Digestive health centre

Constipation in children

Constipation in children overview

Constipation is a common problem in children. It occurs in up to 10%, although only 3% of parents actually seek advice from their GP. Constipation is generally described as the infrequent passage of stools (bowel movements) or the passage of hard stools. Any definition of constipation depends on how often the child normally passes stools and the normal consistency of his or her stools.

For some children, it may be normal to pass stools as far apart as every few days. But 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 from adults because patterns of bowel movements change from the time they are born until they are age 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 the avoidance of going to the toilet for various reasons. For example, toddlers are often too involved in their play and lack the time or patience for toilet breaks.
• At school they may be concerned with lack of privacy or cleanliness of the toilet.
• They may have had a prior painful or frightening experience that makes them want to avoid going to the toilet. Over time, their brain learns to ignore repeated urges by the colon to go to the toilet. As stool remains in the colon, the colon will absorb water out of the stool, making it hard and dry. This makes it even more difficult or painful to pass and causes the child to continue "holding it."
• Diet or changes in diet have been thought to have an effect on bowel habits. In adults, high-fibre diets have been shown to improve bowel function. In children, however, high-fibre diets have not been proven to improve constipation. Infants and children who eat well-balanced meals typically are not constipated.
• Breast-fed infants will generally have more stools per day. Their stools vary more in frequency when compared to bottle-fed infants. For example, breast-fed infants have anywhere between five and 40 bowel movements per week; whereas formula-fed infants have between five and 28 bowel movements per week. Also, switching the type of milk or formula a child is taking can also cause constipation.
• Teenagers and toddlers who eat a lot of sugar and desserts are also prone to difficulties in emptying their bowels.
• Any intense changes in a child, such as illnesses causing fever, a long time in bed, eating less, or dehydration may cause decreased 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. Most newborns are tested for it at birth as part of the newborn screening blood test. This condition is usually diagnosed when a baby is very young.
• True constipation in infants and children that has been present since birth may be Hirschsprung disease. This is a congenital condition that is uncommon. It is a condition in which there are no ganglion cells (a type of nerve cell) located in a segment of the colon. As a result, the colon cannot receive directions from the brain to go to the toilet properly. Most infants with Hirschsprung disease will generally have symptoms within the first few weeks of life. They may be underweight or small for their age. They may vomit and have small stools, which are described as ribbon like. Hirschsprung disease is generally more common in boys and in babies with Down’s syndrome. If Hirschsprung is suspected, your GP may refer you to a specialist (gastroenterologist) or paediatric surgeon for further tests.
• Diabetes is another common medical problem that is associated with constipation.
• Alterations of electrolytes, such as calcium or potassium, can produce changes in 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.
• Children with disorders of the nervous system such as cerebral palsy or spinal cord problems have a high rate of constipation because they have prolonged time in one position, abnormal colon movement, and lack coordination in moving their bowels.
• Medication can make children more likely to be constipated. Over-the-counter cold treatments and antacids are common causes. Antidepressants, anticonvulsants, chemotherapy medication, or narcotic pain medication, such as codeine, can contribute to the problem.
• Other possible causes of constipation are depression, coercive toilet training, attention deficit disorders, and sexual abuse.