Among infants and children there is considerable variability in the number of stools per day.  Newborn breast fed infants can have six to eight loose stools per day while formula fed infants may pass one formed stool every two or three days. Both patterns are entirely normal.  Straining, grunting and turning red in the face are part of the normal physiologic process involved in passing stool.  Only when stools are extraordinarily hard or infrequent is there cause for concern.  Occasionally, when the stools are very firm, streaks of blood will be noticed on the outside of the stool.  Bleeding is caused by a tiny tear in the lining of the anal canal. This is called an anal fissure and is nothing to worry about, unless the bleeding persists.

Bear in mind that most infants will experience a dramatic decrease in their frequency of stools at two months of age and whenever formula is introduced (previously breast fed).  This change is harmless and should not arouse concern. 

Management of constipation is often directed towards softening the stools, either through dietary changes or specific softening agents.  Decreasing intake of milk, a frequently constipating food, increasing fruit intake (especially prunes, pears and peaches), or using bran cereal may be of benefit.  For infants we usually recommend adding either prune juice or dark Karo syrup to the formula.  Start with one tablespoon of prune juice or one teaspoon of syrup in the bottle of formula twice a day.  In older children, fiber supplements (Benefiber) or lubricants (mineral oil) may be used.  The dose of mineral oil is one tablespoon per day.

When bowel movements are infrequent but not particularly hard, anal stimulation with a glycerin suppository or liquid glycerin mini-enema (Baby lax) may be effective.  These methods should not be used more often than every two days.

Laxatives (polythyelene glycol, senna) and enemas (Fleet’s) are generally NOT recommended without prior office evaluation.