Constipation in Children
Constipation refers to delay or difficulty in passing stool
for a period of at least 1 month in infants and toddlers and a period of 2
months in older children (see also Constipation in adults). Stools are harder
and sometimes larger than usual and may be painful to pass. Constipation is
very common among children. It accounts for up to 5% of children’s visits to
the doctor. Infants and children are particularly prone to developing
constipation at three periods of time. The first period is when cereals and
solid food are introduced into the infant's diet, the second period is during
toilet training, and the third period is around the start of school.
The frequency and consistency of bowel movements (BMs) vary
throughout childhood, and there is no single definition of what is normal.
Newborns typically have 4 or more stools per day. During the first year,
infants have 2 to 4 a day. Breastfed infants typically have more BMs than
formula-fed infants and may have one after each breastfeeding. The stools of
breastfed infants are loose, yellow, and seedy. After a month or two, some
breastfed infants have BMs less frequently, but the stools remain mushy or
loose. After 1 year of age, most children have one or sometimes two soft but
formed stools a day. However, some infants and young children typically have
BMs only once every 3 to 4 days.
Guidelines for identifying constipation in infants and
children include
No BMs for 2 or 3 more days than usual
Hard or painful BMs
Large stools that may clog the toilet
Drops of blood on the outside of the stool
In infants, signs of effort such as straining and crying
before successfully passing a soft stool usually do not indicate constipation.
These symptoms are usually caused by failure to relax the pelvic floor muscles
during passage of stool and typically resolve spontaneously.
Parents often worry about their child's BMs, but
constipation usually has no serious consequences. Some children with
constipation regularly complain of abdominal pain, particularly after meals.
Occasionally, passing large, hard stools may cause a small tear in the anus (
anal fissure). Anal fissures are painful and may result in streaks of bright
red blood on the outside of the stool or on toilet paper. Rarely, chronic
constipation can contribute to urinary problems such as urinary tract
infections and bed-wetting.
Causes of Constipation in Children
Common causes
In 95% of children, constipation results from
Dietary issues
Behavioral issues
Constipation that results from dietary or behavioral issues
is called functional constipation.
Dietary issues that cause constipation include a diet that
is low in fluids and/or fiber (fiber is present in fruits, vegetables, and
whole grains).
Behavioral issues that may be associated with constipation
include stress (as may be felt when a sibling is born), resistance to toilet
training, and a desire for control. Also, children may intentionally put off
having BMs (called stool withholding) because they have a painful anal fissure
or because they do not want to stop playing. Sexual abuse may result in stress
or injury that causes children to withhold stool. If children do not move their
bowels when the natural urge comes, the rectum eventually stretches to
accommodate the stool. When the rectum has stretched, the urge to have a BM
lessens, and more and more stool accumulates and hardens. A vicious circle of
worsening constipation may result. If the accumulated stool hardens, it
sometimes blocks the passage of other stool—a condition called fecal impaction.
Looser stool from above the hardened stool may leak around the impaction into
the child's underwear and lead to stool incontinence (encopresis). Parents may
then think that the child has diarrhea when the actual problem is constipation.
Less common causes
In about 5% of children, constipation results from a
physical disorder, drug, or toxin. Disorders may be apparent at birth or
develop later. Constipation that results from a disorder, drug, or toxin is
called organic constipation.
In newborns and infants, the most common disorder that
causes organic constipation is
Hirschsprung disease (an inadequate nerve supply to the
large intestine)
Other causes of organic constipation include
Birth defects of the anus
Cystic fibrosis
Metabolic and electrolyte disorders, such as an abnormally
high level of calcium ( hypercalcemia) or low level of potassium ( hypokalemia)
in the blood
Spinal cord problems (such as spina bifida)
Hormonal disorders, such as an underactive thyroid gland (
hypothyroidism)
Intestinal disorders, such as a cow's milk protein allergy
or celiac disease
Drugs, such as powerful pain relievers called opioids (for
example, codeine and morphine)
Toxins, such as lead or those that cause infant botulism
Children with serious abdominal disorders (such as
appendicitis or a blockage in the intestine) often do not have BMs. However,
these children typically have other, more prominent symptoms, such as abdominal
pain, swelling, and/or vomiting. These symptoms typically lead parents to seek
medical care before the number of BMs decreases.
Evaluation of Constipation in Children
Doctors first try to determine whether constipation results
from dietary or behavioral issues (functional) or from a disorder, toxin, or
drug (organic).
Warning signs
Certain symptoms are cause for concern and should raise
suspicion for an organic cause of constipation:
No bowel movements (BMs) during the first 24 to 48 hours
after birth
Weight loss or poor growth
Decreased appetite
Blood in the stools
Fever
Vomiting
Abdominal swelling
Abdominal pain (in children old enough to communicate this)
In infants, loss of muscle tone (the infant appears floppy
or weak) and reduced ability to suck
In older children, an involuntary release of urine ( urinary
incontinence), back pain, leg weakness, or problems with walking
When to see a doctor
Children should be evaluated by a doctor right away if they
have any warning signs. If no warning signs are present but the child is
passing infrequent, hard, or painful BMs, then the doctor should be called.
Depending on the child's other symptoms (if any), the doctor may advise trying
simple home treatments or ask the parents to bring the child for an
examination.
What the doctor does
Doctors first ask questions about the child's symptoms and
medical history. Doctors then do a physical examination. What they find during
the history and physical examination often suggests a cause of the constipation
and the tests that may need to be done (see table Some Physical Causes and
Features of Constipation in Infants and Children).
