Childhood constipation tends to be undertreated by primary care physicians according to research published in the journal Pediatrics.
The study looked at 119 otherwise healthy children between two and seven years of age, who came to 26 primary care physicians with the complaint of constipation. A pre-study survey of the physicians showed they believed they successfully treated more than 80% of their cases of childhood constipation. However, after two months of treatment, usually with laxatives and stool softeners, nearly 40% of the children continued to be constipated. Based on these results, Borowitz and his colleagues suggest earlier and more aggressive intervention of childhood constipation before it becomes a persistent condition.
Constipation in children is a common problem
The researchers say 3% of visits to paediatricians are regarding constipation. Others sources say the prevalence of childhood constipation may be as high as 28% but only a smaller percentage actually seek medical help. This may be because some parents may not realize there is a problem. One reason is that older children may be embarrassed to speak to their parents about being constipated. Another reason is that there is a wide range of frequency of bowel movements that is considered normal. However, a general established standard is three bowel movements per day for infants, reducing to one bowel movement per day by four years of age.
This study defined constipation as less than seven bowel movements over a course of two weeks, but factors like hard stools and painful motion are also involved. After several days of no bowel movement, other symptoms such as stomach cramps and distension, decreased appetite, fecal soiling, and irritability may also be evident.
When we speak of constipation, we are generally referring to functional constipation, meaning constipation without any evidence of an underlying illness.
There are several common causes of functional constipation. A previous study by Borowitz revealed painful motion as a primary cause of constipation in early childhood. Dr. Mark Feldman, Director of Community Paediatrics at the Hospital for Sick Children, refers to this as the pain-retention cycle: "Children fear the painful passage of stool if constipated, hold off as long as possible, which in turn contributes to constipation." Other causes are an unbalanced diet, not enough fluids, change in diet, after-effects of an illness, side effects of medication, and just avoiding going to the bathroom because it's an interruption or an inconvenience.
Ways to prevent and treat constipation at home
There are several simple things parents can do at home to promote healthy bowel movements in their children or treat early signs of constipation:
- Encourage the child to drink plenty of fluids, specifically water and fruit juices. Prune, pear, and apple juices can be particularly helpful.
- Encourage the child to eat a well-balanced diet, including whole grains, fruits, and vegetables.
- Encourage the child to exercise daily for at least 15 minutes.
- Offer matter-of-fact education and positive reinforcement to the child for regular bowel movements.
- Encourage the child to try, without pressure or straining, for a bowel movement after every meal, taking advantage of the body's normal urge then to empty the bowel.
Doctors' treatment of constipation
If home remedies such as the above fail to improve the child's constipation, parents should consult their doctor. In 1999 the North American Society of Pediatric Gastroenterology and Nutrition produced guidelines for primary care physicians for the evaluation and treatment of childhood constipation. These guidelines recommend treating functional constipation in a three-step process:
Clear any stools stuck in the bowel using oral medicines, enemas, or suppositories. This is called disimpaction.
Establish a regular and easy pattern of defecation, using stool softeners and laxatives.
Prevent re-occurrence, using education, regular toilet habits, positive reinforcement, balanced diet, fluids, and exercise.
Dr. Feldman concurs with this three-step process, and also emphasizes the importance of fibre in the diet: "It's often difficult for parents to convince younger children to eat a high fibre diet. However, disimpaction, stool softeners, followed by a high fibre diet with adequate fluids is the mainstay of treatment." The results of the recent study also showed that, while the most commonly used treatment by primary care physicians was stool softeners and laxatives, the most effective was indeed some form of disimpaction procedure first, followed by daily laxatives or stool softeners.
Chronic constipation
Persistent or chronic constipation may be the symptom or result of a more serious underlying disease, such as hypothyroidism, salt imbalance, diabetes, cystic fibrosis, cerebral palsy, mental retardation, and spinal cord problems. In cases of chronic constipation or constipation complicated with another disease, the primary care physician should recommend a consultation with a specialist such as a paediatric gastroenterologist.
For more information about constipation, please see the pages on � Constipation� and � Soiling� in the AboutKidsHealth A-Z Health Library.