Symptoms of Constipation in Children
A child is considered constipated when having a bowel movements with difficulty or less than three times a week. Having hard and dry stool, or having a bowel movement every other day and without difficulty is not already considered constipation.
Constipation is called chronic when it lasts for more than two weeks.
An infant is considered constipated when straining at defecation and having less than one bowel movement in a week..
Symptoms of constipation may include:
- No bowel movements for several days
- Hard and dry pebbly stool that is hard to pass, bright red blood on the surface of the stool
- Poor appetite, nausea
- Abdominal pain or bloating
Common Causes of Chronic Constipation in Children
1. Psychological Factors
- A child can react to early or forced toiled training by withholding the stool.
- Anxiety or depression slows down bowel motility resulting in constipation. Over-demanding parents and emotional problems with peers may be the cause.
- A child can deliberately hold the stool back as the way of protest or to express the need for attention.
- Children, mainly adolescent girls, with anorexia nervosa or bulimia are usually also constipated. Constipation may persist even after the eating disorder is treated.
- In children who were sexually abused, a paradoxical action of the anal sphincter may occur: when a child tries to push the stool out, the anus closes.
- Anismus (dyschezia) is a an inability to relax external anal sphincter after pelvic floor muscles relaxation. This might be provoked by “laboratory environment” where an investigation is made, so it is uncertain if this is the real cause of constipation.
If causes of psychological stress persist, a child will hardly overcome constipation without the help of the experienced and caring advisor.
2. Bowel Evacuation Habit
Children often neglect the urge to defecate, because they do not want to leave a game, or are embarrassed to use the toilet outside of home. They may not take due time to have a bowel movement in the morning and then hold it back during the day. This way the colon muscles slowly stop to respond to presence of the stool in the rectum and lose their tone.
Parents can instruct their children to use the toilet for 5 to 10 minutes shortly after breakfast, because food in the stomach triggers the motion of the colon (gastro-colic reflex). A child can be awarded for discipline, regardless of success achieved. Awards should not include food, but rather some desired activities, like visiting a favorite place. This type of toilet training should be avoided in 2-3 years old children because it may have just the opposite effect.
3. Diet: Insufficient Fluid Intake and Lack of Dietary Fiber
Foods that may cause constipation and are popular among children: pizza, hamburger, eggs and bacon, pastries, crackers, potato chips, cheese, peanut butter, ice cream, chocolate, sweets, green (unripe) bananas. Diet based on white bread or pasta, white rice, pommes frites and fried meat can also be constipating. Constipating drinks include caffeinated soda, energy drinks, milk and alcohol.
A constipated child does not need to avoid all abovementioned foods, but eat them in limited amount and in combination with foods and drinks that may relieve constipation:
- Breakfast: whole grain bread or bread with seeds, morning cereals, oatmeal or cornmeal, herbal tea (without caffeine and teine), fruit juice without added sugar, unsweetened milk (NOTE: milk can be constipating for some children)
- Lunch: vegetable sandwich, orange, grapefruit, apple
- Dinner: cooked potatoes, wholegrain pasta, or pasta with vegetables, brown rice, roasted fish, chicken without skin, vegetable soup, vegetable sauce, foods from beans, peas or other legumes, salad
- Snack: cereal bar, wholegrain crackers
- Supper: oatmeal, cornmeal, milk
- Drinks: plain water, mineral water, herbal tea, fruit or vegetable juice
Foods high in fiber should be introduced slowly and without forcing. A child should not have a feeling of being on a diet, and all food changes have to be clearly explained.
4. Intestinal Parasites
Even children from developed countries can contractintestinal parasites; main symptoms include:
- Abdominal pain or cramps
- Diarrhea or constipation
- Distended abdomen
- Mucus or blood in the stool
- Itchy skin
- Anemia (tiredness and paleness)
Diagnosis can be made by a stool test for ova and parasites (O&P); treatment is by prescribed anti-parasitic medications.
5. Celiac Disease
Children with celiac disease may have various non-characteristic symptoms:
- Diarrhea, constipation, abdominal bloating, excessive gas
- Growth delay, weight loss
- Tiredness, brain fog
- Paleness, itchy or non-itchy rash
Symptoms usually resolve after introducing a strict gluten-free diet (no wheat, barley, rye).
6. Diabetes Mellitus Type 1
Diabetes mellitus type 1 may occur at any age, often between the age of 6 and 13. Typical symptoms may include:
- Excessive thirst
- Excessive urination
- Constipation (due to dehydration)
- Weight loss
- Acetone breath smell
Treatment with sugar lowering medications or insulin is usually required. Drinking enough water is needed to prevent dehydration and constipation.
7. Chronic Diseases
Any chronic health condition, like hypothyroidism, kidney failure or other can cause constipation.
Antidepressants, painkillers, antacids or other medications can be constipating.
Rare Causes of Chronic Constipation in Children
- Spinal cord injury or abnormality can result in urinary retention, loss of defecating reflex, paralysis and loss of sensations in the legs.
- In juvenile polyposis syndrome (JPS), non-cancerous polyps appear in the digestive tract, mostly in the colon. Symptoms of this hereditary condition may include abdominal pain, constipation or diarrhea, mucus or blood in the stool and anemia (paleness and tiredness). Diagnosis is with colonoscopy during which the polyps can be removed.
- In cystic fibrosis, salivary glands, and glands in the respiratory and digestive system excrete excessive amount of thick mucus resulting in diarrhea, constipation, mucus in the stool, frequent respiratory infections, or death (often before the age of 30).
- In Hirschsprung’s disease, a nervous network in the wall of the last part of the colon is missing, resulting in progressive widening of the colon – megacolon. As a result, diarrhea or constipation may appear in childhood or early adulthood. Diagnosis can be made by X-ray with barium enema and histological examination of the sample of colonic tissue obtained during sigmoidoscopy. Sometimes a surgical removal of the affected part of the colon is required.
- Distended colon (megacolon) can also appear after severe amebiasis or other infection of the colon.
Short-Term (Acute) Constipation
- During any disease or after an injury, a child can be temporarily constipated because of inactivity (bed rest), pain, stress, change in diet, skipping meals, change of environment (in hospital), and various medications.
- Stress, like travel or hot weather can be constipating.
Complications of Chronic Constipations in Children
Constipation itself is usually not a serious condition in children. Constant straining at defecation may result in anal cracks (anal fissure) that have to be checked by a doctor. Hardened stool may stuck in the colon (fecal impaction) and rarely an enema is required to empty the colon.
General Rules About Treatment of Constipation in Children
- The cause of constipation has to be identified and treated if possible.
- Next, diet with sufficient amount of fluid and dietary fiber should be tried. A child should not be forced by any food, since this can have just the opposite effect.
- Usually there is no need for ‘herbal remedies for constipation’, since most of substances from these remedies can be found in a regular food (cereals, fruits and vegetables).
- A massage of the child’s abdomen may promote bowel activity
- Laxatives can be tried only when the diet has not helped and only with a doctor approval.