Dear Mbak Ami..

Ini ada bebrapa artikel dr web sehat ttg konstipasi..
yg penting sih ubah pola makan deh.. banyak serat n
sayuran banyak minum air putih… n kurangin manis…

Btw, bon2 tu coklat yah… aduhhh mendingan dikurangin
deh pelan2… anaknya taruh kata nangis kejer biarin
deh… ntar lama juga terbiasa… kan demi anaknya juga..
Eh, Mbak kayanya juga pengasuh susunya lho yg berasa
manis.. lebih ok kalo cobain susu Uht yah.. yg plain
aja..

Ok, moga2 bisa Bantu yah..

Uci mamaKavin

http://www.sehatgroup.web.id/
Constipation

Constipation is a very common and frustrating problem
in children. It is usually defined as the passage of
hard and painful stools or going four or more days
without a bowel movement. It is most commonly caused
by a diet that is low in fiber, but can also be caused
by drinking too much milk (more than 12-16oz/d), not
drinking enough water or waiting too long to go to the
bathroom. 
Once a child becomes constipated and has hard and
painful stools, he will then begin to hold in his
bowel movements to prevent it from hurting again. This
creates a cycle that makes the constipation continue
and become worse.


Treating Constipation
Constipation is best treated by making changes in your
child's diet. Until the constipation has improved with
a non-constipating diet, your child will most likely
also be on stool softeners. The goal of treatment is
for your child to have one to two soft stools each
day.

Diet Treatment for Infants
Increase fluids: Give 2-4 oz of water or diluted fruit
juices (such as grape or prune) 1-2 times each day, or
try switching to a soy formula. 

Increase fiber: If your infant is over four months
old, you may also try feeding foods with a lot of
fiber, such as cereals, strained prunes, apricots, or
spinach.


Diet Treatment for Children
Increase fluids: Increase the amount of water and
fruit juices (minimum of 2-3 glasses) that your child
drinks each day. 

Increase fiber: Increase the amounts of fruits and
vegetables that your child eats. Raw, unpeeled fruits
and vegetables (especially beans, sweet potatoes,
peas, turnip greens, raw tomatoes and corn) have the
most fiber. Popcorn also has lots of fiber in it. Give
enough grams of fiber to equal their age in years plus
5 each day (check the nutritional label for high fiber
foods and snacks with at least 3-4g of fiber per
serving). Vegetable soups are especially high in fiber
and also add more fluid to your child's diet.

Increase bran in your child's diet by offering bran
cereals, bran muffins, shredded wheat, graham
crackers, or whole wheat bread.

Decrease constipating foods: These include milk,
yogurt, cheese, cooked carrots, and bananas which can
make your child more constipated. Drinking too much
milk (your child may only be drinking 2-3 cups a day,
but it may be too much for his system to handle) is
heavily associated with being constipated. Switching
to soy milk has been shown to soften stools. If your
child is unable to drink milk, then offer a daily
multivitamin or other sources of calcium.

Stool Softeners
Most of these medications are available in the
pharmacy over the counter and do not require a
prescription. They include Metamucil, Milk of
magnesia, Citrucel, mineral oil or Senokot. Unlike
laxatives in adults, they are generally not considered
to be habit forming. You should use them once or twice
a day and work up on the dose until your child is
having a soft BM each day. If you child starts to have
diarrhea, then you are giving too much and you should
cut back on the dose.

Changing doses
Once your child is having 1-2 soft stools each day you
should continue with the doses of the medicines that
you are using for 6-12 months until he is accustomed
to his new non-constipating diet. You can then
gradually stop the stool softeners by slowly lowering
the amount you are giving every 1-2 weeks. 

If stools are too loose then cut back on the dose by
one-third. If stools are still too hard then increase
the dose by one-third. Avoid making changes in the
medicines based on one bowel movement, or you will
wind up ‘seesawing' with the doses.


