Constipation in children

Constipation is a common problem in children. For most children, constipation means hard stools pass with difficulty, less often than normal. Normal soil (often confused with watery diarrhea) may indicate that a child has bad constipation with impaction (a blockage of stool / feces). When no particular disease or illness is the cause of constipation, which is known as idiopathic constipation. It is important that constipation is recognized and treated early, with laxatives, to prevent it from becoming a long-term (chronic) problem.

On this page

  • Intestines of your child – what is normal?
  • Intestines of your child – what is abnormal?
  • What is constipation?
  • Types of constipation in children and infants
  • Does my child need any proof?
  • What causes idiopathic constipation?
  • What is idiopathic constipation with impaction?
  • What is the treatment of idiopathic constipation?
  • How can constipation in children?
  • Learn more
  • References

Parents often get very concerned about your child's bowel habits. This anxiety may begin when the child is an infant, with his concern for the number of dirty diapers. The most important thing is to realize that each child is different. Normal may vary slightly. This is a change in what is normal for your child, that suggests a problem.

Infants open its entrails anything from several times a day, once every few days. The frequency of bowel movements is not particularly important. What is important is that the stools (motions, poop, feces) are soft and passed easily.

Breastfed babies tend to spend runnier, mustard yellow stools. This is because breast milk is digested better than artificial milk (formula). Newborn Babies breastfed open the bowels of each food. However, it is also normal for a breastfed baby to go up to a week without a bowel movement.

Bottle-fed infants often need to open your bowels every day, and that feces are voluminous. Bottle-fed baby stool smells worse (more like an adult).

It is not uncommon for baby's stools to vary in color and consistency from day to day. Any changes prolonged hard stools can mean less frequent constipation.

Because babies are weaned to solid foods, his stools change color and smell. The frequency can change again. In general, the stool becomes thicker, darker and more smelly. You will notice that your baby's stools will change depending on what you have fed him or her. Some high-fiber foods, such as raisins, may even pass through the intestines almost unchanged from her baby, who appears in the next diaper change.

As your baby grows into a child and then a young child, you can see changes in stool frequency and consistency, often depends on what you are eating.

As you can see, there is great variation in bowel habits of children, depending on their age and what they are fed. As already mentioned, it is a change in what is normal for your child, that suggests a problem. Anything from three times daily to once every two days is common and normal. Less frequently than every two days means that constipation is likely. However, it still may be normal if the stool is soft and well formed, and passed easily.

It may be normal for your baby to go a bit red in the face when Straining to pass stool. Constipation is a problem more than this. Breastfed babies rarely get constipated as breast milk contains just the right balance of nutrients to keep stools soft and passed easily.

Diarrhea often means very loose stools and often go more often than usual. Breastfed babies have diarrhea less often than other babies because breast milk has a protective effect against germs that cause diarrhea.

Constipation in children or infants can mean any or all of the following:

  • Difficulty or straining.
  • Painful bowel movements, sometimes with a small amount of blood in the diaper or toilet paper, due to a small tear in the anus skin.
  • Defecate less often than normal. Usually, this is less than three complete stools (right) a week.
  • Stools that are hard, and perhaps very large, or as a bar and small like rabbit droppings.

Other symptoms of constipation

Besides stool less frequently, difficult (and perhaps painful), constipation can cause:

  • Stomach pain (abdominal pain).
  • Lack of appetite.
  • Malaise ('color off' feeling).
  • Behavioral changes, such as being more unhappy or irritable.
  • Restlessness, agitation and other symptoms that the child needs to go to the bathroom.
  • Feeling sick (nausea).

Severe constipation can cause impaction (where a very large bank is stuck in the rectum). This can cause additional symptoms. In particular, this can cause a child to soil his pants regularly with very soft stools with mucus or fecal staining. This is often mistaken by parents as diarrhea. Impaction discussed in detail below.

  • Idiopathic constipation. This is common. The word idiopathic means of unknown cause. Several factors may be involved (discussed later), but many children constipation without known reason.
    • Short bouts of constipation. It is common for children and babies to have an attack of mild constipation for a day or two. This can be resolved quickly, often without medical treatment.
    • In the long term constipation. In about 1 in 3 children who are constipated, the problem becomes more long-term (persistent). This is also called chronic idiopathic constipation.
  • Constipation due to an underlying disease or condition. This is rare. Constipation is said that this is secondary to another problem. Some examples of conditions and problems that can cause constipation are:
    • Some neurological diseases.
    • Hypothyroidism (underactive thyroid gland).
    • Cystic Fibrosis.
    • Rare diseases with abnormal development of the intestine, such as Hirschsprung's disease.
    • As a side effect of certain medications your child has to take for another condition.

    Treatment may include treatment of the underlying disease (if that's possible), along with the fight against constipation.

