Constipation In Children

1 What is Constipation in Children?

Fewer bowel movements and passage of dry, hard stools are common in children and can be due to constipation.

Constipation in children is caused by various factors including unhealthy dietary habits and early toilet training.

The good news is that constipation in children is not a long lasting condition.

Increasing fiber intake and drinking more fluids are some of the simplest ways to ease the symptoms.

However, some cases may require using laxatives.

2 Symptoms

Common signs and symptoms of constipation in children are:

  • Infrequent bowel movements, less than three per week
  • Passage of hard, dry stool
  • Straining during bowel movement and associated pain
  • Pain in stomach
  • Nausea
  • Clay-like stool in child’s underwear, which indicates rectum clogged with stool
  • Blood in stool
  • Avoiding bowel movement to escape from associated pain and discomfort
  • Visible signs of distress in your child include crossing legs, clenching buttocks, or facial expressions that indicate discomfort

When to see a doctor?

Most cases of constipation in children are simple and may not require special medical care. But take care not to miss the warning signs as they can lead to complications or may be indicative of an underlying condition.

Visit your child’s doctor if the symptoms including the following, last for more than two weeks:

  • Fever
  • Vomiting
  • Blood in the stool
  • Abdominal swelling
  • Loss of weight
  • Tear in the anus (anal fissures)
  • Rectal wall sticking out of the anus (rectal prolapse)

3 Causes

Slower than normal movement of stool along the intestinal tract is the most common cause of constipation in children, which causes the stool to become hard and dry.

Some contributing factors for constipation in children are:

Suppressing the urge to pass stool

Your child may hold and avoid toilets as s/he may be too busy playing or prefer not to use public toilets. Sometimes, your child may refrain from having a bowel movement to avoid the pain during the process.

Early toilet training

Introducing your baby to toilet too soon can seed feeling of rebel in your child. The condition deteriorates further when voluntary withholding turns into a habit.

Dietary factors

Lack of fiber in your child’s diet or not enough fluid intake can cause constipation. Often, the problems of constipation may come up while your child starts taking solid foods.

Changes in normal routine

When you child is exposed to a condition that’s not normal such as travel, hot weather or stress, s/he may observe changes in bowel function. For most children, the first day at school is constipating.

Medications

Medications that alter intestinal movement such as certain antidepressants and other drugs can cause constipation.

Milk allergy

Children who are allergic to milk or those consuming a large amount of dairy products may also develop constipation.

Family history

Having a family member with constipation may cause your children to have the same possibly due to common genetic or environmental factors.

Medical conditions

Constipation in children could occur secondary to underlying anatomic malformation, a metabolic or digestive system problem, or others.

4 Making a Diagnosis

Making a diagnosis of constipation in children is done by performing several tests and procedures.

Visit your child's doctor if symptoms last for more than two weeks. S/he may refer your child to a specialist in digestive disorders (gastroenterologist).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms including changes in bowel habit, stool consistency and frequency.

Write down your key medical information. Write down the names of all your medications, vitamins or supplements.

Make a list of the questions to ask your doctor

Some typical questions can be:

  • What could be probable causes of my child's symptoms?
  • What kinds of tests are needed?
  • Is my child’s condition long lasting?
  • What are treatment options?
  • Does my baby need any dietary changes?
  • Should we see a specialist?
  • Is this condition treatable without medication?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your child’s doctor.

Your doctor might ask you typical questions like:

  • When did the symptoms start appearing and do they occur continuously or occasionally?
  • How severe are the symptoms?
  • Does anything improve or aggravate your child's symptoms?
  • Have you noticed blood in your child's stools, in the toilet water or on the toilet paper?
  • Does your child strain while evacuating bowel?
  • Is there a family history of digestive problems?
  • Has your child been given any new medications?
  • How do you describe your child's toilet-training experience?

What you can do in the meantime?

