Constipation (Child)

Bowel movement patterns vary in children. A child around age 2 will have about 2 bowel movements per day. After 4 years of age, a child may have 1 bowel movement per day.

A normal stool is soft and easy to pass. But sometimes stools become firm or hard. They are difficult to pass. They may pass less often. This is called constipation. It is common in children. Each child's bowel habits are a little different. What seems like constipation in one child may be normal in another. Symptoms of constipation can include:

• Abdominal pain.
• Refusal to eat.
• Bloating.
• Vomiting.
• Problems holding in urine or stool.
• Stool in your child's underwear.
• Painful bowel movements.
• Itching, swelling, or pain around the anus.
• Any behavior that looks like the child is trying to hold stool in, such as standing on toes, holding in abdominal muscles, or "dance like" behaviors.

Sometimes streaks of blood can occur in the stool, usually due to an anal fissure. This is a tearing of the anal lining caused by straining with constipation. However, any blood in the stool needs to be evaluated by your child's doctor.

Constipation can have many causes such as:

• Eating a diet low in fiber.
• Not drinking enough liquids.
• Lack of exercise or physical activity.
• Stress or changes in routine.
• Frequent use or misuse of laxatives.
• Ignoring the urge to have a bowel movement or delaying bowel movements.
• Medicines such as prescription pain medicine, iron, antacids, certain antidepressants, and calcium supplements.
• Less commonly, bowel blockage and bowel inflammation.
• Spinal disorders.
• Thyroid problems.
• Celiac disease.

Simple constipation is easy to stop once the cause is known. Doctors may or may not do any tests to diagnose constipation.

The first goal of therapy is to treat impacted stool. Your child's doctor may prescribe a bowel stimulant, lubricant, or suppository. Your child may also need an enema or a laxative. Follow all instructions on how and when to use these products.

You can help treat and prevent your child's constipation with some simple changes in diet and habits.

Make changes in your child's diet such as:

• Talk with your child's doctor about their milk intake. In children who don't respond to other conservative measures, your doctor may advise stopping cow's milk for 2 weeks to see if symptoms improve. If symptoms improve during this trial, you may switch to a nondairy form of milk. This is likely a form of milk allergy rather than true constipation.
• Make sure your child is eating enough fiber. Children get an adequate amount of fiber with 5 servings of fruits and vegetables.
• Encourage an increase in your child's activity or exercise level. Exercise with your child to increase their enjoyment.
• Make sure your child eats less meat and processed foods.
• Make sure your child drinks plenty of water. Certain fruit juices, such as orange, pear, prune, and apple, can be helpful but should be limited. While they may contain some vitamins fruit juices are high in sugar and low in healthy fiber found in whole foods. The American Academy of Pediatrics recommends no juice for children under 1 year of age. Children age 1 to 3 should have no more than 4 ounces of juice per day. Children 4 to 6 should have no more than 4 to 6 ounces of juice per day. Children 7 to 18 should have no more than 8 ounces (1 cup) of juice per day.
• Be patient and make diet changes over time. Most children can be fussy about food. Don't shame or punish your child. Frame the situation as a challenge you will manage as a team, not as a problem that is the child's "fault."

Help your child have good toilet habits. Make sure to:

• Teach your child not to wait to have a bowel movement.
• Have your child sit on the toilet for 10 minutes at the same time each day. It is helpful to have your child sit after each meal. This helps to create a routine.
• Give your child a comfortable child's toilet seat and a footstool.
• You can read or keep your child company to make it a positive experience.

Follow up with your child's doctor as advised.

Learn to be familiar with your child's normal bowel pattern. Note the color, form, and frequency of stools. Laxatives can be dangerous to children. Never give your child laxatives or enemas unless your child's doctor says it's okay to do so.

Contact your doctor or get medical care right away if any of these occur:

• Abdominal pain that gets worse
• Fussiness or crying that can't be soothed
• Refusal to drink or eat
• Blood in stool
• Black, tarry stool
• Constipation that does not get better
• Weight loss
• Symptoms get worse or your child has new symptoms