Doctors determine whether newborns have ever had a BM (the
first BM is called meconium). Newborns who have not had a BM within 24 to 48
hours after birth should have a thorough examination to rule out the
possibility of Hirschsprung disease, anorectal malformations, or other serious
disorder.
For infants and older children, doctors ask whether
constipation began after a specific event, such as introducing cereal or other
solid foods, eating honey, beginning toilet training, or starting school. For
all age groups, doctors ask about diet and about disorders, toxins, and drugs
that can cause constipation.
For the physical examination, doctors first look at the
child overall for signs of illness and measure height and weight to check for
signs of delayed growth. Doctors then focus on the abdomen, the anus (including
examination of the rectum using a gloved finger), and nerve function (which can
affect how the digestive tract functions).
Testing
If the cause of constipation appears to be functional, no
tests are needed unless children do not respond to treatment. If children do
not respond or if doctors suspect that the cause is another disorder, an x-ray
of the abdomen is taken, and tests for other disorders are done based on the
results of the examination.
Some Physical Causes and Features of Constipation in Infants
and Children
Treatment of Constipation in Children
Treatment of constipation depends on the cause.
For organic constipation, the causative disorder, drug, or
toxin is treated, corrected, or removed.
For functional constipation, measures include
Changing the diet
Modifying behavior
Sometimes using stool softeners or laxatives
Changing the diet
Dietary changes for infants include giving them 1 to 4
ounces (30 to 120 milliliters [mL]) of prune, pear, or apple juice each day.
For infants younger than 2 months, 1 teaspoon (5 mL) of light corn syrup can be
added to their formula in the morning and evening.
Older infants and children should increase their consumption
of fruits, vegetables, and high-fiber cereals and decrease consumption of
constipating foods, such as milk and cheese.
Modifying behavior
Behavioral modification can help older children. Measures
include
Encouraging children who are toilet trained to sit on the
toilet for 5 to 10 minutes after meals and encouraging them when they make
progress (for example, noting progress on a wall chart)
Giving children who are being toilet trained a break from
toilet training until constipation resolves
Sitting on the toilet after a meal can help because eating a
meal triggers a reflex to have a BM. Frequently, children ignore the signals
from this reflex and put off having a BM. This technique uses the reflex to
help retrain the digestive tract, establish a toilet routine, and encourage
more regular BMs.
Stool softeners and laxatives
If constipation does not respond to behavioral modification
and changes in diet, doctors may recommend certain drugs that help soften stool
(stool softeners) and/or increase the spontaneous movement of the digestive
tract (laxatives). Such drugs include polyethylene glycol, lactulose, mineral
oil, milk of magnesia (magnesium hydroxide), senna, and bisacodyl. Many of
these drugs are now available over the counter. However, doses should be based
on the age and body weight of the child as well as the severity of
constipation. Thus, parents should consult a doctor regarding the appropriate
dose and number of doses per day before using these treatments. The goal of
treatment is the passage of one soft stool per day.
If children have a fecal impaction, options include gentle
enemas and agents (such as mineral oil or polyethylene glycol) taken by mouth
with large amounts of fluid. If these treatments are ineffective, children may
need to be hospitalized to have the impaction removed.
Infants do not usually require any of these treatments.
Typically, a glycerin suppository is adequate.
To maintain regular BMs, some children may require fiber
supplements (such as psyllium), which may be obtained without a prescription.
For these supplements to be effective, children must drink 32 to 64 ounces of
water a day.
Key Points about Constipation in Children
Usually, constipation is caused by behavioral or dietary
issues (called functional constipation).
Children should be evaluated by a doctor if the interval
between BMs has been 2 or 3 days more than usual, if their stools are hard or
large, if stools cause pain or bleeding, or if children have other symptoms.
If a newborn does not have a BM within 24 to 48 hours after
birth, a thorough evaluation should be done to rule out the presence of
Hirschsprung disease or another serious disorder.
Addition of fiber to the diet or behavioral modification can
help when dietary or behavioral issues are the cause.
- CORONA VIRUS
- MONKEY POX
- VAGINAL DRYNESS
- FIBROID
- INFERTILITY
- OVULATION CYCLE
- OVARIAN CANCER
- VAGINAL BACTERIA
- MALE INFERTILITY
- BEST DAYS OF CONCIEVING
- MUCUS AFTER OVULATION
- FOODS FOR ERECTILE FUNCTIONS
- PREGNANCY ANEMIA
- DO AND DONT DURING PREGNANCY
- ERECTILE DYSFUNCTION
- U.T.I IN PREGNANCY
- STROKE RISK
- EAT THIS NOT THAT
- HOOKWORMS INFECTION
- OMEGA 3 BENEFITS
- FASTING
- WEIGHT LOSS TIPS
- vitiligo
- ABORTION
- DENGUE VIRUS
- EBORA VIRUS
- FEVER
- URINARY TRACT INFECTION
- HOSPITAL INFECTIONS
- WEST NILE VIRUS
- YELLOW FEVER
- EYE DISEASE
- ZIKA VIRUS
- STRESS
- IRON DEFFICIENCE
- INSOMNIA (SLEEPING PROBLEMS)
- HEART PROBLEMS
- COMPONENTS OF BLOOD
- BLOOD DISORDER
- LABORATORY TEST OF BLOOD DISORDER
- BONE MARROW EXAMINATION
- BLOOD ANEMIA
- ANIMAL BITES
- EYE BURN
- CHOCKING
- HEAT STROKE
- SMOKE EFFECTS
- SNAKE BITE
- MALARIA VACCINE
- BEST WAY TO SLEEP A CHILD
- CHILD FEVER REDUCING
- ELEPHANTIASIS
- WOMEN BEARDS
- DATES
- PAPAYA FRUITS