Constipation

Constipation in Children

What is constipation in children?

Constipation is when a child has very hard stools and has fewer bowel movements than normal. It is a very common gastrointestinal (GI) problem.

Signs that a child has constipation include:

• Having fewer bowel movements than normal. Constipation is often defined as having fewer than 3 bowel movements a week. The number of bowel movements may be different for each child. But a change in what is normal for your child may mean there is a problem.
• Passing stool that is hard and sometimes large
• Having bowel movements that are difficult or painful to push out

What causes constipation in a child?

Stool gets hard and dry when the large intestine (colon) takes in (absorbs) too much water.

Normally, as food moves through the colon, the colon absorbs water while it makes stool. Muscle movements (contractions) push the stool toward the rectum. When the stool gets to the rectum, most of the water has been soaked up. The stool is now solid.

If your child has constipation, the colon's muscle movements are too slow. This makes the stool move through the colon too slowly. The colon absorbs too much water. The stool gets very hard and dry.

Once a child becomes constipated, the problem can quickly get worse. Hard, dry stools can be painful to push out. So the child may stop using the bathroom because it hurts. Over time, the colon will not be able to sense that stool is there.

There are many reasons why a child may become constipated. Some common diet and lifestyle causes include:

Diet

• Eating too many foods that are high in fat and low in fiber. These include fast foods, junk foods, and soft drinks.
• Not drinking enough water and other fluids
• Having a change in diet. This includes when babies change from breastmilk to formula, or when they start eating solid foods.

Lack of exercise

• Children who watch a lot of TV and play video games don’t get enough exercise. Exercise helps move digested food through the intestines.

Emotional issues

• Not wanting to use public bathrooms. Children may then hold in their bowel movements, causing constipation.
• Going through toilet training. This can be a difficult time for many toddlers.
• Having power struggles with parents. Toddlers may hold in their bowel movements on purpose.
• Feeling stressed because of school, friends, or family

Busy children

• Some children don’t pay attention to signals that their body gives them to have a bowel movement. This can happen when children are too busy playing. They forget to go to the bathroom.
• Constipation can also be a problem when starting a new school year. Children can’t go to the bathroom whenever they feel the need. They have to change their bowel routine.

Underlying physical problem

In rare cases, constipation can be caused by a larger physical problem. These physical issues can include:

• Problems of the intestinal tract, rectum, or anus
• Nervous system problems, such as cerebral palsy
• Endocrine problems, such as hypothyroidism
• Certain medicines, such as iron supplements, some antidepressants, and narcotics, such as codeine

What are the symptoms of constipation in a child?

Symptoms can occur a bit differently in each child. They may include:

• Not having a bowel movement for a few days
• Passing hard, dry stools or blood-streaked stools
• Having belly (abdominal) bloating, cramps, or pain
• Not feeling hungry
• Showing signs of trying to hold stool in, such as clenching teeth, crossing legs, squeezing buttocks together, turning red in the face
• Small liquid or soft stool marks on a child's underwear

The symptoms of constipation can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is constipation diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. The provider will give your child a physical exam. Depending on how old your child is, you might be asked questions, such as:

• How old was your baby when they had their first stool?
• How often does your child have a bowel movement?
• Does your child complain of pain when having a bowel movement?
• Have you been trying to toilet train your toddler lately?
• What foods does your child eat?
• Have there been any stressful events in your child's life or your family's situation lately, such as divorce or death?
• How often does your child poop in their pants?

Your child’s provider may also want to do some tests to see if there are any problems. Some of these tests involve the most intimate areas of a child's body. So make sure you explain the procedures to your child and answer any questions in an age-appropriate manner beforehand. These tests may include:

• Digital rectal examination. Your child’s healthcare provider puts a gloved, greased (lubricated) finger into your child’s rectum. The provider will feel for anything abnormal.
• Abdominal X-ray. This test checks how much stool is in the large intestine.
• Barium enema. This is an X-ray exam of the rectum, the large intestine, and the lower part of the small intestine. Your child will be given a metallic fluid called barium. Barium coats the organs so they can be seen on an X-ray. The barium is put into a tube and inserted into your child’s rectum as an enema. An X-ray of the belly will show if your child has any narrowed areas (strictures), blockages (obstructions), or other problems.
• Anorectal manometry. This test checks the strength of the muscles in the anus and the nerve reflexes. It also checks your child’s ability to sense that the rectum is full (rectal distension) and a bowel movement is needed. And it looks at how well the muscles work together during a bowel movement.
• Rectal biopsy. This test takes a sample of the cells in the rectum. They are checked under a microscope for any problems.
• Sigmoidoscopy. This test checks the inside of part of the large intestine. It helps to find out what is causing diarrhea, belly pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube (sigmoidoscope) is put into your child’s intestine through the rectum. This tube blows air into the intestine to make it swell. This makes it easier to see inside.
• Colorectal transit study. This test shows how well food moves through your child’s colon. The child swallows pills (capsules) filled with small markers that can be seen on an X-ray. The child eats a high-fiber diet for the next few days. X-rays will be taken 3 to 7 days after your child takes the pills. The X-rays will show how the pills moved through the colon.
• Colonoscopy. This test looks at the full length of the large intestine. It can help check for abnormal growths, red or swollen tissue, sores (ulcers), and bleeding. The test uses a long, flexible, lighted tube (colonoscope). The tube is put into your child’s rectum up into the colon. This tube lets the healthcare provider see the lining of the colon and take out a tissue sample (biopsy) to test it. The provider may also be able to treat some problems that are found.
• Lab testing. Several tests may be done. These include tests to check for issues, such as celiac disease, a urinary tract infection, thyroid problems, metabolic problems, and blood lead level.

