Constipation may seem to be a common problem; however, when encountered by children and in severe levels, it can be rather problematic. Although constipation can be treated with medicine, chronic constipation in children can be a sign of an underlying cause.
Hard stools that are difficult to pass are a symptom of constipation. Severe constipation can even lead to a tear in the anal region. For this reason, it is necessary to recognize the signs of constipation and take proper action before it becomes chronic.
In this article, you will find answers to all major questions on childhood constipation, such as the symptoms, common causes and effective treatments of chronic constipation in children. Constipation may be a topic for comics, but when it happens to children, it’s no laughing matter. Be sure to read all the way to the end, so you’ll know what to do if you happen to have an autistic child in your family.
Knowledge is power, so you’ll first get an overview of constipation in children, so you’ll know the important basics:
1. Chronic Childhood Constipation: An Essential Overview
Constipation is one of the most common problems affecting children who get referred to a pediatrician. Compared to adults, babies have much more frequent bowel movements, often several times in a day. The bowel movements of toddlers change when mothers wean them from breast milk to solid foods.
There are different kinds of constipation, such as:
- Idiopathic constipation
- Bowel dysmotility
- Intestinal pseudo-obstruction
- Anorectal malformation
In general, the bowel habits of children alter depending on their age and the food they regularly consume. Constipation occurs if a child does not have a bowel movement at least once every other day.
Experts have defined the characteristics of chronic constipation to prevent any terminology issues. If the child has less frequent bowel movements than three times in a week, it can be a sure shot sign of chronic constipation in toddlers.
Other symptoms of chronic constipation include:
- Loss of control over fecal expulsion.
- Passing large stools.
- Painful defecations frequently or even once in a week.
- The child becomes irritable and offset.
2. Red Flags: What Should You Know About the Symptoms of Constipation
Before you get chronic constipation in children treated, it is essential to that you know about the symptoms of this condition. This is because some parents mistake incontinence for constipation. In general, most babies who are less than three months old deal with the condition dyschezia. In this condition, a child cries for a while before passing stool; however, it is not constipation.
Here are the symptoms of constipation that can help you recognize the condition.
Tummy Aches: This condition is characterized by stomach cramps that stay for a while. There can be several reasons for belly pain, such as diarrhea, a stomach infection, poor diet, appendicitis or even stress. Yet constipation is the most common reason for the tummy pain in children. Usually, stomach pain caused by constipation is located over all or at least half of the stomach area.
Poor Appetite: Most parents are concerned about the picky eating habits of their children. It even works like a cycle, where a chronically constipated child will be irritated and does not feel like having food. The child may even be suffering from vomiting or abdominal cramps.
The problem of anal fissure will worsen the situation. With chronic constipation, the situation gets so bad that the child is not able to interpret what their body is telling them to do. The body has to expel the waste in order to get ready for receiving food. When the bowel has not moved the waste out of the body, it will directly impact the eating ability of the child.
Tiredness: Children may feel fatigued due to various reasons; however, when constipation is coupled with fatigue, the underlying factor could be severe, such as irritable bowel syndrome, or even colon cancer. Certain drugs, such as antidepressants can also cause constipation along with fatigue.
When you don’t have regular bowels, your body accumulates toxins, which may lead to a nauseated feeling. The child will eventually feel sick, tired and less energetic.
Reduced Bowel Movements: Solely breastfed babies may go a long time without passing a stool, but this does not mean that the child is constipated. Breast milk is a natural laxative and, unless they are introduced to milk formulas or solid foods, they do not usually become constipated.
Going without bowel movement for more than a week for babies on solid foods can be a warning sign. As long as the stool is not hard, it may not be chronic constipation.
Large and Hard Stools: This is the sure sign that your child is suffering from constipation and needs medical care. Long-term constipation may need an advanced examination. Infants may strain to pass bowel, but the poop will be soft.
They face difficulty in passing stools because they are mostly lying down and their abdominal muscles have just started to function. Dry, pebble-like stools can also be a symptom of constipation, even though this may not be coupled with difficulty in expulsion.
Blood in Stools: Tinges of blood in the stool is always an alarm signal. Large chunks of stool that occur due to constipation can cause an anal fissure. Newborns, as well as adults, can face this issue. Chronic constipation causes severe pain while passing stools, and a child will often refrain from pushing out the bowel due to the fear of the pain. This will eventually worsen the constipated condition.
3. What Parents Need to Know: The Common Causes of Chronic Constipation in Children
Most of the time, lifestyle factors are responsible for causing constipation. Thankfully, it is rare to find an underlying disease is the cause of a child’s chronic constipation. Here’s a more detailed look at the various reasons for severe constipation problem in children.
Psychological Factors: In a few cases, the cause of constipation is due to stress or even a repulsion by the child, which in turn leads to reduced bowel movements. Here’s some insights for parents, family members, caregivers and teachers:
- Parents and teachers exert too much pressure on the child with respect to their studies. This may lead to anxiety and depression in the child especially during exams. This in turn may affect their bowel movement considerably.
- During toilet training, the child may forcibly hold the bowel movement as they are new to the procedure.
