CONSTIPATION
What is constipation?

Constipation is a condition in which bowel movements occur less frequently than usual or stools tend to be hard, dry, and difficult and painful to pass.

Constipation is common in children and is usually without long-term consequences; however, it can diminish a child’s quality of life, cause emotional problems, and create family stress. Rarely, constipation is a sign of a more serious health problem.

What causes constipation in children?

Children often develop constipation as a result of stool withholding. They may withhold stool because they are stressed about potty training, are embarrassed to use a public bathroom, do not want to interrupt playtime, or are fearful of having a painful or unpleasant bowel movement.

Delaying a bowel movement causes stool to become hard, dry, and difficult to pass—sometimes resulting in a large mass of stool in the rectum called a fecal impaction. Stool builds up behind the impaction and may unexpectedly leak, soiling a child’s underwear. Parents often mistake this soiling as a sign of diarrhea.

Other causes of constipation in children include

•    a low-fiber diet
•    certain medications or drugs, such as antacids, opiates, and antidepressants
•    diseases, such as Hirschsprung disease, diabetes, and Down syndrome
•    anatomic abnormalities, such as a birth defect

What are the symptoms of constipation in children?

Symptoms of constipation in children include

•    fewer bowel movements than usual.
•    postures that indicate the child is withholding stool, such as standing on tiptoes and then rocking back on the heels of the feet, clenching buttocks muscles, and other unusual dancelike behaviors. Parents often mistake such postures as attempts to “push.”
•    abdominal pain and cramping.
•    painful or difficult bowel movements.
•    hard, dry, or large stools.
•    stool in the child’s underwear.

When should a child with constipation see a doctor?

A child should see a doctor if symptoms of constipation last for more than 2 weeks. A child should see a doctor sooner if the constipation is accompanied by one or more symptoms that may indicate a more serious health problem, including

•    fever
•    vomiting
•    blood in the stool
•    a swollen abdomen
•    weight loss
•    painful cracks in the skin around the anus, called anal fissures
•    intestine coming out of the anus, called rectal prolapse

The doctor will ask questions about the child’s history of symptoms and will perform a physical examination. The doctor may perform a rectal exam by inserting a gloved finger into the child’s anus to check for anatomical abnormalities and for the presence of a fecal impaction.

How is constipation in children treated?

Constipation is treated by changing diet, increasing exercise, adopting healthy bowel habits, and sometimes medication. Treatment depends on the child’s age and the severity of the problem.

Diet changes


Often, making changes in your child's diet will help constipation. Consider the following suggestions:

•    Increase the amount of fiber in your child's diet by:
What are good fiber sources?

Foods Moderate Fiber High Fiber
Bread   Whole wheat bread, granola bread, wheat bran muffins, Nutri-Grain® waffles, popcorn      
Cereal    Bran Flakes®, Raisin Bran®, Shredded Wheat®, Frosted Mini-Wheats®, oatmeal, Muslix®, granola, oat bran All-Bran®, Bran Buds®, Corn Bran®, Fiber One®, 100% Bran®
Vegetables Beets, broccoli, brussel sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado
Fruits Apples with peel, dates, papayas, mangos, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins Cooked prunes, dried figs
Meat Substitutes   Peanut butter, nuts Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix
           
      
      

•    Offer your child fruit juice instead of soft drinks.
•    Encourage your child to drink more fluids, especially water.
•    Limit fast foods and junk foods that are usually high in fats and sugars, and offer more well-balanced meals and snacks.
•    Limit drinks with caffeine, such as cola drinks and tea.
•    Limit whole milk to 16 ounces a day for the child over 2 years of age, but do not eliminate milk altogether. Children need the calcium in milk to help their bones grow strong.
•    Serve your child's meals on a regular schedule. Often, eating a meal will stimulate a bowel movement within 30 minutes to an hour. Serve breakfast early so your child does not have to rush off and miss the opportunity to have a bowel movement.


Increase exercise


Increasing the amount of exercise your child gets can also help with constipation. Exercise aids digestion by helping the normal movements the intestines make to push food forward as it is digested. People who do not move around much are often constipated. Encourage your child to go outside and play rather than watch TV or engage in other indoor activities.


Proper bowel habits


Have your child sit on the toilet at least twice a day for at least 10 minutes, preferably shortly after a meal. Make this time pleasant; do not scold or criticize the child if they are unable to have a bowel movement. Giving stickers or other small rewards, and making posters that chart your child's progress can help motivate and encourage him/her.

Medication

If these methods do not help, or if your physician notices other problems, he/she may recommend laxatives, stool softeners, or an enema. These products should ONLY be used with the recommendation of your child's physician. DO NOT use them without consulting your child's physician first.


Resource: Children’s Hospital Boston, 2007 & National Digestive Diseases Information Clearing House (NDDIC), 2008




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