Squatting Position to Help Stool Release  

    - The squatting position gives faster stool release and less straining. Reason: it lines up the rectum with the anus. 

    - The squatting position means that the knees are above the hips. 


Warm Water to Relax the Anus  

    - Warmth helps many children relax the anal sphincter and release a stool. 

    - For prolonged straining, have your child sit in warm water. 

    - If not successful, apply a warm wet cotton ball to the anus. 

    - Vibrate it side-to-side for about 10 seconds to help relax the anus. 


Anal Stimulation for Acute Rectal Pain Due to Constipation (Age Over 3 Months) 

    - If external anal stimulation with a warm cotton ball or sitting in a warm bath doesn't work, try internal anal stimulation. 

    - Method: Use a lubricated thermometer. Insert it slightly into the anus. Gently move it side to side for about 10 seconds. That should trigger release of a stool. 

    - Caution: Do not insert it more than 1/2 inch (12 mm). 


Non-constipating Diet for Infants Under 1 Year 

    - For infants over 1 month And only on breast milk or formula: Add fruit juice. 

    - Amount: 1 ounce (30 ml) per month of age, per day. Limit amount to 4 ounces (120 mL) per day. Pear or apple juice are good choices. After 3 months, can use prune (plum) juice. (Reason fruit juice approved for babies: using it to treat a symptom.) 

    - If over 4 months old, also add baby foods with high fiber content 2 times per day (peas, beans, apricots, prunes, peaches, pears, plums). 

    - If on finger foods, add cereal and small pieces of fresh fruit. 


Glycerin Suppository (Age Over 3 Months) 

    - If anal stimulation with a wet cotton ball doesn't work, use a glycerin suppository (OTC). A suppository is inserted past the anal sphincter. It will melt at body temperature. Dosage is based on age: 

    - 3 months - 1 year: 1/2 Pedia-Lax or 1/2 pediatric suppository cut lengthwise (Note: Liquid suppositories work best for children who push out solid suppositories.) 


    - If a suppository is not available and external anal stimulation with a warm wet cotton ball doesn't work, can try internal anal stimulation. Age range 3 months to 3 years. 


Miralax Stool Softener (Age Over 6 Months Old)  

    - For chronic or recurrent constipation, recommend Miralax (OTC) until seen.  

    - Miralax is a colorless, tasteless, odorless powder that can be mixed with any fluid. 

    - Age 6 - 11 months: half tsp (2 ml) powder per day mixed in 2 oz. (60 ml) fluid 

    - Age 1 - 5 years: 1 tsp (5 ml) powder per day mixed in 2 oz. (60 ml) fluid 

    - Age 6 - 12 years: 2 tsp (10 ml) powder per day mixed in 4 oz. (120 ml) fluid 

    - Age 13 years or older: 3 tsp (15 ml) powder per day mixed in 6 oz. (180 ml) fluid 

    - Fiber products (such as Benefiber) are also helpful. Give 1 teaspoon (5 ml) twice a day. 

    - Stool softeners and fiber should produce soft stools in 1 to 3 days after they are given. 


Reasons To Call Back 

    - Stool is not released 

    - Rectal or abdominal pain occurs 

    - Your child becomes worse 


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