Constipation in Children Causes, Symptoms, Diagnosis, Treatment,

Constipation occurs commonly in children, affecting up to 10% at any given time. Still, only 3% of parents actually seek advice from the doctor for this condition. Constipation describes the infrequent passage of stools (bowel movements) or the passage of hard stools. Any definition of constipation depends upon comparison to how often the child normally passes stools and to the normal consistency of his or her stools.

Many children normally pass stools as far apart as every few days. Regardless, you should treat hard stools that are difficult to pass and those that happen only every three days as constipation.

Constipation in Children Causes

Infants and children with constipation are treated differently than adults because patterns of bowel movements change from the time they are born until they reach the age of 3 or 4 years. The majority of children with constipation do not have a medical disease or disorder causing the constipation. Rarely, a disorder causes infants and children to have significant problems moving their bowels.

Many things can contribute to constipation.

* The most common cause in a child older than 18 months is their willful avoidance of the toilet (for various reasons). For example, toddlers are often so involved in their play that they lack time or patience for toilet breaks.
* At school they may be concerned with lack of privacy or the cleanliness of the bathroom.
* They may have had a prior painful or frightening experience that makes them want to avoid the bathroom. Over time, their brain learns to ignore repeated urges by the colon to visit the bathroom. As stool remains in the colon, the colon will absorb water out of the stool, making it hard and dry. This hard stool is even more difficult or painful to pass, which causes the child to continue “holding it.”
* Changes in diet, or a different diet affect bowel habits. In adults, high-fiber diets have been shown to improve bowel function. In children, however, high-fiber diets have not been proven to improve constipation. Infants and children who eat well-balanced meals typically are not constipated.
* Breastfed infants will generally have more stools per day. Their stools vary more in frequency when compared to bottle-fed infants. For example, breastfed infants produce anywhere from 5-40 bowel movements per week; whereas formula-fed infants have 5-28 bowel movements per week. Switching the type of milk (or formula) can also cause constipation.
* Teenagers and toddlers who eat a lot of sugar and desserts are prone to difficult passing of their stools.
* Any intense changes in a child-such as illnesses causing fever, a long time in bed, eating less, or dehydration-may decrease frequency of stools or may harden stools.
* A number of medical disorders can cause chronic constipation.

• Hypothyroidism (lowered activity of the thyroid gland) is a condition that causes decreased activity of the intestinal muscles along with many other symptoms. All newborns should be tested for hypothyroidism as part of the newborn screening blood test (heel prick or Guthrie test). This condition is usually diagnosed when a baby is very young but can occur at any age.
• True constipation in infants and children that has been present since birth may be from Hirschsprung’s disease. In this rare congenital condition, a segment of the colon lacks ganglion cells (a type of nerve cell). The affected colon cannot receive directions from the brain to work properly. Most infants with Hirschsprung disease display symptoms within the first few weeks of life. They may be underweight or small for their age. They may vomit and pass small stools, which are described as ribbon-like. Hirschsprung’s disease is generally more common in boys and in babies with Down syndrome. If Hirschsprung’s disease is suspected, you need to take your child to a specialist (gastroenterologist or pediatric surgeon) for further tests.
• Diabetes is common medical problem associated with constipation.
• Alterations in electrolytes levels, such as calcium or potassium, can changes bowel habits.
• Although other symptoms of lead poisoning will be more obvious, children with chronic lead exposure may have constipation.
• Cystic fibrosis, for many reasons, causes constipation in children by many mechanisms.
• Children with disorders of the nervous system (such as cerebral palsy, mental retardation, or spinal cord problems) display a high rate of constipation because they spend prolonged time in one position, experience abnormal colon movement, or lack coordination in moving their bowels.

* Some medications can make children more likely to be constipated. Common contributors include over-the-counter cold medications and antacids. Antidepressants, anticonvulsants, chemotherapy medications, or narcotic pain medications (such as codeine) can also constipate.
* Other possible causes of constipation are depression, coercive toilet training, attention deficit disorders, and sexual abuse.

Constipation in Children Symptoms

Generally, if a child has fewer than three bowel movements per week and they are hard and difficult to pass, he or she may have constipation.

* Children often exhibit characteristic behaviors while trying to keep from having a bowel movement.

• Infants having painful bowel movements may extend their legs and squeeze their anal and buttock muscles to prevent passage of stool.
• Toddlers often rise up on their toes, rock back and forth, and hold their legs and buttocks stiffly.

* Some medications can make children more likely to be constipated. Common contributors include over-the-counter cold medications and antacids. Antidepressants, anticonvulsants, chemotherapy medications, or narcotic pain medications (such as codeine) can also constipate.

* Other signs that children are constipated are these:

• Vague abdominal pain around the navel (belly button) or even severe attacks of abdominal pain
• Decreased appetite, nausea, or vomiting
• Urinary incontinence, frequent urination, or bedwetting
• Reappearing urinary tract infections

Constipation in Children Treatment Self-Care at Home

A few important steps at home can keep constipation from becoming a continuous problem:

* Positive reinforcement is the first step in giving children the desire to begin regulation of their bowels. It is important to remove any negative thoughts about being constipated, especially if fecal soiling is present.
* Bowel retraining is the next step. The body has a natural reflex called the gastrocolonic reflex. After a meal, the colon undergoes peristalsis and attempts to clear the bowels. Have your child take advantage of the gastrocolonic reflex after each meal. Have him or her sit on the toilet for at least 10 minutes. It is often easier for the child if the feet are on the floor or on a footstool.
* Give your child plenty of fluids and juices, such as prune juice.
* A well-balanced meal consisting of whole bran cereals, fruits, and vegetables with less candy and dessert also helps.

Medical Treatment

Treatment usually consists of educating parents about the cause of the constipation. It is important for the doctor to reassure parents that it is neither their fault nor the child’s and that nothing is psychologically wrong. If fecal soiling is present, negative attitudes about the condition need to be removed.

* Treatment can begin after education. If a child has a large amount of hard stool present in the colon, disimpaction will need to be done. In other words, the stool needs to be removed. This is done using either oral or rectal medications, or a combination of both. The type of medication used also depends on the child’s age and exact problem.
* After disimpaction, preventing the reaccumulation of hard stools is the key to maintaining good bowel habits. This usually has to be done with long-term medication.

Prevention

To prevent constipation from returning, the child should make changes in behavior, diet, and fluid intake.

* Long-term use of laxatives may be indicated for several months or up to a full year.
* Regular toilet habits have to be started after each meal to take advantage of the body’s normal urge to empty the bowel.
* Continued use of positive reinforcement with verbal or other rewards or both often contributes to long-term bowel success.

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