Constipation in Children

Some medications can make children more likely to be constipated.

• Constipation describes the infrequent passage of stools (bowel movements) or the passage of hard stools. Any definition of constipation depends upon comparison with how often the child normally passes stools and with the usual consistency of his or her stools.
• Constipation occurs commonly in children. Still, not many parents seek advice from their Pediatrician or another doctor for this constipation in children. 
• Examples of causes of constipation in infants and children are;
  • Hirschsprung's disease,
  • hypothyroidism,
  • nervous system problems, and
  • lead poisoning.
• A child usually has constipation if he or she has less than three bowel movements per week, and the stools are hard to pass and are painful. 
• Children often exhibit characteristic behaviors while trying to keep from having a bowel movement. 
• Toddlers often rise 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 to constipation in toddlers and children include; 
  • over-the-counter cold medications and antacid,  
  • antidepressants, 
  • anticonvulsants, 
  • chemotherapy medications, and
  • narcotic pain medications (such as codeine).
• Other signs that toddlers and children are constipated are;
  • vague abdominal 
  • pain around the navel (belly button),
  • severe attacks of abdominal pain, 
  • decreased appetite, 
  • nausea, or vomiting, 
  • urinary incontinence, 
  • frequent urination, or bedwetting, and 
  • reappearing urinary tract infections.
• Natural home remedies that help relieve pain and constipation are;
  • to make them drink plenty of water, 
  • add two tablespoons of baking soda to a warm bath and have you child relax in the tub, and
  • apply a moist, warm cloth to the anus.

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

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

1. Infants having painful bowel movements may extend their legs and squeeze their anal and buttock muscles to prevent passage of stool.
2. 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;

1. Over-the-counter cold medications and antacids.
2. Antidepressants.
3. Anticonvulsants. 
4. Chemotherapy medications.
5. Narcotic pain medications (such as codeine) can also constipate.

Other signs that children are constipated include:

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

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. Most 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.

Examples of medical disorders that can cause chronic constipation.

Hypothyroidism (reduced 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.

Hirschsprung's disease. 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's 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.

Blood mineral and electrolyte levels. Blood mineral and electrolyte levels/Alterations in blood mineral and electrolyte levels (especially calcium and potassium) can change the bowel habits.

Lead Poisoning. Although other symptoms of lead poisoning should be more obvious, children with chronic lead exposure may have constipation.

Cystic fibrosis. 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.

Many other things can contribute your baby or child getting constipated.

• The most common cause in a child older than 18 months is a 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, becoming bedridden, eating less, or dehydration may decrease the frequency of stools or may harden stools.
• 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 constipation.
• Other possible causes of constipation are depression, coercive toilet training, attention deficit disorders, and sexual abuse.

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 or apple juice.
• A well-balanced meal consisting of whole bran cereals, fruits, and vegetables (with less candy and dessert) also helps.

If none of the home care measures is working, call the doctor. He or she may prescribe a laxative. The type of laxative depends on the age of the child and the exact problem. You may need to make an appointment with a doctor.

If the child has significant abdominal pain, nausea, vomiting, decreased appetite, fever, or bloody diarrhea, he or she needs to see a doctor immediately. Many of these symptoms can be related to constipation. Some symptoms can indicate a serious medical condition.

A health care practitioner will perform an examination to assess the child's general appearance and growth. The health care practitioner will look for signs of diseases that may cause constipation. Close attention to the abdominal exam may reveal distention, tenderness, or hard stool that can be felt. Anal inspection will be performed to check for problems. The health care practitioner may perform a digital rectal exam with his or her finger to check for hard stool in the rectum or to see if the rectum is dilated. The stool may need to be tested for blood. Usually no diagnostic tests or X-rays have to be performed if the history and exam suggest constipation. Sometimes an abdominal radiograph (X-ray) is obtained and shows stool in the colon. If a medical problem is suspected as the cause of constipation, blood tests or other abdominal imaging studies may need to be performed.

The most useful tool the doctor can use to diagnose constipation is the history given by the parents. A doctor needs to know are:

• What is meant when parents use the term constipation and how long has the condition been present?
• What is the size and consistency of the stools?
• How frequent are the bowel movements?
• Is pain present with stooling and is there blood present?
• Is abdominal pain a problem?
• Is there poor appetite, weight loss, or poor weight gain?
• Are episodes of fecal soiling present?
• Does the child use the bathroom at school?
• What over the counter, herbal, or prescription medications are being taken?
• What type of diet is the child on?
• After the initial diagnosis, regular scheduled visits to the doctor should be made in order to ensure that the therapy continues to work and to prevent relapses. As soon as a problem develops, call your pediatrician or other health care professional.

• Give plenty of water to the affected child.
• Try 2 to 4 ounces of half-strength pear or apple juice (diluted with water). Alternatively, add one-half ounce of table syrup to 3 ounces of warm water, then administer by mouth to soften the stool.
• Add two tablespoons of baking soda to a warm bath. Let your child relax for 5-15 minutes, soaking in the warm bath.
• Applying a warm, moist cloth to the anus can sometimes stimulate a bowel movement.
• To stimulate a bowel movement, a plastic swab tipped with cotton (Q-tip) with a small amount of Vaseline ointment can be gently inserted through the anus (not too far, just the cotton tip) and promptly removed. Your health care practitioner may prescribe a glycerin suppository for the same purpose but with greatest effect.

Chronic constipation in infants and babies usually is medically treated by educating parents or caregivers about the cause of the constipation. It is important for the doctor and other health care professionals to reassure parents that it is neither their's, nor the child's fault, and that nothing is psychologically wrong. If the baby or child has fecal soiling (an elimination disorder in children); negative attitudes about the condition need to be removed.

After parental or caregiver education about the infant or child's cause of the problem medical treatment can begin. If a child has a large amount of hard stool present in the colon the stool needs to be removed (disimpaction). This is done either using 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 the stool is removed, preventing re-accumulation of hard stools is the key to maintaining good bowel habits. This usually has to be done with long-term medication.

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

• Long-term use of laxatives for several months or up to a year may be indicated.
• 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.

Acute constipation can be corrected easily. After the dehydration or illness improves, bowel function improves.

Chronic constipation, however, often requires long-term therapy with oral medication. Most children respond to therapy and are able to discontinue medications within a year. Relapses can be common, especially if the child or parents do not follow the health care practitioner's instructions, or medical intervention is not present. If therapy fails, the child may need to see a pediatric gastroenterologist, the doctor who specializes in the stomach and intestines.