Published on Jun 20, 2014 and last reviewed on Feb 06, 2023 - 3 min read
Constipation in children is often unrecognized and neglected by most. This article discusses the causes, symptoms, diagnosis, and treatment for constipation in children.
Constipation in children is a common disorder. About 10-30% of patients attending pediatric gastroenterology OPD (Out Patient Department) have the disorder of fecal elimination.
As we know constipation is a well identified and easily noticebale disorder in adults. But it is not so easy to identify in children due to their infrequent/irregular bowel movements. It is more difficult to identify in early phase in the present scenario because most of the parents are working and someone else takes care of their children. If this problem does not get attention at the earlier stages, it can lead to psychosocial disturbances in the child, decreased school performance and growth failure. So, a simple disorder like this can lead to a devastating condition.
Normal stool frequency in children is 4-5 times a day in infancy and 1-2 times a day in toddlers.
Simple definition for constipation is "Frequency of bowel movements less than 2 per week or passing of hard stools requiring excessive straining with or without presence of blood in stool".
Causes for constipation in infants include :
Causes for constipation in elder age group include :
Passing of hard pellet like stool requiring excessive straining with or without decreased frequency of stool or presence of blood. Some children present with nonspecific abdominal pain. These children may withhold stool if there is pain experience due to anal fissure or hard stool. This creates a vicious cycle. These children may pass hard stools that block the toilet. These children may have retentive posturing and may pass stool behind the door/sofa/curtain. If not diagnosed earlier this can lead to decreased appetite and decreased food intake subsequently anemia and growth failure. Untreated children may present with acute gastrointestinal obstruction in emergency.
In acute cases of constipation (2 weeks to 2 months duration), paediatricians give short term laxative (lactulose for 2 weeks) to relieve symptoms and then dietary management has to be continued.
In chronic cases of constipation (more than 2 months) we need to identify if there is impaction of stool (fecal impaction is hard stool stuck in the rectum due to chronic constipation). If there is no impaction, use Polyethylene glycol (PEG) as osmotic laxative for atleast 6 months duration, titration of dose is required during follow up. If fecal matter is impacted, first we need to do disimpaction by saline enema then continue polyethylene glycol for at least 6 months.
Along with management of constipation it is necessary to manage nutritional issues with multivitamin supplement.
To some extent it is preventable by good toilet training started at the age of 12 to 15 months and by regularising the bowel movements. Toilet trainingis the art of teaching the child to make a routine defecation. Make sure the child sits in the toilet for 10 to 15 minutes daily during a fixed time preferably in the morning after having breakfast. Because eating something leads to an urge to defecate. So one can take advantage of these reflex movements. Use a single word to indicate defecation, otherwise your child may get confused what to do and actually this is also a cause for constipation in children belonging to multilingual families.
Other preventive method is dietary management in the form of adequate fibre diet.
Management of constipation is done in two phases: cleaning out and maintenance.
The clean-out phase may be started with large doses of mineral oil to soften the stool. The maintenance phase includes giving Milk of magnesia and Miralax to further clean the bowel and maintain a constipation-free state. Other medications for constipation are Senna, Bisacodyl, Maltsupex, and Lactulose.
To prevent constipation in children:
- Give soft fibrous food.
- Give plenty of fluid.
- Encourage physical activity.
- Create a toilet routine.
- Discourage withholding.
- Positive reinforcement for bowel movements.
- Review medication that might cause constipation.
The most common reasons for a child’s constipation are
- The tendency of the child to withhold pooping.
- Toilet-training issues.
- Changes in diet or routine.
Certain food items that cause constipation are wheat, barley, rye, spelt, kamut, triticale, white bread, white rice, white pasta, and dairy products.
To relieve constipation in babies, they should be given water, fruit juices, and pureed baby food. If all that fails, certain laxative medications can be given that induce bowel movement.
To encourage a baby to defecate:
- Make the baby exercise, like moving the legs.
- A warm bath.
- Dietary changes.
- Massaging the tummy.
- Fruit juices.
Gripe water has been proven to relieve a baby by easing stomach discomfort, making it easier to pass gas, relieving constipation, and even soothing colic in babies.
Babies may become constipated due to:
- Deficient fiber in their diet.
- Switch from breast milk to solid food.
- Changes in lifestyle like starting school, shifting to a new place, traveling, etc.
Infants may go a long time without pooping as they may utilize the entire nutritional content of breast milk. Sometimes, a baby may go a week without defecating.
Breast milk is considered a natural laxative for babies. It is very rare for babies to constipate when exclusively fed on breast milk; in such cases, the baby might be lactose intolerant.
It is not uncommon for a baby to pee and not poop, as breast milk is digested differently than formula. Breast milk may be completely utilized by the baby and not produce any poop while urinating normally.
Constipation may be considered an emergency if the baby has not pooped for over two weeks and may be accompanied by non-specific symptoms like fever.
If the baby remains constipated for more than two weeks with fever, loss of appetite, abdominal swelling, stomach pain, and weight loss.
Constipation may result in a fussy baby and sleeping disturbances in the baby due to abdominal discomfort and stomach pains.
Colic is not the reason for constipation, but it may result from abdominal pain and discomfort from being constipated.
Last reviewed at:
06 Feb 2023 - 3 min read
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