What is Constipation?
Constipation can have many different definitions. These include a decrease in frequency of bowel movements compared to a child's usual stooling pattern, having difficulty and/or pain pushing out a bowel movement, and passing hard, dry stools.
Constipation can be caused by several different factors including poor diet and lack of exercise. Emotional issues can also play a role, such as stress over toilet-training, starting a new school year, or a major family event (e.g. a new baby, divorce, or death in the family). Other factors that can contribute to constipation include when children are so involved in whatever they are doing that they ignore the signals their body is sending them and forget to use the bathroom, as well as school restrictions on what times of the day children are allowed to use the bathroom, so even if a child feels the urge he has to suppress it because he is not allowed to use the bathroom at that time.
In addition, constipation can be caused by many medical conditions, such as abnormalities of the intestinal tract, hypothyroidism, and nervous system disorders, as well as medications, such as iron and certain pain medicines.
Warning Signs
You should always call your pediatrician if your child has any of the following warning signs or if you have any questions or concerns.
* Age younger than 6 months old
* Pre-existing medical conditions and/or medication use
* Blood in the stool
* Abdominal pain, vomiting, or decreased appetite
* Hemorrhoids or small tears around the anus
* Leakage of liquid stool
* Episodes lasting longer than 3 weeks
* Interference with normal activities
Treatment for Constipation
The treatment for constipation depends on your child's age and developmental level, how long he has been constipated and the severity of the condition, and his overall health and other medical conditions, including any medications he may be taking. If you have a healthy child with occasional constipation and without any of the warning signs above, you may try some of the measures below. If your child's constipation does not get better or you have any concerns, you should always call your pediatrician. Do not give any laxatives, suppositories, or enemas without checking with your pediatrician first.
Treatment for constipation can include dietary changes, exercise, good bowel habits, and medications. A child's diet plays a large role in his stool pattern; please see below for diet recommendations to improve bowel habits. Exercise helps with digestion by stimulating movement of the intestines and pushing food forward during the digestion process, so active children and adults are less likely to be constipated than those who are more sedentary.
Good bowel habits are very important for preventing constipation. For young children who are being toilet-trained, it is important that your child is ready for the training process. Otherwise, toddlers who are not ready for toilet-training but who are pressured to do so will often withhold stool and become constipated, which makes toilet-training even more difficult. If you child seems anxious or reluctant about using the potty, it might be best to wait for a few months until he or she gives you signs that he is ready to use the potty. If you have any questions about toilet-training, you should ask your pediatrician or consult one of the recommended websites or books for suggestions.
For children that are toilet-trained, encourage good bowel habits by having them sit on the toilet twice a day for about 10 minutes at a time a few minutes after a meal. Make this a pleasant time by having books or games available, and do not become upset if your child does not have a bowel movement during this time or does not want to stay on the toilet. For young children, sticker charts or other small rewards can help motivate and encourage your child to maintain good bowel habits.
School-age children often are unwilling to use the bathroom at their school or other places outside your home. Talk to your child about this issue and what his specific concerns are and encourage him to use the bathroom when he feels the urge to go. You may also need to speak to your child's school to see if there are any barriers to his being able to use the bathroom when he needs to (e.g. some schools only allow children to go to the bathroom at certain times of the day, such as at lunch) and to discuss solutions to these problems on an individual basis. Breakfast can often stimulate a bowel movement, so make sure your child eats breakfast every day and that there is enough time between breakfast and going to school for him to use the bathroom.
Dietary Changes for Constipation
Improving your child's nutrition can often help with constipation. It is best to make dietary changes for the family as a whole rather than focusing on one individual, not only because your child will be more likely to change his habits if everybody around him is doing the same, but in addition, the whole family will benefit from improved nutrition.
Strive for 5 servings of fruits and vegetables a day. Fruits such as pears, prunes, grapes, raisins, and apples with the peel are especially effective in helping with constipation. Fruit juices such as apple, pear, or prune will also help; however, in general juice should be limited to no more than 4-6 ounces a day for children under 2 and 8-12 ounces a day for older children and adults. Bananas may make constipation worse, so try to limit them to 1 or 2 a week.
Increase the amount of whole grains in your child's diet. Check the nutritional information on food packages to find foods with more fiber as well as looking at the ingredient label (e.g. make sure the first ingredient is "whole wheat flour", not "wheat flour"). Specific suggestions include replacing white bread with whole wheat bread, white rice with brown rice, regular pasta with whole grain pasta, and regular muffins with bran muffins.
Encourage your child to drink plenty of water. Avoid soft drinks and caffeinated beverages such as coffee or tea.
Dairy products can be constipating; however, the effect on bowel patterns has to be balanced with the importance of adequate calcium intake. In general, 3 servings a day of calcium-rich foods are encouraged, but if your child is eating or drinking more than 3 servings a day, this could be contributing to his constipation and there may be room to cut back. You should discuss your child's dairy intake with your pediatrician if you have any questions about whether it could be making his constipation worse or if he is getting sufficient calcium in his diet.
Limit the amount of fast food, other foods high in fat such as fried foods, and highly processed foods that your child eats.
Try to serve meals on a regular schedule from day to day, whether at home or while traveling.
Remember, you should always call your pediatrician if your child has any of the warning signs above, you have any questions or concerns, or if your child's condition does not improve with the above treatment recommendations.
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