Constipation in children
Constipation is a common childhood problem characterised by bowel motions that are hard, dry and difficult to pass.
How do I know if my child is constipated?
Bowel patterns can vary from child to child. Some have several bowel movements a day, while others have one only every couple of days. The fact that a child does not go to the toilet every day does not mean they are constipated. However, no matter how frequently bowel movements occur, they should not hurt.
Some indications that your child may be constipated
- Complaining of abdominal pain and cramps (tummy ache).
- Loss of appetite — getting full without eating much food.
- Nausea and vomiting.
- Decreased interest in usual activities.
- Small tears (anal fissures) around the anus.
- It hurts to pass a motion and motions may be unusually large.
- More frequent urination because of pressure on the bladder.
- Soiling of underwear with liquid faeces.
What causes constipation?
Unlike constipation in adults, childhood constipation is more often the result of a behavioural rather than a nutritional disorder. The most common cause of constipation in children is their decision to delay going to the toilet and passing a bowel motion. Their reasons for this may include:
- having had painful bowel movements in the past;
- being too busy to find time to go to the bathroom;
- avoiding school or public toilets because they lack privacy, are smelly, lack toilet paper, or the child is bullied or teased in the toilets;
- rebellion against toilet training; or
- being anxious as a result of a stressful situation such as separation from parents, the birth of a brother or sister, or death or divorce in the family.
Constipation can also be aggravated by a lack of fibre or fluid in the diet, or by a lack of exercise. It can also occur as a result of infectious illnesses, or medications such as codeine. In a very small percentage of cases, constipation may indicate some other disorder such as Hirschsprung’s disease (a serious childhood condition caused by the absence of nerve cells in the wall of the intestine), abnormalities of the anus or rectum, or lead poisoning.
What can you do to help relieve constipation in your child?
You can help to ease constipation in your child by making changes to their diet and encouraging them to change any habits which are leading to constipation.
Try to introduce more fibre into their diet, by gradually increasing the quantity of fruit, vegetables and wholegrain breads and cereals that they eat. Do not increase the amount of fibre in too-large quantities, as this may result in gas and bloating.
You may also wish to try giving your child prune juice. Prune juice contains complex sugars that cannot be absorbed by the intestine and which help to retain water in the bowel, keeping the stool soft.
Give your child plenty of clear fluids, such as water, although research has suggested that this is not as important as increasing the amount of dietary fibre.
If possible try to get your child into the habit of going to the toilet as soon as they have the urge to defaecate.
It may also help to encourage your child to sit on the toilet after meals, especially breakfast or dinner, as this can take advantage of the natural intestinal contractions that occur after eating. This is a good habit to encourage as children with constipation often do not get the sensation of the bowel being full which would normally tell them to go to the toilet.
Try rewarding your child for sitting on the toilet and for a successful motion by means of a star chart. Do not punish them for not having a bowel motion.
When should you consult your doctor?
Sometimes additional help is required to empty the bowel. Once the condition has become chronic, it is likely that laxatives may be required. Most of the laxatives used for treating chronic constipation in children work by retaining water in the intestines, making the faeces softer and able to move more quickly through the bowel.
However, in serious cases, your child may need suppositories or an enema. These are administered via the anus. Enemas work by introducing fluid into the rectum which softens the stool and also stretches the rectum so that your child feels an urgent need to go to the toilet. Suppositories work by irritating the lower intestine so that it squeezes.
Once the bowel has been emptied, your child may need laxatives until regular bowel habits have been re-established. This can take between 3 and 12 months. Talk to your doctor if you have any concerns that your child might be suffering from abnormal constipation.
Last Reviewed: 10 April 2009
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