    Worrying symptoms or signs that may indicate a secondary cause are as follows. These should be referred to their GP. It is also possible that some of these symptoms may mean that your child is more serious evil:

    • Vomiting.
    • Weight loss or failure to gain weight (growth).
    • A bloated, stretched face down.
    • Severe pain.
    • A baby who does not pass their first stool (called meconium) in the first 48 hours of life.
    • Abnormalities of the year – for example, if it is closed again.
    • Neurological (nervous system) problems such as leg weakness or paralysis.
    • Sores near the anus.
    • Excessive thirst.
    • Urinary symptoms – such as the passage of a large volume of urine, very dark urine or painful urination smelly urine.
    • Very pale colored stool (especially if urine is dark too).

The rest of this booklet is about idiopathic constipation.

The evidence is not normally necessary to diagnose idiopathic constipation. Your GP is likely that several questions and do a comprehensive review to rule out secondary causes of constipation. In reviewing your child's abdomen (tummy), a doctor can tell if there are a lot of feces in the intestine. This can give an indication of whether the impaction (explained later) has been developed. (If an underlying cause of constipation is suspected, your doctor will refer your child to a pediatrician (children's doctor) and other tests may be done.)

As mentioned, idiopathic means any disease or no known cause constipation. However, it is believed that several factors may contribute to developing constipation, or worse. These include diet, holding stool and emotional factors.

Diet

Dietary factors that may play a role in constipation are:

  • Not eating enough fiber (the fiber portion of food that are not digested and stays in the gut).
  • Not having enough to drink.

Stools tend to be harder, drier, and more difficult to overcome if there is little fiber and fluids in the intestine.

Stool celebration

This means that the child has the feeling of having to urinate, but resists it. The child clings to the stool, trying to ignore the desire to empty the bowels. This is quite common. You can see your child crossing her legs, sitting in the back of the heels, or do similar things to help resist the feeling of having to urinate. Your child can squeeze your buttocks to try to stop the stool out, and can seem quite restless. You may notice spots of fecal matter in your child's pants, often when they can not take it anymore. The longer the child clings, larger stool gets. Finally, the child has to go, but the big stool is more difficult to pass, and often painful. This can lead to a kind of vicious circle in which the child is even more reluctant to open his heart the next time. There are a number of reasons why children can grab a stool:

  • A stool passed earlier that might have been a struggle or painful. So I try to put it out again.
  • Your anus may be sore or have a fissure (anal fissure) pass large stool before. Then additional painful defecation. Thus, the child may resist passing a stool.
  • They may have an aversion to the unknown or smelly toilets, and in school or in the holidays. The child may want to set things up to get home.

Emotional problems

Constipation can worsen problems with discomfort due to the change in environment or routine. Common examples are moving house and starting kindergarten. Potty training can be a factor if a child is scared to use the potty. Fears and phobias are often the underlying reasons for these problems.

The bowel impaction means is, in effect, blocked by a large amount of hard stools. Idiopathic constipation with impaction occurs most commonly in children between the ages of 2 and 4 years, but children older or younger may be affected. The symptoms and characteristics include:

  • Recurrent episodes when the child is uncomfortable or distressed trying to pass a stool.
  • The child soils his pants regularly with very soft stool, mucus or fecal staining. This is often mistaken by parents as diarrhea.
  • The child may also become irritable and not eating much, feel sick, have stomach pains from time to time, and may be generally cranky.
  • A doctor can often feel a build up of hard stools and unequal as he or she examines the child's belly (abdomen).

The following diagram shows how a child may develop impaction, and symptoms can cause this.

chronic constipation in children

  • Typically, feces accumulate in the lower part of the intestine.
  • When feces accumulate, begin to pass into the rectum (the last part of the intestine) extending. This sends nerve messages to the brain, telling you that you have to empty your bowels.
  • If the stool is not removed then more stools above also reach the rectum.
  • Over time, large hard stools can accumulate in the rectum.
  • The rectum then can stretch and enlarge (dilate) much more than usual, to deal with the excessive amount of feces.
  • A very large stool can develop and become trapped (impacted) in an enlarged rectum.
  • If time remains enlarged rectum normal sensation of needing the toilet is reduced. The power to pass a large stool is also reduced (the rectum becomes 'floppy').
  • More feces accumulate in the colon after the stool in the rectum.
  • The lowest part of a fecal impaction is located just above the anus. Some of these stool liquefies (becomes liquid) and leakage from the anus. These soils child or linen trousers. In addition, some softer, more liquid stool in the colon above may miss around the impacted stool hard. It also leaks on the floor and pants or bedding can be confused with diarrhea. The child is not in control of this leakage and dirt.
  • When a bank is finally approved, because the rectum is distended and weakened, but simply fills up quickly again with more hard stools portfolio ago.

Laxatives

Idiopathic constipation that has lasted more than a few days is usually treated with laxatives. Your doctor will advise you on the type and strength. This may depend on factors such as the age of the child, constipation severity and response to treatment. Children laxatives are commonly either as a powder sachets or preparing a beverage, or as liquid / syrup. Laxatives used for children are divided into two types.

