Constipation
in Children
What
is it?
Constipation
means bowel movements occur less often than usual
or consist of hard, dry stools that are painful or
difficult to pass. A
child who has not had a bowel movement in four
days is usually considered constipated.
Who
gets it?
It
is a common, but usually temporary problem in
children.
What
causes it?
Constipation
may occur when a child does not eat enough fiber,
drink enough liquids, or get enough exercise. School-age
children sometimes ignore the urge to have a bowel
movement, either out of embarrassment or because
they don’t want to take a break from play. Constipation
can also be caused by some medicines. While
unusual, chronic constipation
can be caused by Hirschsprung disease.
Hirschsprung disease occurs in 1 in 5000 children,
and is diagnosed in 40% of patients by 3 months,
in 61% by 12 months, and in 82% by 4 years of age.
What
are the symptoms?
Symptoms
of constipation include no bowel movement for
several days or daily bowel movements that are
hard
and
dry; cramping abdominal pain; nausea; vomiting;
weight loss; and liquid or solid, clay-like stool
(soiling) in the child's underwear, which is a
sign that stool is backed up in the rectum
(impacted). Soiling
is also called “encopresis.” When a child has
soiling without a history or signs and symptoms of
constipation, physicians will look for an
underlying gastrointestinal, neuromuscular, or
behavioral disorder.
Because constipation can make a bowel
movement painful, a child may try to hold in the
bowel movement, which further complicates the
problem. Over
time, impacted stool can cause the child to have
diminished feeling at the rectum and weakened
rectal and sphincter muscles. Although
constipation is usually harmless, it can be a sign
or cause of a more serious problem. Make sure your
child sees a doctor if constipation lasts longer
than 3 weeks; the constipation causes your child
to stop normal activities; there are small,
painful tears in the skin around the anus; your
child develops hemorrhoids; he or she cannot expel
stool with normal pushing; or liquid or soft stool
leaks out of the anus.
How
is it diagnosed?
Diagnosis
is based upon the presence of the above symptoms. The doctor will use his fingers to feel for a
hardened
mass in the abdomen, and may perform a rectal
examination.
An x-ray of the abdominal area may be
necessary if the doctor cannot feel any impaction
in the rectum.
Your doctor will also take a developmental
history because persistent soiling can also
accompany developmental delays, autism, or other
behavioral disorders.
What
is the treatment?
Treatment
depends on the child's age and how often he or she
is constipated. Often
eating more fiber, such as fruits, vegetables, and
whole-grain cereal; drinking more liquids; and
getting more exercise solves the problem.
Sometimes a child may need an enema to remove the
stool or a laxative to soften it or prevent future
constipation.
However, laxatives should only be given
with a doctor’s approval.
The treatment for Hirschsprung disease is
surgical.
Self-care
tips
A
healthy diet that is high in fiber (fruits and
vegetables) and adequate liquids goes a long way
in preventing constipation.
Encourage your child to sit on the toilet 3
- 4 times per day for a period of 5 - 10 minutes
to encourage bowel movements in a relaxed manner.
Avoid embarrassing or punishing your child
for accidents or soiling.
Instead, praise and reward your child for
sitting and give rewards for having a bowel
movement in the toilet.
Avoid using diapers or pull-ups on children
of toilet-training age and use loose-fitting
underwear instead.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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