in 12-72 hours. Your child must have a good liquid intake.

Dose: 1 tsp-1 Tbsp 1-3 times a day as directed by your physician.

   

 

            MIRALAX

            Dose: 1 capful in 8 ounce beverage 2-3 times a day over a weekend until fecal excretion is clear. Miralax usually works within a few days.  Typical maintenance dosing is 1 capful/8 ounces of any beverage once/day, though the amount may be adjusted to produce a soft stool every day.

 

 

 

 

                                                    

                                

                                 

                                      

                          

                               

 

 

 

 

 

Resources:

 

Pediatric Nutrition Handbook.  6th edition, AAP, 2009

                    

Instructions for Pediatric Patients.  2nd edition, Dr. Barton Schmitt, 1999

 

Revised 5/10