Treating Acute Constipation
If your child has been constipated for a long time or
he is having discomfort or significant pain with bowel
movements then you may need to ‘clean out' backed up
stool before the stool softeners will work by using an
enema, a glycerine suppository or high doses of
mineral oil. See your pediatrician for information on
how to start begin this treatment.

Behavior Modification
You should encourage your child to have regular bowel
patterns. Have your child sit on the toilet for about
ten minutes after meals 1-2 times each day.
The use of simple rewards or a daily calendar with
stars or stickers for days that your child takes his
medicine and has a bowel movement may be helpful.

Important Reminders
*       Be patient. This is a chronic problem that can take
time to improve. Avoid embarrassing or punishing your
child. 
*       Avoid the frequent use of enemas or suppositories. 
*       Call your pediatrician if your child is not
improving in 2-3 weeks, is regularly needing to use
enemas or suppositories, or is soiling his pants
because of leakage of stool. 


Constipation Treatment Guide

Constipation is a very common and frustrating problem
in children. It is usually defined as the passage of
hard and painful stools or going four or more days
without a bowel movement. Constipation is most
commonly caused by a diet that is low in fiber, but
can also be caused by drinking too much milk (more
than 12-16oz/d), not drinking enough water or waiting
too long to go to the bathroom.  Once a child develops
constipation and has hard and painful stools, he will
then begin to hold in his bowel movements to prevent
it from hurting again. This creates a cycle that makes
the constipation continue and become worse.

Treating Constipation

Constipation is best treated by making changes in your
child's diet. Until the constipation has improved with
a non-constipating diet, your child will most likely
also be on stool softeners. The goal of treatment is
for your child to have one to two soft stools each
day.

Diet Treatment for Infants

Constipation is uncommon in breastfed infants. Because
breastmilk is digested so well, it can be common for a
baby that is exclusively breastfed to only have a
bowel movement every one to two weeks. If the bowel
movement is soft or watery, then it is not
constipation, even if it occurs infrequently. 

It can also be normal for infants (whether breastfed
or drinking an iron fortified infant formula) to
strain and groan when they have a bowel movement.
Again, if the bowel movement is soft or watery, then
it is not constipation, even if your infant has to
strain or groan to have a bowel movement. And remember
that the iron in infant formulas does not cause
constipation. You should not switch to a low iron
formula because your child has constipation.

If you do think your infant has constipation, then you
can:

Increase fluids: Give 2-4 oz of water or diluted fruit
juices (such as apple or prune) 1-2 times each day, or
try switching to a soy formula.

Increase fiber: If your infant is over four months old
and has constipation, you may also try feeding foods
with a lot of fiber, such as cereals, strained prunes,
apricots, or spinach. 

Keep in mind, that although rare, the first symptoms
of botulism in infants is usually constipation. If
your infant has severe or difficult to treat
constipation, especially if he also has other
symptoms, like weakness and poor muscle tone, ask your
doctor about botulism.

Diet Treatment for Children

Constipation in children is best done by making
changes in your child's diet. Some things that you can
do to treat and prevent constipation in your children
include: 

Increasing fluids: Increase the amount of water and
fruit juices (minimum of 2-3 glasses) that your child
drinks each day. 

Increasing fiber: Increase the amounts of fruits and
vegetables that your child eats. Raw, unpeeled fruits
and vegetables (especially beans, sweet potatoes,
peas, turnip greens, raw tomatoes and corn) have the
most fiber. Popcorn also has lots of fiber in it. Give
enough grams of fiber to equal their age in years plus
5 each day (check the nutritional label for high fiber
foods and snacks with at least 3-4g of fiber per
serving). Vegetable soups are especially high in fiber
and also add more fluid to your child's diet.

Increasing bran in your child's diet by offering bran
cereals, bran muffins, shredded wheat, graham
crackers, or whole wheat bread.

