Constipation in children

Constipation is a common problem in children. It is characterized by less frequent bowel movements and stools that are difficult to pass.

Certain criteria are used to detect constipation in children. A minimum of 2 of these criteria must be present at least once a week over a one month period:

• 2 or fewer bowel movements per week
• A history of withholding bowel movements (child holds in their bowel movements)
• A history of painful or difficult bowel movements
• Presence of a fecal mass in the child's rectum

In addition, if the child is potty trained:

• A history of large stools that have blocked the toilet
• Fecal incontinence (involuntary soiling)

It's important to note that bowel movement frequency is not the same for all children. It can also vary according to the child's age and the type of food they eat.

Causes and triggers

Children are at greater risk of developing constipation during the following life stages and situations:

• Dietary changes, especially when solid foods are being introduced
• Potty training
• Stressful events such as starting school or the birth of a sibling

Keep in mind that the iron contained in commercial infant formula does not cause constipation. However, not getting enough fluid or fibre can contribute to constipation.

The child may also hold their stool voluntarily, because passing it is painful. This can lead to a vicious cycle as holding in bowel movements results in harder and bulkier stools, which are even more painful to evacuate.

The accumulation of stools that a child has held in can also form a hard stool plug. New stool may flow around the plug and find its way into the child's diaper or underwear. This is called fecal incontinence. Fecal incontinence is sometimes confused with diarrhea.

More rarely, certain health problems may explain constipation in children. However, constipation is less likely to be due to a health problem if it starts during one of the high-risk periods mentioned above.

Treatment

Treatment of constipation in children depends on their age and the cause. For children who do not have a health problem, dietary changes are the first step. Here are a few tips:

• For babies under 6 months old who are solely nursing (breast milk or commercial formula), make sure they are drinking enough.
• For children who are fed commercial infant formulas, be sure to follow the preparation method on the package.
• For children over 6 months, feed them high-fibre foods (prunes, apples, pears, vegetables, legumes, and whole grain cereals).
• For children over 6 months, give them water in addition to the milk they drink, especially if they eat high-fibre foods.
• Get your child moving. If your child is not yet walking, gently move their legs as if they were riding a bicycle 3 to 4 times a day. You can also gently massage their belly in a clockwise direction.

If these measures do not work, consult your health care provider. An evaluation may be necessary and a medication such as a laxative may be recommended.

When should I see a health care professional?

You should consult your health care provider if your child is showing signs of constipation in the following cases:

• They are under than 4 months old
• They are eating less or not gaining enough weight
• They have blood in their stool
• They have very bad stomach aches
• They are vomiting
• They have not had a bowel movement for more than a week despite taking medication