Constipation in Children

How can I tell whether my child is constipated?

Don't gauge it by how many trips your child makes to the toilet. Some children need to move their bowels twice a day; others go only once every two or three days. Unless four or more days have passed since your child's last bowel movement, you probably don't need to worry. The important thing is how easily he goes, not how often. If he has large or hard stools that cause him discomfort, he is constipated and needs your help.

A single uncomfortable bowel movement can make your child anxious about using the bathroom, and that's where the trouble starts. Some kids begin to put off bowel movements as long as possible. Others may use the toilet every day, but not take enough time to completely empty their lower colon. Either way, feces can build up in the colon, causing it to stretch and leading to painful cramping. An enlarged colon can lead to larger-than-normal stools, possibly big enough to clog the toilet. Heavily soiled underwear can be another sign of constipation: Liquid stools can slip past the blockage in the lower intestine and catch a child by surprise.

You may also notice some changes at the dinner table. If your child is constipated, he may often have a small appetite or not eat much at a single sitting. In addition, his appetite may soar after a large bowel movement, then quickly fade.

What causes constipation?

Many factors can set the process in motion. If your child fights the urge to defecate -- because he doesn't like using the toilets at school, for example -- there's a good chance his stools will become large and hard. Dehydration, which often follows a bout of diarrhea or other illness, can also harden stools. And while diet alone usually doesn't cause constipation, a regimen of high-fat, low-fiber food (including many snack foods and pastries) can definitely make it worse. Regularly eating lots of dairy products, especially cheese, can also contribute to constipation.

In rare cases, constipation is a sign of an underactive thyroid or lead poisoning. Your pediatrician should check for these and other possible disorders if your child's constipation is a near-constant problem.

How can I treat it?

Most cases of constipation are easily treated at home. You can soften your child's stools by giving him prune juice and making sure he drinks plenty of other liquids. Exercise and frequent servings of whole wheat bread, bran cereals, oatmeal, fruits, vegetables, popcorn (for older children), and other high-fiber foods will help as well. Avoid or limit cooked carrots and squash as well as large quantities of dairy products such as cheese, yogurt, and ice cream.

You may also need to encourage him to use the bathroom as soon as he feels the urge to defecate. If he still has trouble, suggest that he spend five or 10 minutes on the toilet after every breakfast and dinner -- he might just fall into a new and healthy routine. Talk to him about spending time on the toilet in a matter-of-fact way, never in anger, so that he'll feel relaxed about the procedure.

Although stool softeners and some laxatives such as Metamucil are generally safe and effective in small doses, most children can get relief without these drugs. If a doctor recommends them for your child, use them with confidence. Otherwise, skip them. And don't give your child a suppository or an enema unless his pediatrician says it's a good idea.

When does my child need a doctor?

Call your pediatrician if:

• You are worried about your child.
• Your child has gone more than four days without a bowel movement.
• His constipation has lasted more two or three weeks.
• He's soiling his clothes.
• The problem is interfering with his normal activities.

Your child's doctor can determine the cause of the constipation and help you develop a strategy for relief. He may recommend further diet or behavior changes, or prescribe laxatives or stool softeners.

If your child feels severe pain during bowel movements or if there's blood in his stool, he may have a small tear in the membrane of his anus. Although this kind of tear, called an anal fissure, will eventually heal on its own, a doctor can speed the process with stool-softening medications.

And remember: Constipation may just be a signal that your child needs more exercise as well as more fiber and water in his diet.

Further Resources

Pantell, Robert H. M.D., James F. Fries M.D., and Donald M. Vickery M.D. Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care, Eighth Edition. Da Capo Lifelong Books.

References

Stephen M. Borowitz, Chronic Constipation and Encopresis in Children, Children's Medical Center, University of Virginia:

Nemours Foundation, KidsHealth.org. Constipation. http://kidshealth.org/parent/general/sick/constipation.html