What if my child has constipation?

What if my child has constipation?

[mme_highlight] Constipation is a common health problem in childhood accounting for 3% of general pediatric visits. It is classified as functional in 90% of cases (not linked to a disease).  Signs frequently seen in constipated children are a reduction of bowel movements and crying when having one. Dietary and hygienic measures resolve the majority of constipation episodes.  [/mme_highlight]

Constipation is a common health problem in childhood accounting for 3% of general pediatric visits. Constipation is a common symptom and frequently believed to be something that children “grow out of.” However, studies have found that complaints of constipation of about 30% chronically constipated children persisted into young adulthood. Approximately 50% of the children also experienced at least one relapse within the first 5 years after initial successful treatment.

What is the norm regarding bowel habits?

There is a huge variation for that concept. However, in a UK based study of 350 pre-school children (1-4 years of age), 96% of the children passed bowel motions between 3 times a day to alternate daily. Stool frequency is also age-dependent. A study with 800 babies described a peak frequency of 4.4 bowel movements per day at 5 days of age, which may be as high as 13 per day in breast fed infants.

What are the causes of constipation?

90% of cases of constipation in children are defined as functional – this means no organic cause is subjacent. Functional constipation can be explained by factors such as withholding stool, problems during toilet training and lack of fiber in diet. When constipation is secondary to a disease it is named organic.
There are three periods during which a child may be more prone to develop constipation complaints: the first, when solid food and cereals are introduced; the second occurs with toilet training; the third period may occur when children enter school, not only because this is a milestone for child’s development, but also because of some reluctance in using the bathroom as it is unfamiliar to the child.

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Causes of Constipation in Children

  • Functional: 91%
  • Organic: 9%
  • Cerebral Palsy: 6%
  • Hypothyroidism: 1%
  • Down Syndrome + Hypothyroidism: 1%
  • Meningomyelocele: 0.5%
  • Hypokalemia (low potassium levels): 0.5%

Study design: 355 children were assessed for constipation.
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What are the signs of constipation?

Some signs may indicate your child has constipation:

  • Less number of bowel movements, compared to your child’s normal;
  • Pain, crying or arch back (in babies) with bowel-movement;
  • Leak small amounts in pants (in children already toilet trained).

What can I do to help my child?

  • Give her/him aliments with fiber, such as fruit, vegetables, and cereals.
  • Offer him juice of prune, apple or pear.
  • Avoid milk and milk-derived aliments, like yogurt, cheese and ice cream.
  • Put your child to sit on the toilet for 5 to 10 minutes after meals.
  • To help constipation ameliorate, stop potty training for a while.

What serious diseases can be associated with constipation?

Examples of diseases presenting with constipation and requiring additional investigation and specific treatment are: cow’s milk intolerance, Hirschsprung disease, cystic fibrosis and anorectal anomalies.

What if constipation persists?

If constipation seems to be recurrent, it may happen because of insufficient time using the bathroom, fear of using an unfamiliar one or fear of feeling pain either because of hard stools or an anal fissure.

In the case of recurrent constipation, a “clean out” treatment can be attempted in order to empty bowels, always in addition to the dietary measures stated above. It can be done with PEG (polyethylene glycol) and/or Milk of Magnesia®.

Summary and Recommendations

  • Constipation is very common in children and it is classified as functional in 90% of cases (not linked to a disease).
  • Signs frequently seen in constipated children are a reduction of bowel movements and crying when having one. Dietary and hygienic measures resolve the majority of constipation episodes.
  • There are some alarm signs you should keep in mind:
  • Frequent constipation or constipation in children younger than 4 months old.
  • If your child does not have a bowel movement even after trying the measures explained above for one day.
  • Blood in stools or in diaper/underwear (look for an anal fissure).
  • If your child seems to be in serious pain.
  • If you noticed your child has lost weight or is not thriving adequately.
  • If your child presents fever, vomiting or diarrhea.

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References

  1. Borowitz SM, Cox DJ, Tam A, et al. Precipitants of constipation during early childhood. J Am Board Fam Pract 2003; 16:213.
  2. Ozlem Bekem Soylu. Clinical Findings of Functional and Secondary Constipation in Children. Iran J Pediatr. 2013 June; 23(3): 353–356.
  3. Weaver LT, Steiner H. The bowel habit of young children. Arch Dis Child. 1984;59:649–652. doi: 10.1136/adc.59.7.649
  4. Nyhan WL. Stool frequency of normal infants in the first week of life. Pediatrics. 1952;10:414–425.

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