- Doctors say that children can even withhold bowel activity for attention or as their way of protest.
- Wrong eating habits leading to anorexia or bulimia, which can also be a cause.
- Sexually abused children face a problem of closing of the anal sphincter when the child tries to push the stool out.
Habit of Bowel Expulsion: Sometimes, children are engrossed in their games and therefore fail to acknowledge their urge to go. Several children even refrain from going to a toilet other than in their own home. Even though this might seem to be an occasional issue, it causes long term harm. The holding of bowels may eventually cause the colon muscles to lose their tone.
In addition, children do not get enough time to go to the toilet in the morning and they end up holding the stool for the rest of the day. To prevent this, make enough time after breakfast so that the child can go to toilet before leaving for school.
Improper Diet: Kids love to eat junk food such as pizza, burgers, pastries, processed foods and ice creams. Other foods, such as white bread, white rice, soda and milk can also cause constipation. If it is not possible, do not completely stop giving such foods to your child. Fulfilling the fiber requirement for the body by incorporating the right foods along with their usual diet can do the trick. Here is what you can do:
- Use whole grain alternatives for bread and pasta.
- You can also alternate cereals, oats and cornmeal for breakfast.
- Include enough vegetables and fruits at least three to four times in a day.
- Brown rice, legumes and a good deal of plain water will form a good diet plan.
Intestinal Parasites: They are mostly worms or single celled organisms that live in the stool or blood as a food source. People in third-world countries usually suffer from them due to consumption of contaminated food or water. In developed countries they spread through swimming pools or lakes. Here are the other parasitic infection symptoms to look out for:
- Mild diarrhea
- Mucus in stool
- Fatigue and weight loss
- Worms or eggs found in stool
Celiac Disease : Celiac disease is the inability to eat gluten due to an autoimmune response triggered in the body. This immune reaction damages the villi of the intestine and hinders the ability to absorb vitamins and nutrients. Experts have still not found the reason for celiac disease, but hereditary factors do apply.
Here are a few symptoms of celiac disease:
- Reduced appetite
- Stomach pain
- Growth problem
- Weight loss
Type 1 Diabetes Mellitus: Diabetes in childhood is usually diagnosed between 6 and 13 years of age. There are several complications that arise with diabetes and constipation is one among them. Common constipation prevention measures may not work for people with diabetes.
Uncontrolled blood sugar levels will eventually lead to nervous system damage. When the nerves of the digestive tract are affected, this ends in constipation and even diarrhea. Neuropathy and medication can be the best cure even though lifestyle changes can show its impact in providing relief to children.
Chronic Diseases: Hypothyroidism and kidney failure can also, in rare cases, lead to constipation. In such condition, doctors will target the root cause of the disease in order to treat constipation.
Hypothyroidism is a common condition in children. In this condition, the thyroid glands don’t produce enough hormones. Prompt diagnosis and treatment is crucial, especially in newborns. Thyroid is an essential component for the functioning of several bodily processes.
4. Chronic Constipation in Children: Treatment Options
For common constipation issues that are due to lifestyle and psychological factors, measures like bowel cleansing and diet can be as effective as medical treatment. But for constipation caused by any disorder, it is essential to acknowledge and treat the underlying disease.
Colon Evacuation: Doctors will conduct a physical examination or abdominal radiograph if they suspect that feces are stuck on the walls of the colon. The first treatment step will be to evacuate the bowel from the colon. If treating children, doctors will explain the procedure to the parent.
Doctors make use of various treatment options, such as oral cathartics like PEG, sodium phosphate, magnesium citrate or an enema to loosen the deposited pieces of feces. Oral cathartics are also available, but doctors don’t use them for young children. This is because the anal method is an easier alternative to medicating the child.
Rectal Washout: Practitioners often use this treatment for infants to relieve low intestinal obstruction. They perform this treatment by injecting the required quantity of saline into the rectum. The saline is then pulled back into the syringe in order to bring along the stool, which is then disposed into a bowl. The practitioner repeats this procedure until the saline runs clear.
Treating the Pain Associated with Defecation: After the doctor has removed the deposited stool, the next step is to administer a laxative until the child produces one to two soft stools daily. In children, when they experience pain defecating, they will repulsively refrain from going potty. It is therefore necessary to give a high enough dose of laxative to soften their stool.
For anal fissure, the practitioner will prescribe Xylocaine Ointment or hydrocortisone suppositories.
Proper Diet: Doctors will administer them a diet to chart in order to regularize their bowels:
- Balanced diet plan: Fruit juices, such as prune, pear and apple will increase the fecal water content and thus increase bowel frequency. Increase fiber and non-absorbable carbohydrates in diet.
- Avoid cow’s milk: Breast-milk is best for infants when compared to formula and cow’s milk. Parents can use other substitutes such as soy milk for older children instead of cow’s milk.
Regular Bowel Habits: For the treatment of long term constipation, proper bowel habit is essential. The best time to send your child to the toilet is after breakfast and supper. Make it a routine to ask the child to visit the toilet twice times in a day for five to 10 minutes.