Decreasing constipating foods: The foods most
notorious in causing constipation include cow's milk,
yogurt, cheese, cooked carrots, and bananas. Drinking
too much milk (your child may only be drinking 2-3
cups a day, but it may be too much for his system to
handle) is heavily associated with having
constipation. Switching to soymilk has been shown to
soften stools. If your child is unable to drink milk,
then offer a daily multivitamin or other sources of
calcium (such as calcium fortified orange juice).

Stool Softeners

Most of these medicines for constipation are available
in the pharmacy over the counter and do not require a
prescription. They include Metamucil, Milk of
magnesia, Citrucel, or mineral oil. 

Unlike laxatives in adults, they are generally not
considered to be habit forming. You should use them
once or twice a day and work up on the dose until your
child is having a soft BM each day. If you child
starts to have diarrhea, then you are giving too much
and you should cut back on the dose. See the table
below for dosing information for treatment of children
with constipation.

Senokot is also often commonly used in children, but
it is actually a stimulant laxative and not a stool
softener, so you may not want to use it for long
periods of time.

A newer medicine, Miralax, is available only by
prescription to treat constipation, but is very
effective.

Changing doses

Once your child is having 1-2 soft stools each day you
should continue with the doses of the medicines that
you are using for 6-12 months until he is accustomed
to his new non-constipating diet. You can then
gradually stop the stool softeners by slowly lowering
the amount you are giving every 1-2 weeks. 

If stools are too loose then cut back on the dose by
one-third. If stools are still too hard then increase
the dose by one-third. Avoid making changes in the
medicines based on one bowel movement, or you will
wind up ‘seesawing' with the doses.


Treatment for Acute Constipation

If your child has been constipated for a long time or
he is having discomfort or significant pain with bowel
movements then you may need to ‘clean out' backed up
stool before the stool softeners will work by using an
enema, a glycerine suppository or high doses of
mineral oil. See your pediatrician for information on
how to start begin this treatment for acute
constipation.

Behavior Modification

You should encourage your child to have regular bowel
patterns. Have your child sit on the toilet for about
ten minutes after meals 1-2 times each day. 

The use of simple rewards or a daily calendar with
stars or stickers for days that your child takes his
medicine and has a bowel movement may be helpful.


Important Reminders

*       Be patient. Constipation in children is a chronic
problem that can take time to improve. Avoid
embarrassing or punishing your child. 
*       Avoid the frequent use of enemas or suppositories. 
*       Call your pediatrician if your child's constipation
is not improving in 2-3 weeks, if he is regularly
needing to use enemas or suppositories, or he is
soiling his pants because of leakage of stool
(encopresis).


Medications for Constipation

Stool Softeners Age     Dose
Metamucil/Citrucel 

(mix in 8oz water/juice)
        2-5 years 

6-11 years

>12 years
        3/4 teaspoon 1-3 times each day 

1/2 tablespoon 1-3 times each day

1 tablespoon 1-3 times each day

Mineral oil 

(stir into oatmeal or mix with orange juice).
        4-11 years 

>12 years
        1-4 teaspoons 1-2 times each day 

1-3 tablespoons 1-2 times each day

Milk of magnesia 

(mix with 1-2 tsp. of Tang or Nestle Quick)
        <2 years 

2-5 years

6-11 years

>12 years
        1-3 teaspoons 1-2 times each day 

1-2 tablespoons 1-2 times each day

2-4 tablespoons 1-2 times each day

Senokot (stimulant laxative to be used less than a
week at a time) 1-5 years 

5-15 years
        1/2 -1 teaspoons 1-2 times each day 

1-2 teaspoons 1-2 times each day

Colace Syrup (20mg/5ml) 1-3 years 

3-6 years

>6 years
        1/2 —2 teaspoons each day 

1-3 teaspoons each day

1 —2 tablespoons each day

Maltsupex 

(mix in 8oz water/juice)
        <2 years 

>2 years
        1 —2 tablespoons 1-2 times each day
Lactulose (10g/15ml)    >6 months       By prescription only


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