Constipation in Children

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Constipation in Children

NIDDK - National Digestive Diseases Information Clearinghouse
Constipation in Children

Constipation in children is a condition in which a child has fewer than two bowel movements a week or has bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass. The child may feel bloated or have pain in the abdomen—the area between the chest and hips. Children with constipation may be unable to push all of the stool out of their body.

Constipation can be acute, which means sudden and lasting a short time, or chronic, which means lasting a long time, even years. Most constipation is acute and not dangerous. In rare cases, children can have chronic constipation.

What causes constipation in children?

Constipation is caused by stool spending too much time in the colon. The colon absorbs too much water from the stool, making it hard and dry. Hard, dry stool is more difficult for the muscles of the rectum to push out of the body.

Common factors or disorders that lead to constipation in children are:

  • Diets low in fiber
  • Certain medications 
  • Ignoring the urge to have a bowel movement
  • Specific diseases  and conditions
  • Functional gastrointestinal disorders

Diets Low in Fiber

A common cause of constipation is a diet with too little fiber. Fiber is a substance in foods that comes from plants. Fiber helps stool stay soft so it moves smoothly through the colon. Liquids such as water and juice help fiber to be more effective.

Medications

Medications that can cause constipation in children include:

  • Pain medications, especially narcotics
  • Antacids that contain aluminum and calcium
  • Some antidepressants
  • Anticholinergics—medications that relax the bladder muscles to prevent urgent, frequent, or uncontrolled urination

Ignoring the Urge to Have a Bowel Movement

Children most commonly develop constipation as a result of holding in stool. As the child squeezes the muscles around the anus to prevent a bowel movement, stool is pushed back into the rectum. Eventually, the muscles in the rectum and lower colon stretch, reducing muscle tone and causing the child to retain stool. Fluid continues to be absorbed from the stool, causing the stool to become hard, dry, and difficult to pass. Children may withhold stool because they are feeling 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 an unpleasant bowel movement.

Specific Diseases and Conditions

Certain diseases and conditions can delay movement of stool through the GI tract and cause constipation, including:

  • Botulism—a rare but serious illness caused by a toxin from a bacterium that affects the nerves and causes constipation. Infant botulism is usually caused by consuming contaminated honey.
  • Hirschsprung disease—a birth defect in which the large intestine is lacking some nerve cells, which means the signals that tell the muscles to push stool along are missing; stool remains in the large intestine and causes blockage.
  • Obstructive conditions that block part of the lower GI tract.
  • Diabetes and other metabolic or endocrine disorders that disrupt the process the body uses to get or make energy from food.

Functional GI Disorders

Functional GI disorders are problems caused by changes in how the GI tract works. Children with a functional GI disorder have frequent symptoms; however, the GI tract does not become damaged. Functional constipation often occurs in children during one of three periods:

  • When infants are transitioned from breast milk to formula or when solid foods are introduced
  • When toddlers are being toilet trained and attempt to control bowel movements
  • When children start school and avoid using the bathroom at school for bowel movements

Functional constipation is diagnosed in children up to 4 years of age who have had at least two of the following symptoms for 1 month:

  • Two or fewer bowel movements per week
  • At least one episode of fecal incontinence—accidental leakage of solid or liquid stool—per week in toilet-trained children
  • History of excessive stool retention
  • History of painful or hard bowel movements
  • Presence of a large fecal mass in the rectum
  • History of large-diameter stools that may block the toilet

Functional constipation is diagnosed in children 4 to 18 years of age who have had at least two of the following symptoms for 2 months and do not have irritable bowel syndrome (IBS):

  • Two or fewer bowel movements per week
  • At least one episode of fecal incontinence per week
  • History of excessive stool retention
  • History of painful or hard bowel movements
  • Presence of a large fecal mass in the rectum
  • History of large-diameter stools that may block the toilet

IBS is a functional GI disorder with symptoms that include abdominal pain or discomfort, often reported as cramping, along with diarrhea, constipation, or both. Read more in Irritable Bowel Syndrome in Children at www.digestive.niddk.nih.gov.

 

What are the signs of constipation in children?

Symptoms of constipation in children include:

  • 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
  • Stool in the child’s underwear. Delaying a bowel movement can result 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.
  • Urinary incontinence. Stool in the colon can press against the bladder and cause daytime or nighttime wetting.

When should a child see a doctor for constipation?

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:

  • Fever
  • Vomiting
  • Blood in the stool
  • A swollen abdomen
  • Weight loss

How is constipation in children treated??

Treatment for constipation in children may include one or more of the following:

  • Changes in eating, diet, and nutrition
  • Behavioral changes
  • Medication

Eating, Diet and Nutrition

Dietary changes to help treat constipation in children include drinking prune juice and increasing fruits and vegetables. Children should drink liquids throughout the day. A health care provider can recommend about how much a child should drink each day based on the child’s age, health, and activity level and where the child lives.

The Academy of Nutrition and Dietetics recommends that daily consumption of fiber be “age plus 5” grams for children.3 A 7-year-old child, for example, should get “7 plus 5,” or 12, grams of fiber a day. Children often eat too many refined and processed foods from which the natural fiber has been removed. A health care provider can help plan a diet with the appropriate amount of fiber. A list of high-fiber foods is shown below. For children prone to constipation, limiting foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, is also important.

Behavioral Changes

Older children should be encouraged to use the toilet shortly after meals to promote regular stool passage. Some children may respond well to a reward system. Children who are still in the process of toilet training may need to take a break from toilet training until the constipation resolves.

Medications

Initial treatment of constipation in children often involves a thorough cleansing of the bowel. An enema involves flushing water or laxative into the anus using a special squirt bottle.

Laxatives are medications that loosen stool and increase bowel movements. Different laxatives work in different ways. Children should take medication until their bowel habits are normal for an extended period of time and they have overcome their holding behavior. If treatment is stopped too soon, a child will likely become constipated again. Caregivers should not give children laxatives unless told to do so by a health care provider. Read more about different types of laxatives in Constipation at www.digestive.niddk.nih.gov.

Oral therapies can also be used to clear out the bowel. Both enemas and oral therapies can usually be given at home as directed by a child’s health care provider. However, a child who does not respond to treatment may need to be admitted to the hospital.

For More Information

American Academy of Pediatrics 
www.aap.org

International Foundation for Functional Gastrointestinal Disorders (IFFGD) 
www.iffgd.org

Additional Information on Constipation in Children

The National Digestive Diseases Information Clearinghouse collects resource information about digestive diseases for the NIDDK Reference Collection. This database provides titles, abstracts, and availability information for health information and health education resources.

You may view the results of the automatic search on constipation in children. If you wish to perform your own search of the database, go to NIDDK Reference Collection.

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (463–6332) or visit www.fda.gov. Consult your doctor for more information.

National Digestive Diseases Information Clearinghouse

2 Information Way
Bethesda, MD 20892-3570
Phone: 1-800-891-5389
TTY: 1-866-569-1162
Fax: 703-738-4929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov

NIH Publication No. 02-4633
October 2008

Last updated July 03, 2014


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