  • Macrogol (also called polyethylene) is a type of laxative which causes water in the intestine, maintain soft feces. They are also known as osmotic laxatives. For example, Movicol ® Paediatric Plain is a brand that is commonly used in the first place. This is mixed with water to make a drink that cordial, such as blackcurrant squash can be added to improve the taste nicer. Lactulose is another type of osmotic laxative.
  • Stimulant laxatives. These stimulate (encourage) the intestine to move the stools out. There are several different types of stimulant laxative. Picosulfate sodium, bisacodyl, senna and docusate sodium are examples. A stimulant laxative tends to be added in addition to a macrogol macrogol if not enough by itself.

Laxatives are usually continues for several weeks after the constipation has eased and a regular bowel habit is established. This is known as maintenance therapy. Thus, overall, the duration of treatment may be several months. Do not stop abruptly prescription laxatives. Stopping abruptly can cause constipation laxatives to repeat soon. Your doctor will advise a gradual reduction of the dose over a period of time, depending on how the stools have become consistency and frequency. Some children may require laxative therapy for several years.

Treating impaction – if necessary

Similar treatments are used for the treatments listed above. The main difference is that higher doses of laxatives are initially required to remove the large amount of feces straight block. Secondly, laxatives also typically required for much longer, as maintenance therapy. The aim is to prevent the accumulation of hard feces that are repeated again, thus avoiding impaction return.

As a result of maintenance treatment:

  • The enlarged rectum can gradually return to normal size and function properly again.
  • Constipation is then unlikely to recur.

If laxatives are stopped early, a large bank is likely to be repeated again in the weakened 'floppy' rectum that has not had time to return to normal size and strength.

Treatment to remove impacted stool from the rectum can be a difficult time for you and your child. Chances are your child actually have a bit of stomach pains before, and there will be no more dirty pants. It is important to persevere, as these problems are only temporary. Removing the impacted stool is an essential part of treatment.

On rare occasions, when the treatment has failed impacted stool, a child can be treated in hospital. In the hospital, stronger medications to empty the bowel, called enemas, can be given through the rectum. For hard to treat cases, the child may have a general anesthetic and intestine can be cleared manually by a surgeon.

Diet

Dietary measures should not be used alone to treat idiopathic constipation as it is unlikely to solve the problem. However, it is still important to get a child into the habit of eating a well balanced diet. This is to include plenty of drinks (especially water) and foods with fiber. This will help prevent recurrence of constipation, once it has been resolved.

Eat foods high in fiber and drink plenty makes stools are bulky, but soft and easy to pass out. Getting plenty of exercise is also thought to help.

Food and fiber

This advice applies to babies and children who are weaned. Foods that are high in fiber include fruits, vegetables, cereals, wholemeal bread. A change to a high fiber diet is often "easier said than done", as many children are picky eaters. However, any change is better than nothing. Here are some ideas to try to increase fiber intake for your child:

  • A meal of jacket potatoes with baked beans, or vegetable soup with bread.
  • Dry (or semi-dry) appetizers apricots or raisins.
  • Porridge or other high-fiber cereal (like Weetabix ®, Shredded Wheat ® or All Bran ®) for breakfast.
  • Offering fruit with every meal – maybe chopped to make it look more attractive.
  • Perhaps not allow sweets or desserts until your child has eaten a piece of fruit.
  • Another tip for when children refuse to eat foods rich in fiber bran powder is added to yogurt. The yogurt will feel grainy, but powdered bran is tasteless.

Drink

If a bottle-fed baby has a tendency to be constipated can try to offer water between meals. (Never dilute infant formula (milk) that is given to bottle-fed babies.) Although it is rare for a breastfed baby to become constipated, can also offer water between meals. Older, weaned babies can give diluted fruit juice (preferably without sugar added). Puree fruits and vegetables are the usual starting points for weaning, after rice baby, and these are good for preventing constipation.

Encourage children to drink heavily. However, some children in the habit of only drinking pumpkin soda or milk to quench your thirst. These can fill them, and makes them less likely to eat proper meals with foods that are high in fiber. Try to limit these beverages. Give water as the primary beverage. However, fruit juices which contain fructose or sorbitol have a laxative action (for example, plum, pear, apple or juice). These can be useful from time to time if the stool becomes harder than normal and constipation can be suspected development.

Some other tips that can help

  • Help the children in a hygienic habit regular. After breakfast, before school or day care, it is often best. Try to leave enough time to not feel rushed.
  • Some type of reward system is sometimes useful in young children with tendency to cling to the stool. You could give a gift, or use stickers or star charts to reinforce the message. Praise your child to pass a stool in the potty or toilet, but not punish accidents. It's easy to get frustrated with stained pants or a child who refuses to evacuate. Try to stay calm and not make a fuss about the health issue. If your child can see that you are stressed or upset, they will realize this feeling, and the question of going to the bathroom can become even more of a tense battle. The goal is to be "matter of fact" and relaxed about it.

Your doctor, nurse and health visitor are good sources of advice and information on childhood constipation. The school nurse may also be able to give practical support and help.