What is constipation?
Constipation is an abnormal pattern of bowel movements in which stools are passed less often than usual. They may be difficult to pass or harder than usual. Constipation is associated with discomfort. In more extreme cases, there may be soiling, which is called encopresis.
Everyone has a different bowel pattern. A normal frequency of stools can vary from several times a day to once every few days to a week. If your child's pattern has slowed down, he may be constipated.
Constipation can occur over days, weeks, or months. It can also occur during a change in routine such as toilet training, start of school, travel, or following a change in diet. Often the stools may appear normal, but stool builds up in the bowels over time. This build-up causes stomach cramps and pain. For children who have been constipated for a long time, training the bowel back to a normal pattern can take weeks or months.
What causes constipation?
In most children, constipation is caused by poor bowel habits or poor diet.
Some common causes of constipation are:
- not drinking enough fluids
- not enough fibre from whole grains or cereals, fruits, and vegetables in your child's diet
- too much junk food or other foods that promote constipation in your child's diet
- poor bowel habits, problems with toilet training, and sometimes refusing to spend time on the toilet. Some children may have a fear of public bathrooms. Other children simply prefer to keep playing rather than go to the bathroom when they feel the urge to have a bowel movement. Instead, they 'hold back,' causing a build-up of stool.
- pain with bowel movements from fissures (small tears) at the bowel opening (anus), causing the child to withhold stools to avoid pain
Other less common causes of constipation are:
- illnesses that cause vomiting, diarrhea, or fever and lead to a loss of body fluids and dehydration
- some medicines such as iron or codeine
- underactive thyroid gland (hypothyroidism)
- Hirschsprung's disease, a disease of the bowel that is usually diagnosed in the first few weeks of life
- infant botulism, which can occur if affected honey is given to children less than one year of age. Pasteurized honey can still be contaminated.
How to care for your child with constipation
In most children, constipation can be relieved by making diet and lifestyle changes. Once constipation starts, it can last a long time. Be patient with treatment.
Diet in children less than 1 year old
Babies under 2 months old generally do not have constipation. Talk to your child's doctor before you make any changes to your baby's milk or formula or give any medicine to treat constipation.
If your baby is under 4 months old, you may consider giving 1 ounce (30 mL) of apple or prune juice once or twice a day. You may want to consider switching to soy formula. It can sometimes lead to looser stools.
Once your baby is more than 4 months old, try giving high fibre, strained foods. These include apricots, beans, cereals, peaches, pears, peas, plums, prunes, or spinach.
Diet in children over 1 year old
Give your child plenty of fluids, especially water.
Make sure that your child eats fruits and vegetables every day. Canada's Food Guide recommends that children have 4 to 6 servings of fruits and vegetables per day. Some good examples are apples, apricots, beans, blueberries, brocolli, cabbage, cauliflower, dates, figs, lettuce, peas, pears, prunes, and raisins. Avoid any foods that could cause choking in younger children.
Take steps to increase the amount of fibre in your child's diet. Have your child eat bran every day as it is high in fibre. It is a natural stool softener. There are many sources of bran to choose from. Try bran cereals, bran muffins, whole wheat or multigrain bread, graham crackers, or oatmeal. If your child is over 4 years of age, popcorn is another great fibre source. You may also want to try mixing a natural fibre supplement like Benefibre into your child's drinks.
For more information, please see "Higher Fibre Diet."
Some foods are known to cause constipation. You may wish to limit them in your child's diet. These foods include bananas, white anything (rice, bread, pasta), peanut butter, and too much dairy. Junk food such as potato chips, candy, or pop, are also constipating.
Toilet training
Once or twice a day, right after meals, have your child spend a few minutes on the toilet or the potty. Even if there is no bowel movement, you are helping to set a pattern.
Your child should be comfortable, with the knees up. A foot rest can prevent your child's legs from hanging down. It will also keep the knees bent, which helps bowel movements pass more easily.
If you are having problems with toilet training and your child is holding back stool, you may need to delay the toilet training.
Medicines
If a change in diet does not relieve your child's constipation, talk to your child's doctor.
Your child's doctor may give a stool softener such as docusate (Colace) to use once or twice a day. Stool softeners are not addictive or habit-forming. This is in contrast to laxatives which can be habit-forming.
Mineral oil or Lansoyl jelly is often used to help stool pass more easily. If your child is under 1 year old, do not give him mineral oil. Do not give mineral oil with food, because it could affect how the body absorbs some vitamins.
Your child may also need bowel laxatives. Some laxatives such as senna, cascara, bisacodyl, or castor oil work by stimulating the bowel and are not generally recommended for children. The more usual laxatives for childrens constipation are 'osmotic' laxatives, which work by drawing water into the bowel to 'flush' out the stool. These include lactulose or sorbitol, polyethylene glycol (PEG-Lyte, PEG Flakes, PEG 3350), or PicoSalax.
Sometimes, suppositories or enemas are needed, but these should be avoided when possible.
When to call your child's doctor
Call your child's doctor if:
- your child's general health seems to be affected
- your child has blood in the stool
- your child has a fever
- your child is urinating (peeing) often, or if it is painful to urinate
- your child has a hard time passing a bowel movement after 4 days
- your child loses some bowel control or starts to soil underwear
Take your child to the nearest Emergency Department if:
- your child is having a lot of pain
- your child is vomiting (throwing up) repeatedly
- your child's abdomen (belly) becomes swollen
Key points
- Constipation means bowel movements that are fewer than usual, painful, or hard to pass.
- In most children, constipation is not caused by disease.
- Constipation can be caused by foods, poor bowel habits, fissures in the anus, medicines, or not drinking enough fluids.
- Changes in your child's diet may stop constipation.
- Your child's doctor may also suggest giving medicine.