Children experiencing constipation often face:

• A reduction in the frequency of bowel movements compared to their usual pattern. Some physicians define constipation as fewer than three bowel movements per week.
• Passage of hard, dry stools that are difficult or painful to push out.
• Hard stools can irritate or tear the lining of the anus (fissures), making bowel movements painful. This can lead to a cycle where the child avoids bowel movements, exacerbating the constipation.

What Causes Constipation in Kids?

Constipation in children can sometimes have no identifiable cause. However, common causes include:

Diet:

• Consuming high-fat, low-fiber foods (e.g., fast foods, junk foods, soft drinks).
• Not drinking enough water and liquids.

Lack of Exercise:

• Physical activity helps move digested food through the intestines.

Emotional Issues:

• Pre-school and school-aged children may feel embarrassed using public bathrooms, leading them to hold in their bowel movements.
• Toilet training can overwhelm toddlers, especially if there’s parental pressure to transition out of diapers.
• Toddlers may engage in power struggles, asserting their independence by intentionally holding in bowel movements.
• Stress at school, with friends, or within the family can contribute to constipation.

Busy Schedules:

• Children may ignore signals to have a bowel movement when they’re too busy playing.
• A new school year can disrupt a child’s bowel routine.

Once constipation sets in, a vicious cycle can develop, with hard stools causing pain and further avoidance of bowel movements. Over time, the intestine may lose its ability to sense the presence of stool.

Physical Issues:

• Abnormalities in the intestinal tract, rectum, or anus.
• Nervous system issues, such as cerebral palsy.
• Endocrine problems, such as hypothyroidism.
• Certain medications (e.g., iron supplements, narcotics like codeine).

Symptoms of Constipation in Kids

Common symptoms include:

• Not having a bowel movement for several days or passing hard, dry stools.
• Abdominal bloating, cramps, or pain.
• Decreased appetite.
• Exhibiting behaviors like clenching teeth, crossing legs, squeezing buttocks, or turning red in the face while trying to hold in a bowel movement.
• Small liquid or soft stool smears that soil the child’s underwear.

Consult your child’s physician for a diagnosis, as these symptoms may resemble other conditions.

Diagnosing Constipation

A physician will examine your child and obtain a complete medical history. Questions may include:

• When did your baby have their first stool?
• How often does your child have a bowel movement?
• Does your child complain of pain during bowel movements?
• Have you been trying to toilet train your toddler recently?
• What does your child’s diet consist of?
• Have there been any recent stressful events in your child’s life?
• How often does your child soil their pants?

Diagnostic tests might include:

• Abdominal X-ray: Evaluates the amount of stool in the large intestine.
• Barium enema: Examines the large intestine for abnormalities using a fluid called barium.
• Anorectal manometry: Measures the strength of the anus muscles, nerve reflexes, and coordination during defecation.
• Rectal biopsy: Examines rectal cells under a microscope.

Treating Constipation in Kids

Consult your child’s physician if:

• Constipation episodes last longer than three weeks.
• Constipation prevents the child from participating in normal activities.
• Normal pushing is insufficient to expel stool.
• Liquid or soft stool leaks from the anus.
• Painful tears appear around the anus.
• Hemorrhoids develop.

Treatment, determined by the physician based on various factors, may include:

Diet Changes:

• Increase the amount of fiber by adding more fruits, vegetables, and whole grain cereals and breads.
  • Good Sources of Fiber:
    • Bread: Whole wheat, granola bread, wheat bran muffins.
    • Cereal: Bran Flakes™, Raisin Bran™, Shredded Wheat™, oatmeal.
    • Vegetables: Beets, broccoli, Brussels sprouts, carrots, corn.
    • Fruits: Apples with peel, dates, papayas, mangos, oranges.
    • Meat Substitutes: Peanut butter, nuts, baked beans.
• Serve meals on a regular schedule to stimulate bowel movements.

Increase Exercise:

• Physical activity aids digestion by promoting the normal movements of the intestines.

Taking these steps can help manage and alleviate constipation in children, ensuring they maintain good digestive health. Always consult with a healthcare provider for the best course of action for your child.