Constipation in Children

Pediatric Basics

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Constipation is very common in children. In fact, up to 3% of visits to the pediatrician are because of constipation.

While often caused by not drinking enough fluids, constipation can also be caused by not eating enough fiber or having a diet high in constipating foods (whole milk, cheese, bananas, etc.).

There are also some medical reasons for being constipated, such as being born with Hirschsprung's disease.

Symptoms of Constipation

Children with constipation usually either have very large hard stools or hard, pellet-like stools. Bowel movements are also infrequent and painful.

In addition to having pain when they pass a bowel movement, children with constipation might have cramping abdominal pain.

Diagnosing Constipation

Children are usually diagnosed with constipation after a careful history and physical exam. Further testing is usually not necessary.

In general, constipation is usually defined as having "difficulty with defecation for at least 2 weeks, which causes significant distress to the patient."

Keep in mind that parents often don't know how often their school age children are have bowel movements, which often delays the diagnosis of constipation.

Careful attention should be made for children who have had severe constipation from birth, especially if they did not pass meconium stools until 2-3 days after they were born.

These children might have Hirshsprung's disease.

Treatments for Constipation

Treatments for childhood constipation usually includes stool softeners and changing the child to a less constipating diet, with more fiber and fluids.

Good choices of fluids include apple and prune juice and perhaps switching children low-fat milk or soy milk.

Reading food labels can help you to find high fiber foods.

What To Know about Constipation

Other things to know about constipation include that:

  • If your child is having soft bowel movements, then she likely isn't constipated, even if she doesn't have one every day.
  • Some children with severe constipation develop a blockage, past which liquid stool sometimes leak, causing your child to have soiling accidents. This condition is caused encopresis.
  • Unlike laxatives, stool softeners used in children are not usually addictive and can be given every day if necessary. A common mistake is for parents to stop stool softeners once a child begins having soft bowel movements, only to have the child soon develop constipation again. Stool softeners are often used for 4 to 6 months and then slowly decreased to prevent reoccurrences.
  • Polyethyline glycol 3350 (Miralax), a tasteless and odorless powder that can be mixed with water, is well tolerated by most children and often prescribed by pediatricians for children with constipation.
  • In addition to dietary changes and stool softeners, many kids with constipation need a 'clean out' regimen to help get backed up stool out.
  • You should not have to frequently use enemas or laxatives to help your child have a BM.

    A pediatric gastroenterologist can provide extra help if your child has chronic constipation that is hard to treat.




    Pediatric Gastrointestinal and Liver Disease (Third Edition)

    Tabbers and DiLorenzo et al. Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations from ESPGHAN and NASPGHAN. Journal of Pediatric Gastroenterology and Nutrition - Volume 58, Number 2, February 2014

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