Here are some tips that you can apply while waiting for the doctor's appointment:

  • Increase your child’s fluid intake: You may give prune juice mixed with other juices. Make sure you child drinks sufficient water.
  • Limit intake of foods that may cause constipation such as milk and cheese.
  • Involve your child in regular physical activity, you could take for a morning walk.
  • Arrange some easy toilet training to see if strict toilet training is behind your child’s condition.

The diagnosis process includes

Medical history evaluation

Your child's doctor will have thorough look at all the available information on your child’s condition which might include past illnesses, diet and physical activity patterns.

Physical exam

It involves detecting the presence of impacted stool inside the rectum.

Stool exam

It involves test to detect blood in the stool.
Following tests may also be carried out:

X-ray

Abdominal X-ray shows obstructions in your child's abdomen.

Anorectal manometry or motility test

This test assesses coordination of the muscles during bowel evacuation in your child.

Barium enema X-ray

It involves X-ray of the rectum, colon and part of the small intestine by using barium to make the X-ray images more clear.

Rectal biopsy

A small sample of tissue is removed from the lining of the rectum and sent for laboratory analysis.

Transit study or marker study

This test monitors the movements of a capsule containing X-ray sensitive markers along your child's gastrointestinal tract. The monitoring continues for several days.

Blood tests

These tests are rarely recommended.

5 Treatment

The treatments of constipation in children include:

Over-the-counter fiber supplements or stool softeners

You may consider adding an over-the-counter fiber supplement to your child’s diet. Make sure your child takes about 1 liter of water daily while taking these supplements.

Glycerin suppositories might also help children if they cannot take the pills. Learn from your doctor about how to correctly use these products.

A laxative or enema

A laxative or enema such polyethylene glycol, mineral oil helps to clear the blockage caused by stool. These products should NOT be given without consulting your doctor.

Hospital enema

In a process disimpaction, your child who has severe constipation is given more potent enema in a hospital.

6 Prevention

Some preventive measures for constipation in children are:

  • Increase your child’s fiber intake: Encourage your child to take more fiber-rich foods like fruits, vegetables, beans, and whole-grain cereals and breads.
  • Increase your child’s fluid intake.
  • Encourage your child to participate physical activities.
  • Schedule a routine for toilet: Properly timing your child’s bowel movement and following it can help prevent constipation.
  • Ask your child not to avoid urge to pass stool.
  • Review medications: Check to see if some constipating medications are being given to your child.

7 Alternative and Homeopathic Remedies

Here are some alternative remedies that might help your child in coping with constipation:

Relaxation strategies

Ask your child to have slow, deep breaths while having bowel movement. It may help to reduce anxiety and relax pelvic floor muscles.

Mental imagery

A mental picture of an easy, comfortable bowel movement may help to reduce anxiety.

Massage

A gentle abdominal massage may promote bowel evacuation.

Acupuncture

It may help to relieve abdominal pain associated with constipation.

8 Lifestyle and Coping

Lifestyle modifications are necessary for your child in order to cope with constipation.

Simple dietary modifications can prove immensely useful in constipation:

A high-fiber diet

Make sure your child gets recommended amount of dietary fiber, which is 14 grams for every 1,000 calories in your child's diet.

Talk to your child’s doctor how much fiber your child needs. Encourage your child to take more fiber-rich foods like beans, whole grains, fruits and vegetables.

Sufficient fluids

Water is an elixir and promote intake of water in your child along with other fluids. Limit your child’s milk intake.

Ask your child to devote enough time for bowel movements. Generally, 5 to 10 minutes of toilet sitting within 30 minutes of each meal is recommended.

Support your child’s effort in overcoming or managing the symptoms of constipation.

STOP punishing your child for soiling his or her underwear, if you do.

9 Risk and Complications

There are several risks and complications associated with constipation in children.

Risks

  • Lack of physical activity
  • Low dietary fiber
  • Limited fluid intake
  • Medications such as some antidepressants
  • Underlying medical digestive or other conditions
  • Family history

Complications

  • Tears in the anus (anal fissures)
  • Stool withholding
  • Fear of pain during can cause your child to avoid bowel movements which in long run may cause involuntary defecation (encopresis)
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