Serving children and families with kidney disease for over 30 years
What is constipation in children?
Constipation in children is a condition in which a child has fewer than two bowel movements a week or has bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass. The child may feel bloated or have pain in the abdomen—the area between the chest and hips. Children with constipation may be unable to push all of the stool out of their body.
Constipation can be acute, which means sudden and lasting a short time, or chronic, which means lasting a long time, even years. Most constipation is acute and not dangerous. In rare cases, children can have chronic constipation.
What is the gastrointestinal (GI) tract?
The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The body digests food using the movement of muscles in the GI tract, along with the release of hormones and enzymes. Organs that make up the GI tract are the mouth, esophagus, stomach, small intestine, large intestine—which includes the appendix, cecum, colon, and rectum—and anus. The intestines are sometimes called the bowel. The last part of the GI tract—called the lower GI tract—consists of the large intestine and anus.
The large intestine absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine then changes waste from liquid to a solid matter called stool. Stool passes from the colon to the rectum. The rectum is located between the last part of the colon—called the sigmoid colon—and the anus. The rectum stores stool prior to a bowel movement. During a bowel movement, stool moves from the rectum to the anus, the opening through which stool leaves the body.
The lower GI tract
How common is constipation in children?
Constipation is quite common in children. Almost 5 percent of pediatric office visits and 25 percent of referrals to gastroenterology specialists—doctors who specialize in digestive diseases—are for constipation in children.
What causes constipation in children?
Constipation is caused by stool spending too much time in the colon. The colon absorbs too much water from the stool, making it hard and dry. Hard, dry stool is more difficult for the muscles of the rectum to push out of the body.
Common factors or disorders that lead to constipation in children are
Diets Low in Fiber
A common cause of constipation is a diet with too little fiber. Fiber is a substance in foods that comes from plants. Fiber helps stool stay soft so it moves smoothly through the colon. Liquids such as water and juice help fiber to be more effective.
Medications
Medications that can cause constipation in children include
Ignoring the Urge to Have a Bowel Movement
Children most commonly develop constipation as a result of holding in stool. As the child squeezes the muscles around the anus to prevent a bowel movement, stool is pushed back into the rectum. Eventually, the muscles in the rectum and lower colon stretch, reducing muscle tone and causing the child to retain stool. Fluid continues to be absorbed from the stool, causing the stool to become hard, dry, and difficult to pass. Children may withhold stool because they are feeling stressed about potty training, are embarrassed to use a public bathroom, do not want to interrupt playtime, or are fearful of having a painful or an unpleasant bowel movement.
Specific Diseases and Conditions
Certain diseases and conditions can delay movement of stool through the GI tract and cause constipation, including
Functional GI Disorders
Functional GI disorders are problems caused by changes in how the GI tract works. Children with a functional GI disorder have frequent symptoms; however, the GI tract does not become damaged.Functional constipation often occurs in children during one of three periods:
Functional constipation is diagnosed in children up to 4 years of age who have had at least two of the following symptoms for 1 month.
Functional constipation is diagnosed in children 4 to 18 years of age who have had at least two of the following symptoms for 2 months and do not have irritable bowel syndrome (IBS):
IBS is a functional GI disorder with symptoms that include abdominal pain or discomfort, often reported as cramping, along with diarrhea, constipation, or both.
What are the signs of constipation in children?
Signs of constipation in children include the following:
When should a child with constipation see a health care provider?
A child should see a health care provider if symptoms of constipation last for more than 2 weeks. A child should see a health care provider sooner if the child has constipation and one or more of the following symptoms that may indicate a more serious health problem:
How is the cause of constipation in children diagnosed?
To diagnose the cause of constipation in children, the health care provider takes a medical history, performs a physical exam, and may order specific tests.
Medical History
The medical history includes questions about a family history of constipation and the child’s bowel habits, dietary history, and social situations. Bowel habits include the time after birth for the first bowel movement and frequency and consistency of bowel movements. Dietary history includes what the child usually eats and drinks. Social situations that may affect bowel movements include day care attendance and toilet training. The health care provider will also ask whether the child has a disorder or is taking medication that can cause constipation.