How is constipation treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Your child may need to see a pediatric gastroenterologist. This healthcare provider specializes in treating children who have constipation.

Treatment may include diet and lifestyle changes, such as:

Diet changes

Often making changes in your child's diet will help constipation. Help your child to eat more fiber by:

• Adding more fruits and vegetables
• Adding more whole-grain cereals and breads. Check the nutrition labels on food packages for foods that have more fiber.

Foods	Moderate fiber	High fiber
Bread	Whole-wheat bread, granola bread, wheat bran muffins, whole-grain waffles, popcorn
Cereal	Bran cereals, shredded wheat, oatmeal, granola, oat bran	100% bran cereal
Vegetables	Beets, broccoli, Brussels sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado
Fruits	Apples with peel, dates, papayas, mangoes, 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

Other diet changes that may help include:

• Having your child drink more fluids, especially water
• Limiting fast foods and junk foods that are often high in fats. Offer more well-balanced meals and snacks instead.
• Limiting drinks with caffeine, such as soda and tea
• Limiting whole milk as directed by your child’s healthcare provider

It’s also a good idea to have your child eat meals on a regular schedule. Eating a meal will often cause a bowel movement within 30 to 60 minutes. Serve breakfast early. This will give your child time to have a bowel movement at home before rushing off to school.

Get more exercise

Having your child get more exercise can also help with constipation. Exercise helps with digestion. It helps the normal movements the intestines make to push food forward as it is digested. People who don’t move around much are often constipated. Have your child go outside and play rather than watch TV or do other indoor activities. The CDC recommends that preschool-aged children (ages 3 through 5 years) should be physically active throughout the day. Children ages 6 to 17 should get 60 minutes of moderate-to-vigorous physical activity every day. This includes activities that build bones (like running and jumping) and those that build muscles (like climbing or doing push-ups).

Good bowel habits

Try to get your child into a regular toilet habit. Have your child sit on the toilet at least twice a day for at least 10 minutes. Try to do this just after a meal. Be sure to make this a pleasant time. Don’t get mad at your child for not having a bowel movement. Use a reward system to make it fun. Give stickers or other small treats. Or make posters that show your child's progress.

In some cases, these changes may not help. Or your child’s healthcare provider may detect another problem. If so, the provider may recommend using laxatives, stool softeners, or an enema. These products should only be used if recommended by your child's provider. Don't use them without talking with your child's provider first.

What are possible complications of constipation in a child?

Hard stools can irritate or tear the lining of the anus (anal fissures). This makes it painful to have a bowel movement and may cause mild amounts of bleeding. Your child may avoid having a bowel movement because it hurts. This can make constipation worse.

What can I do to prevent constipation in my child?

Constipation can be prevented by figuring out the times when it may occur and making changes.

For instance, when babies start to eat solid food, constipation can result. This is because they don’t have enough fiber in their new diet. You can add fiber to your baby’s diet by giving pureed vegetables and fruits. Or try whole-wheat or multigrain cereals.

Constipation can also happen during toilet training. Children who do not like using a regular toilet may hold in their stool. This causes constipation.

All children should get the right amount of fiber and fluids. Other preventive measures include making sure your child has:

• Regular access to a bathroom
• Enough time to use the toilet
• Regular physical exercise

The same changes that can help treat constipation may also help to stop it from happening.

How can I help my child live with constipation?

Constipation can be either short-term (acute) or long-term (chronic). Children with intestinal diseases may have chronic constipation problems. But in most cases, constipation is a short-term condition. If your child has chronic constipation, work with your child's healthcare provider. In an age-appropriate manner, include your child in treatment discussions and plans. Together you can create a care plan that is correct for your child.

When should I call my child's healthcare provider?

Call your child's healthcare provider if you have any questions or concerns about your child's bowel habits or patterns. Talk with your child's provider right away if your child:

• Has bloody stools
• Is constipated for more than 2 weeks
• Can’t do normal activities because of constipation
• Can’t get a stool out with normal pushing
• Has liquid or soft stool leaking out of the anus
• Has small, painful tears in the skin around the anus (anal fissures)
• Has red, swollen veins (hemorrhoids) in the rectum
• Has belly pain, fever, or vomiting
• Has changes in urination, weakness in the legs, or back pain

Key points about constipation in children

• Constipation is when a child has very hard stools and has fewer bowel movements than normal.
• Constipation can be caused by a child’s diet, lack of exercise, or emotional issues.
• Once a child becomes constipated, the problem can quickly get worse.
• Making diet and lifestyle changes, such as increasing fluid intake and exercise, can help treat and help prevent constipation.
• Never give your child an enema, laxative, or stool softener unless the healthcare provider recommends it.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.