Medicines: The common medications used are laxatives and lubricants. Here is a list:
- Miralax: The most commonly used laxative in children which, chemically, is polyethylene glycol.
- Milk of Magnesia: Doctors prescribe it orally mixed with milk or chocolate milk.
- Lactulose: Specialists administer lactulose as a 70 percent solution. It is a non-absorbable disaccharide.
- Mineral Oil: Mineral oil works as a lubricant, which softens stool.
- Stimulant Laxatives: Stimulant laxatives are a different class of medication, which bring about relief from constipation by increasing the activity of the muscles of the intestine. Senna and Bisacodyl are stimulant laxatives.
5. Ways to Prevent Constipation in Children
It is better to practice ways to prevent constipation. Here are a few tips:
Understand the Role of Fiber in Food: The lack of fiber in food is a main reason for constipation. Pack your child’s food with fibers to prevent constipation. Fiber remains undigested in the human digestive tract and does the vital job of cleaning the intestines and makes way for easy bowel movement. Rather than going for packets of processed foods, try to include fiber rich snacks.
- Make your own trail mix with fruits, nuts, cereals and seeds. You can add a few chips of their choice as well.
- Come up with fun ideas to present your child with fruits and vegetables. Try making faces or animals.
- Use whole grain bread to make healthy sandwich.
- Use berries to add color to foods. Berries are rich in antioxidants in addition to having high fiber content.
- Use ingredients like granola, flaxseed, oats and soya granules into daily food as a secret ingredient.
Increase Water Intake: This might seem to be an easy task, but for vibrantly active children, getting them to drink plenty of water can be a challenge. They have an increased urge to have carbonated and sugary drinks after seeing all those advertisements.
- Use a water filter to remove the unpleasant taste from tap water.
- Try adding berries, lemon or mint to water improve its taste.
Learn the Best Practices for Potty Training : Potty training the child is one of the most difficult and rewarding steps of parenthood. Parents should be patient and relaxed to get their child fall into track. Here are a few tips:
- You can start potty training as early as 18 months. Check for signs like the child beginning to express their need to go for poo or pee.
- Begin by putting up a daily routine so that you can schedule the potty training based on that time.
- Use a potty for the infant until about three years of age before moving to the toilet.
- When using a toilet use a smaller seat that fits in.
- You can get your child to watch a potty training video.
- Teach simple words like wee or poo which the child can use to gesture towards an urge to go to the toilet.
- Make the child sit for potty about 30 minutes after food.
6. Conduct Close Management of Chronic Constipation in Children
The severity of chronic childhood constipation differs from one case to another. Simple measures, such as laxatives and dietary changes cure most of the mild cases. Doctors may administer surgery to fix severe constipation cases. Here are a few ways to manage constipation in children when other things, like increasing fiber, don’t seem to work:
- Parents who are unsuccessful when toilet training their child often seek guidance from a practitioner, who may prescribe an enema to regularize the bowel motion of a child once in a week.
- The practitioner will explain to the parents how to manipulate the colonic motility with diet, medication or both.
Note: It is vital to understand the difference between fecal incontinence and encopresis, as both these conditions requires a different mode of management. For fecal incontinence, a daily enema will be required. For pseudo-incontinence patients, laxatives are used until the bowel movement is back to normal.
7. A Deeper Understanding of What is Happening to Your Child: The Pathogenesis and Management of Chronic Constipation in Children
The successful management of constipation in children requires an understanding of colorectal function and careful characterization of the symptoms. The basis for the treatment of chronic constipation is the nature of the complaint and the presumed pathophysiological mechanisms at work in each patient.
Read below to know about this mechanism:
- The colon is the last part of the digestive system. It extracts water and salt from solid wastes before your body eliminates them.
- The large intestine begins with an area called the cecum. It receives liquid waste and converts it into solid stool while passing through the colon. Peristalsis motion is slow in the colon.
- The rectosigmoid junction remains inactive for about 24 to 48 hours. When it is time to empty, peristaltic waves develop in the rectosigmoid region. The person realizes this push, but has the ability to hold the urge for a while.
8. When Your Child Can’t Tell You What’s Wrong: Detecting Chronic Constipation in Children with Autism
According to statistics, about one in every 110 children suffers from Autism Spectrum Disorder (ASD). Gastrointestinal concerns, such as diarrhea and constipation appear atypically in autistic children, and therefore it becomes a challenge for the parents to recognize and treat it accordingly.
The treatment of constipation in autistic children differs from normal children. They may not be able to tell what is concerning them, so the parents must watch out for symptoms like grinding teeth, holding the belly or arching the back.
The Autism Treatment Network board has been creating treatment guidelines for identifying and handling constipation, chronic diarrhea and food allergies. It will work like a stepwise guide for the practitioners to treat constipation in autism patients. This will also give them the warning signal when to move the case on to a GI specialist.
There are various causes of chronic constipation in children. It is necessary for parents and caregivers to differentiate normal bowel behavior from abnormal bowel behavior to get the best treatment for their child at an early stage before things can become chronic.