Constipation is a condition in which bowel movements occur less frequently than usual or stools tend to be hard, dry, and difficult and painful to pass.
Constipation is common in children and is usually without long-term consequences; however, it can diminish a child's quality of life, cause emotional problems, and create family stress. Rarely, constipation is a sign of a more serious health problem.
Children often develop constipation as a result of stool withholding. They may withhold stool because they are stressed about potty training, are embarrassed to use a public bathroom, do not want to interrupt playtime, or are fearful of having a painful or unpleasant bowel movement.
Delaying a bowel movement causes stool to become hard, dry, and difficult to pass — sometimes resulting in a large mass of stool in the rectum called a fecal impaction. Stool builds up behind the impaction and may unexpectedly leak, soiling a child's underwear. Parents often mistake this soiling as a sign of diarrhea.
Other causes of constipation in children include:
- a low-fiber diet
- certain medications or drugs, such as antacids, opiates, and antidepressants
- diseases, such as Hirschsprung disease, diabetes, and Down syndrome
- anatomic abnormalities, such as a birth defect
Symptoms of constipation in children include:
- fewer bowel movements than usual
- postures that indicate the child is withholding stool, such as standing on tiptoes and then rocking back on the heels of the feet, clenching buttocks muscles, and other unusual dancelike behaviors; parents often mistake such postures as attempts to "push"
- abdominal pain and cramping
- painful or difficult bowel movements
- hard, dry, or large stools
A child should see a doctor if symptoms of constipation last for more than 2 weeks. A child should see a doctor sooner if the constipation is accompanied by one or more symptoms that may indicate a more serious health problem, including:
- blood in the stool
- a swollen abdomen
- weight loss
- painful cracks in the skin around the anus, called anal fissures
- intestine coming out of the anus, called rectal prolapse
The doctor will ask questions about the child's history of symptoms and will perform a physical examination. The doctor may perform a rectal exam by inserting a gloved finger into the child's anus to check for anatomical abnormalities and for the presence of a fecal impaction.
Constipation is treated by changing diet, taking laxatives, and adopting healthy bowel habits. Treatment depends on the child's age and the severity of the problem. Dietary changes include eating more high-fiber foods, such as whole grains, fruits, and vegetables. Laxatives are frequently used to clear a fecal impaction and sometimes to restore regular bowel movements. A doctor should be consulted before giving a laxative to a child. Parents should encourage their child to spend time on the toilet after meals and when their child shows signs of withholding stool.
A child should be seen again by a doctor if treatment fails or if the child begins to show symptoms that suggest a more serious health problem.
American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
International Foundation for Functional Gastrointestinal Disorders (IFFGD)
P.O. Box 17864
Milwaukee, WI 53217
Phone: 1-888-964-2001 or (414) 964-1799
Additional Information on Constipation in Children
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