Constipation in children is a common problem.
A constipated child has infrequent bowel movements or hard, dry stools.
Signs of Constipation
- Infrequent stools that are difficult to pass
- Straining more than normal to have a bowel movement
- Stools formed like small, hard small pebbles, stools that are soft and mushy; stools that are wide and large
- Liquid stool (like diarrhoea) that may be passing around solid stool that stays inside
- Abdomen (belly) swollen with gas
- Painful cramps
- Less than three bowel movements a week
- Bowel movements that are hard, dry and difficult to pass
- Pain while having a bowel movement
- Stomach pain
- Traces of liquid or pasty stool in your child’s underwear — a sign that stool is backed up in the rectum
- Blood on the surface of hard stool
Causes & Risk factors
Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract, causing the stool to become hard and dry.
Many factors can contribute to constipation in children, including:
- The most common cause is when a child will not pass a stool because they expect pain, so they delay toileting and the problem gets worse.
- Your child may ignore the urge to have a bowel movement because he or she is afraid of the toilet or doesn’t want to take a break from play. Some children withhold when they’re away from home because they’re uncomfortable using public toilets.
- Painful bowel movements caused by large, hard stools also may lead to withholding. If it hurts to poop, your child may try to avoid a repeat of the distressing experience.
- Toilet training issues. If you begin toilet training too soon, your child may rebel and hold in stool. If toilet training becomes a battle of wills, a voluntary decision to ignore the urge to poop can quickly become an involuntary habit that’s tough to change.
- Changes in diet. Not enough fiber-rich fruits and vegetables or fluid in your child’s diet may cause constipation. One of the more common times for children to become constipated is when they’re switching from an all-liquid diet to one that includes solid foods.
- Changes in routine. Any changes in your child’s routine — such as travel, hot weather or stress — can affect bowel function. Children are also more likely to experience constipation when they first start school outside of the home.
- Certain antidepressants and various other drugs can contribute to constipation.
- Cow’s milk allergy. An allergy to cow’s milk or consuming too many dairy products (cheese and cow’s milk) sometimes leads to constipation.
- Family history. Children who have family members who have experienced constipation are more likely to develop constipation. This may be due to shared genetic or environmental factors.
- Medical conditions. Rarely, constipation in children indicates an anatomic malformation, a metabolic or digestive system problem, or another underlying condition.
- Unfamiliar surroundings — Children may delay moving their bowels if they do not have a place where they feel comfortable having a bowel movement or if they are busy and ignore the need to use the toilet. This can happen when a child starts going to school and avoids having a bowel movement because they are worried about hygiene concerns or feel embarrassed to use the toilet at school.
Risk factors: Constipation in children is more likely to affect kids who:
- Are sedentary
- Don’t eat enough fibre
- Don’t drink enough fluids
- Take certain medications, including some antidepressants
- Have a medical condition affecting the anus or rectum
- Have a neurological disorder
Teach your child that it is a good idea to have a bowel movement when his or her body says it is time to do so, and reassure him or her that it is okay to use the bathroom at school. This type of training from early childhood may prevent development of constipation when your child starts school.
Further Complications
Constipation in children can be uncomfortable, and If it becomes chronic, however, complications may include:
- Painful breaks in the skin around the anus (anal fissures)
- Rectal prolapse, when the rectum comes out of the anus
- Stool withholding
- Avoiding bowel movements because of pain, which causes impacted stool to collect in the colon and rectum and leak out (encopresis)
Prevention & Treatment
To help prevent constipation in children:
- Offer your child high-fiber foods. A diet rich in fiber can help your child’s body form soft, bulky stool. Serve your child more high-fiber foods, such as fruits, vegetables, beans, and whole-grain cereals and breads. If your child isn’t used to a high-fiber diet, start by adding just several grams of fiber a day to prevent gas and bloating.
- Encourage your child to drink plenty of fluids. Water is often the best.
- Promote physical activity. Regular physical activity helps stimulate normal bowel function.
- Create a toilet routine. Regularly set aside time after meals for your child to use the toilet. If necessary, provide a footstool so that your child is comfortable sitting on the toilet and has enough leverage to release a stool.
- Remind your child to heed nature’s call. Some children get so wrapped up in play that they ignore the urge to have a bowel movement. If such delays occur often, they can contribute to constipation.
- Be supportive. Reward your child’s efforts, not results. Give children small rewards for trying to move their bowels. Possible rewards include stickers or a special book or game that’s only available after (or possibly during) toilet time. And don’t punish a child who has soiled his or her underwear.
- Review medications. If your child is taking a medication that causes constipation, ask his or her doctor about other options.
- If your baby is old enough to eat strained foods, you may give him fruits and vegetables.
- If your baby is not eating jar baby food yet, you may give 2 to 4 ounces of fruit juices (prune, pear, cherry, or apple) per day. If his stools become too loose, give less juice to your baby.
- If your baby is eating rice cereal, it may help to switch to oatmeal or barley cereal. Rice cereal can cause constipation in some children.
- Do not give your baby enemas, laxatives, or suppositories unless you are told to do so by the doctor.
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