Bowel Problems
The number and consistency of stools for a healthy child vary with age and diet. For example, infants who are breastfed normally have mustard-colored stools that are soft and seedy. However, repeated watery bowel movements for a time lasting longer than 12 hours are never normal.
Diarrhea is frequent, watery bowel movements. Acute diarrhea starts suddenly and improves in one to several days. Acute diarrhea is most often caused by viral gastroenteritis, which is especially likely when vomiting accompanies the diarrhea. Typically, vomiting occurs at the beginning of the illness and then tapers off, while diarrhea continues. Acute diarrhea can also be caused by a bacterial or parasitic infection; an infection elsewhere in the body, such as an ear or respiratory tract infection; and as a side effect from the use of antibiotics. Acute diarrhea is a concern mainly because it can cause dehydration. Therefore, the main treatment is administering fluids and electrolytes. Bacterial infections are treated with antibiotics. Antibiotics that cause diarrhea may be discontinued, but only after consultation with a doctor.
Chronic diarrhea lasts for weeks or months. The most common causes of chronic diarrhea in infants and young children are cystic fibrosis, celiac disease, giardiasis, sugar malabsorption, and food allergy. In less developed countries, malnutrition is the most common cause of chronic diarrhea.
Constipation is the infrequent passing of hard, dry stools (see Section 23, Chapter 275). Constipation may be difficult to recognize because some infants and young children have bowel movements only once every 3 to 4 days. In general, children are constipated when they have not had a bowel movement in 5 or more days, when the stools are hard or cause pain, or when drops of blood are seen in the diaper or stool.
Constipation in infants is usually caused by dehydration, insufficient fiber in the diet, or a change in feeding patterns. Rarely, medical disorders, such as inadequate nerve supply to the large intestine (Hirschsprung disease), low thyroid hormone levels, or calcium or potassium abnormalities cause constipation. The use of certain drugs (such as antihistamines, anticholinergic drugs, and opioids) is another rare cause.
Treatment of constipation varies with the age of the child. Infants younger than 2 months of age who consume adequate amounts of formula or breast milk can be given a teaspoon of light corn syrup in their morning and evening bottles. Apple or prune juice is good for infants between 2 and 4 months of age. Infants between 4 months and 1 year can get relief from high-fiber cereals or from strained apricots, prunes, or plums. Children older than 1 year should be given high-fiber foods, such as fruits, peas, cereals, graham crackers, beans, and spinach. Parents should not give their child a laxative, suppository, or enema without first consulting a doctor. For older children with significant constipation, doctors may use various drugs. Treatment of rare disorders includes surgery for Hirschsprung disease, thyroid hormone replacement for low thyroid hormone levels, and calcium supplements for abnormal calcium levels.
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