Health Education

Constipation in children is a common problem. A constipated child has infrequent bowel movements or hard, dry stools.

Common causes include early toilet training and changes in diet. Fortunately, most cases of constipation in children are temporary.

Symptoms

Signs and symptoms of constipation in children may include:

- Less than three bowel movements per week

- Hard, dry and difficult to pass

- Pain while having a bowel movement

- Abdominal pain

- Traces of liquid or clay-like stool in your child's underwear — a sign that stool is backed up in the rectum

- Blood on the surface of hard stool

If your child fears that having a bowel movement will hurt, he or she may try to avoid it. You may notice your child crossing his or her legs, clenching his or her buttocks, twisting his or her body, or making faces when attempting to hold stool.

When to see a doctor

Constipation in children usually isn't serious. However, chronic constipation may lead to complications or signal an underlying condition. Take your child to a doctor if the constipation lasts longer than two weeks or is accompanied by:

- Fever

- Vomiting

- Blood in the stool

- Abdominal swelling

- Weight loss

- Painful tears in the skin around the anus (anal fissures)

- Intestinal protrusion out of the anus (rectal prolapse)

Causes:

Many factors can contribute to constipation in children, including:

- Toilet training issues. If you begin toilet training too soon, your child may rebel and hold in stool.

- Withholding. Your child may ignore the urge to have a bowel movement because he or she is afraid of the toilet or doesn't want to take a break from play. Some children withhold when they're away from home because they're uncomfortable using public toilets. Painful bowel movements caused by large, hard stools also may lead to withholding. If it hurts to poop, your child may try to avoid a repeat of the distressing experience.

- Diet changes. Not enough fiber-rich fruits and vegetables or fluid in your child's diet may cause constipation. One of the more common times for children to become constipated is when they're switching from an all-liquid diet to one that includes solid foods.

- Changes in routine. Any changes in your child's routine — such as travel, hot weather or stress — can affect bowel function. Children are also more likely to experience constipation when they first start school outside of the home.

- Medications. Certain antidepressants and various other drugs can contribute to constipation.

- Cow's milk allergy. An allergy to cow's milk or consuming too many dairy products (cheese and cow's milk) sometimes leads to constipation.

- Family history. Children who have family members who have experienced constipation are more likely to develop constipation. This may be due to shared genetic or environmental factors.

- Medical conditions. Rarely, constipation in children indicates an anatomic malformation, a metabolic or digestive system problem, or another underlying condition.

Prevention

To help prevent constipation in children:

- Offer your child high-fiber foods. Serve your child more high-fiber foods, such as fruits, vegetables, beans, and whole-grain cereals and breads. If your child isn't used to a high-fiber diet, start by adding just several grams of fiber a day to prevent gas and bloating.

- Encourage your child to drink plenty of fluids. Water is often the best.

- Promote physical activity. Regular physical activity helps stimulate normal bowel function.

- Create a toilet routine. Regularly set aside time after meals for your child to use the toilet. If necessary, provide a footstool so that your child is comfortable sitting on the toilet and has enough leverage to release a stool.

- Remind your child to heed nature's call. Some children get so wrapped up in in play that they ignore the urge to have a bowel movement. If such delays occur often, they can contribute to constipation.

- Review medications. If your child is taking a medication that causes constipation, ask his or her doctor about other options.