Physical Exam
A physical exam should include feeling the child’s abdomen for swelling, tenderness, and masses and listening for bowel sounds. The health care provider may perform a rectal exam with a gloved, lubricated finger to evaluate the tone of the muscle that closes off the anus—called the anal sphincter—and to detect tenderness, obstruction, or blood. The health care provider may perform a test for blood in the stool by placing a small sample of the child’s stool on a paper card and adding a drop or two of testing solution. A color change is a sign of blood in the stool.
Diagnostic Tests
Diagnostic testing is not usually needed for children with constipation unless they do not respond to treatment. In some cases, blood may be tested to determine whether a specific disease or condition is causing the constipation. Blood drawn at a health care provider’s office or a commercial facility is sent to a lab for analysis.
An x ray of the abdomen may be performed to look for problems causing the child’s constipation. An x ray is a picture created by using radiation and recorded on film or a computer. The amount of radiation used is small. An x ray is performed at a hospital or an outpatient center by an x-ray technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging. Anesthesia is not needed. The child will lie on a table or stand during the x ray. The x-ray machine is positioned over the abdominal area. The child will hold his or her breath as the picture is taken so that the picture will not be blurry. The child may be asked to change position for additional pictures.
Other diagnostic tests performed depend on the suspected underlying cause based on the medical history and physical exam.
How is constipation in children treated?
Treatment for constipation in children may include one or more of the following:
Examples of Foods That Have Fiber
Beans, cereals, and breads
Fiber
½ cup of beans (navy, pinto, kidney, etc.), cooked
6.2–9.6 grams
½ cup of shredded wheat, ready-to-eat cereal
2.7–3.8 grams
¨÷ cup of 100% bran, ready-to-eat cereal
9.1 grams
1 small oat bran muffin
3.0 grams
1 whole-wheat English muffin
4.4 grams
Fruits
1 small apple, with skin
3.6 grams
1 medium pear, with skin
5.5 grams
½ cup of raspberries
4.0 grams
½ cup of stewed prunes
3.8 grams
Vegetables
½ cup of winter squash, cooked
2.9 grams
1 medium sweet potato, baked in skin
½ cup of green peas, cooked
3.5–4.4 grams
1 small potato, baked, with skin
½ cup of mixed vegetables, cooked
½ cup of broccoli, cooked
2.6–2.8 grams
½ cup of greens (spinach, collards, turnip greens), cooked
2.5–3.5 grams
Source: U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2010.
Eating, Diet, and Nutrition
Dietary changes to help treat constipation in children include drinking prune juice and increasing fruits and vegetables. Children should drink liquids throughout the day. A health care provider can recommend about how much a child should drink each day based on the child’s age, health, and activity level and where the child lives.
The Academy of Nutrition and Dietetics recommends that daily consumption of fiber be “age plus 5” grams for children. A 7-year-old child, for example, should get “7 plus 5,” or 12, grams of fiber a day. Children often eat too many refined and processed foods from which the natural fiber has been removed. A health care provider can help plan a diet with the appropriate amount of fiber. A list of high-fiber foods is shown below. For children prone to constipation, limiting foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, is also important.
Behavioral Changes
Older children should be encouraged to use the toilet shortly after meals to promote regular stool passage. Some children may respond well to a reward system. Children who are still in the process of toilet training may need to take a break from toilet training until the constipation resolves.
Initial treatment of constipation in children often involves a thorough cleansing of the bowel. An enema involves flushing water or laxative into the anus using a special squirt bottle.
Laxatives are medications that loosen stool and increase bowel movements. Different laxatives work in different ways. Children should take medication until their bowel habits are normal for an extended period of time and they have overcome their holding behavior. If treatment is stopped too soon, a child will likely become constipated again. Caregivers should not give children laxatives unless told to do so by a health care provider.
Oral therapies can also be used to clear out the bowel. Both enemas and oral therapies can usually be given at home as directed by a child’s health care provider. However, a child who does not respond to treatment may need to be admitted to the hospital.
What are the complications of constipation in children?
Constipation in children can lead to fecal impaction if hard stool packs the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool. The impaction should be cleared using an enema or large doses of oral laxatives for other treatments to be effective. Constipation in children can also lead to anal fissures—small tears in the anus that may cause itching, pain, or bleeding—or rectal prolapse—a condition in which the rectum slips so that it protrudes from the anus.
Points to Remember
Hope through Research
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders in children, including constipation.
Clinical trials are research studies involving people. Clinical trials look at safe and effective new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses.
Reference: National Digestive Diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/constipationchild/
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