Constipation in Children:
Causes and Symptoms

Dr. Ranjit Agarwala
Pediatrics Specialist

---

Constipation in children is a very common disorder and is responsible for up to 25% of all
pediatric gastrointestinal visits and up to 3% of all pediatric outpatient visits.
90% of cases are functional (no organic cause) in origin whereas 10% have some organic cause.

Normal stool pattern parents should know

The normal frequency of bowel movements varies with age. The frequency of stool can be as frequent as one stool after every feed (8 to 10 stools per day) to almost 1-2 stools every 2-3 days in a breastfeeding child. As the child is introduced to a cereal-based diet, the frequency decreases to 1-2 stools per day at 1 year of age and then one stool every 2-3 days. But as long as the stool is soft and passage is painless it cannot be termed as constipation. To a large extent, this may depend on how effective toilet training is received by the child from the first year.

Functional factors responsible for constipation

1. Improper toilet training.
2. Childrens tendency to withhold stool, either due to laziness, or preoccupation with playing.
3. A painful experience of stool passage on earlier occasions.
4. Stress is another factor. It could be pressure on the child to get ready for school or in older children, the fear of approaching examination

What is functional constipation

To term constipation as functional certain criteria need to be fulfilled. These are:

1. Two stool or less in a week.
2. At least of one episode of incontinence (inability to control) of stool per week.
3. Abdominal pain.
4. History of stool with holding behavior.
5. Stool mass in the rectum.

How to manage constipation in children

Children with such type of constipation require timely and prompt action on the part of parents and health caregivers.

Proper toilet training

Toilet training at an age when the child is able to sit without support that is 8 to 12 months of age is very crucial so that by the time they reach school age, they are completely habituated to a set time to pass stool. Allow the child to get on the toilet for 5- 10 minutes daily in a fixed time after every meal. The child is asked to strain actively while placing his feet on the footrest, thus avoiding holding back the urge to defecate.
A great deal of patience is required by the parents to deal with toddlers as they tend to be restless and easily distractible. Parents should refrain from blaming the child for his/her bowel habits.

Disciplining the child routine

It is equally important to maintain a fixed routine for the child regarding his eating and sleeping pattern. Erratic timings of waking and sleeping also influence the gastrointestinal reflex to conform to a regular normal cycle of evacuation. Waking up late can affect the eating pattern of the child thus disturbing the normal physiological cycle.

Diet in constipation

An adequate diet with a good amount of fiber and residue can help maintain normal bowel movements. Encouraging consumption of green leafy vegetables and liberal amounts of fruits, whole grain cereals, and pulses from early years helps them to develop taste for these foods, and thus develop healthy habits.
Excess consumption of milk and milk products, processed or tinned foods need to be curtailed in the schedule of the child’s diet. Excess of milk in the diet also should be avoided as it can compensate for the solid cereal-based food intake, thereby depriving adequate fiber of the diet.
Plenty of fluids in the form of water are equally important to maintain hydration, thus helping in maintaining the motility of the gut and softening of stools.

Medical management

The adequate and right type of diet is no doubt one factor that can influence bowel habits by a good proportion of dietary fiber. Dietary fiber in therapeutic doses may not always be acceptable by the child due to its high bulk form and difficulty in consuming it, besides being non-palatable.
Therefore the use of laxatives(stool softeners) will help the child in the passage of soft stools. Fears of side effects of prolonged or recurrent use of laxatives are not founded since studies have not revealed any such evidence against them.
Parents should be reassured about the safety of such medicines used in prescribed doses only after proper consultation with a pediatrician.

The primary goal of management is aimed at:

• Providing relief to the child.
• Modifying the diet as per the age and requirement of the child.
• Education of the parents.
• Behavioral therapy and lifestyle modifications.