What is constipation in children?
Constipation is when a child is unable to go to have a bowel motion regularly or has a hard bowel movement. There is a lot of variation in the firmness and frequency of bowel movements in children, and it’s important to know what each type indicates.
- Babies who are breastfeeding may have a bowel motion after each feed or one every seven to ten days.
- Bottle-fed babies and children tend to have a bowel movement every two to three days.
You should only worry about the frequency or firmness of your child’s bowel movement if it seems to be a problem. Constipation tends to be a problem in children, especially when toilet training begins or after a frightening or painful bowel movement. Learning how our bodies work takes some time, and bowel motions are an important part of this.
Signs and symptoms of constipation
Some of the things constipation can cause are:
- Your child may be less hungry than usual
- Irritable behaviour
- Stomach cramps
- Anal fissure – can cause pain and bleeding
- Holding on – avoiding making a bowel movement
- Hard lumps of faeces may be felt when pressing on the abdomen
If your child has constipation for a long time it can result in them soiling themselves. Their bottom may become stretched if they hold onto their poo for a long time. Your child may not get the urge to go to the toilet, as they always feel stretched, which means the faeces can pass into their pants without them knowing.
The cause of constipation
There are many things that can cause constipation, including:
- Poor bowel habits
- ‘Holding on’ behaviour
- Natural tendencies
- Changes in environment
- Diet and low water intake (dehydration)
- Anal fissure
Some children will ignore the urge to have a bowel motion. Young children may be too distracted by playing and will put off going to the bathroom, causing the faeces to become harder and larger.
After experiencing a frightening or painful bowel movement, a child can become scared, which causes them to hold on. Holding on will further harden the waste in the bowel, and make their next bowel movement more painful.
Some children’s constipation is caused by slow gut movement, called motility. Most children have no serious cause of constipation.
Change in environment
Situations such as new or unwanted school toilets, or being told to hold on when they have to go, can lead to constipation.
Diet and water intake
Increasing a child’s fibre and water intake may not solve their constipation problem. Some children who have a tendency to become constipated, however, may have a low fibre diet. Children who consume a lot of milk may also become constipated.
Your child may be resistant to going to the toilet if they have anal fissures, as they are very painful. A cycle can be set in which holding on makes the constipation worse and the eventual bowel movement is even more painful.
Constipation may be a result of a physical disease in a small number of children. Diseases such as spinal cord defects, certain metabolic disorders, thyroid deficiencies and the absence of nerve endings in parts of the bowel can cause constipation. These conditions are rare, but your doctor may check for them if there is a concern.
Any treatment for constipation should continue for long enough to allow the size and sensation in the bowel to return to normal. Treatments should include:
- Healthy bowel habits
- Removing frightening elements
- A healthy diet and plenty of water
Healthy bowel habits
It is very important to develop a regular habit of sitting on the toilet for children with constipation. They should be there for three to five minutes after every meal, even if they don’t have the urge to go. You should provide them with a book and a footstool – to help them feel secure, and using a kitchen timer can help avoid argument about the length of time your child has been sitting.
Using stickers, a rewards chart or other creative options can help encourage good behaviours such as sitting on and using the toilet. Children should learn to recognise and respond to their body’s urge to have a bowel motion.
Removing frightening elements to the toilet
Many young children worry about falling in the toilet which can be helped by using a footstool or railing.
Finding out if your child is scared of a particular bathroom (such as the ones at school) means you can see if anything can be done to make them more confident in that environment.
If your child has had a particularly bad bowel movement, it can cause them to hold on to avoid the pain. Using a laxative to soften the poo can help your child feel more comfortable, allow easy passage of faeces,and provide the time needed for anal fissures to heal.
A healthy diet
It is important to give your child adequate fibre to prevent constipation for those who have a natural tendency. You can add more fibre to your child’s diet by giving them:
- At least two servings of fruit a day – fruit that still has the peel on has a lot of fibre, with apples being one of the highest fibre fruits (especially if it is allowed to brown slightly – this results in more pectin developing)
- A minimum of three serving of vegetables a day
- Less processed cereals – avoid refined cereals and opt for wholegrains that have their fibrous husk left on or re-added during processing
- Wholemeal bread
Reducing your child’s intake of milk to a maximum of 500ml a day for children over 18 months and avoiding sweet drinks before meals can help improve their appetite at mealtimes, stimulating proper digestion.
Managing constipated babies and infants
If you are concerned that your baby is constipated you should consult your family doctor. Some babies may need to have their formula changed. Babies over six months of age may need to have their fruit and vegetable intake increased. You can give the strained, stewed apricots or prunes three times a week and prune juice diluted by water.
Use of laxatives
If your child is constipated you may need to give them laxatives. If you find laxatives don’t work or are needed more than a few times a year you should consult your family doctor. Children who have been constipated for a long time are likely to need laxatives for several months.
Prune juice can work as a mild, natural laxative in some children. Prune juice may need to be mixed with another juice to make it taste better.
Things to remember when dealing with constipation in children
Some of the most important things to remember when your child has constipation are:
- There are a lot of differences in the frequency and firmness of faeces in normal children
- You should only worry about the frequency or firmness of your child’s bowel movements if it appears to be causing a problem
- Constipation can cause irritability, reduced appetite and stomach cramps
- Diet is not as important as treatment of constipation in children
- Constipation can normally be controlled with medication, diet and good bowel habits
- You should see your doctor if you need to give your child laxatives more than a few times a year.