Overview

Constipation in children is a common problem. A constipated child has infrequent bowel movements or hard, dry stools.

Common causes include early toilet training and changes in diet. Fortunately, most cases of constipation in children are temporary.

Encouraging your child to make simple dietary changes — such as eating more fiber-rich fruits and vegetables and drinking more fluids — can go a long way toward alleviating constipation. If your child's doctor approves, it may be possible to treat a child's constipation with laxatives.

Source: http://www.mayoclinic.com

Symptoms

Signs and symptoms of constipation in children may include:

• Less than three bowel movements a week
• Bowel movements that are hard, dry and difficult to pass
• Large-diameter stools that may obstruct the toilet
• Pain while having a bowel movement
• Abdominal pain
• Traces of liquid or clay-like stool in your child's underwear — a sign that stool is backed up in the rectum
• Blood on the surface of hard stool

If your child fears that having a bowel movement will hurt, he or she may try to avoid it. You may notice your child crossing his or her legs, clenching his or her buttocks, twisting his or her body, or making faces when attempting to hold stool.

When to see a doctor

Constipation in children usually isn't serious. However, chronic constipation may lead to complications or signal an underlying condition. Take your child to a doctor if the constipation lasts longer than two weeks or is accompanied by:

• Fever
• Vomiting
• Blood in the stool
• Abdominal swelling
• Weight loss
• Painful tears in the skin around the anus (anal fissures)
• Intestinal protrusion out of the anus (rectal prolapse)

Source: http://www.mayoclinic.com

Causes

Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract, causing the stool to become hard and dry.

Many factors can contribute to constipation in children, including:

• Withholding. Your child may ignore the urge to have a bowel movement because he or she is afraid of the toilet or doesn't want to take a break from play. Some children withhold when they're away from home because they're uncomfortable using public toilets.

  Painful bowel movements caused by large, hard stools also may lead to withholding. If it hurts to poop, your child may try to avoid a repeat of the distressing experience.

• Toilet training issues. If you begin toilet training too soon, your child may rebel and hold in stool. If toilet training becomes a battle of wills, a voluntary decision to ignore the urge to poop can quickly become an involuntary habit that's tough to change.
• Changes in diet. Not enough fiber-rich fruits and vegetables or fluid in your child's diet may cause constipation. One of the more common times for children to become constipated is when they're switching from an all-liquid diet to one that includes solid foods.
• Changes in routine. Any changes in your child's routine — such as travel, hot weather or stress — can affect bowel function. Children are also more likely to experience constipation when they first start school outside of the home.
• Medications. Certain antidepressants and various other drugs can contribute to constipation.
• Cow's milk allergy. An allergy to cow's milk or consuming too many dairy products (cheese and cow's milk) sometimes leads to constipation.
• Family history. Children who have family members who have experienced constipation are more likely to develop constipation. This may be due to shared genetic or environmental factors.
• Medical conditions. Rarely, constipation in children indicates an anatomic malformation, a metabolic or digestive system problem, or another underlying condition.

Source: http://www.mayoclinic.com

Diagnosis

Your child's doctor will:

• Gather a complete medical history. Your child's doctor will ask you about your child's past illnesses. He or she will also likely ask you about your child's diet and physical activity patterns.
• Conduct a physical exam. Your child's physical exam will likely include placing a gloved finger into your child's anus to check for abnormalities or the presence of impacted stool. Stool found in the rectum may be tested for blood.

More-extensive testing is usually reserved for only the most severe cases of constipation. If necessary, these tests may include:

• Abdominal X-ray. This standard X-ray test allows your child's doctor to see if there are any blockages in your child's abdomen.
• Anorectal manometry or motility test. In this test, a thin tube called a catheter is placed in the rectum to measure the coordination of the muscles your child uses to pass stool.
• Barium enema X-ray. In this test, the lining of the bowel is coated with a contrast dye (barium) so that the rectum, colon and sometimes part of the small intestine can be clearly seen on an X-ray.
• Rectal biopsy. In this test, a small sample of tissue is taken from the lining of the rectum to see if nerve cells are normal.
• Transit study or marker study. In this test, your child will swallow a capsule containing markers that show up on X-rays taken over several days. Your child's doctor will analyze the way the markers move through your child's digestive tract.
• Blood tests. Occasionally, blood tests are performed, such as a thyroid panel.

Source: http://www.mayoclinic.com

Complications

Although constipation in children can be uncomfortable, it usually isn't serious. If constipation becomes chronic, however, complications may include:

• Painful breaks in the skin around the anus (anal fissures)
• Rectal prolapse, when the rectum comes out of the anus
• Stool withholding
• Avoiding bowel movements because of pain, which causes impacted stool to collect in the colon and rectum and leak out (encopresis)

Source: http://www.mayoclinic.com

Prevention

To help prevent constipation in children:

• Offer your child high-fiber foods. Serve your child more high-fiber foods, such as fruits, vegetables, beans, and whole-grain cereals and breads. If your child isn't used to a high-fiber diet, start by adding just several grams of fiber a day to prevent gas and bloating.
• Encourage your child to drink plenty of fluids. Water is often the best.
• Promote physical activity. Regular physical activity helps stimulate normal bowel function.
• Create a toilet routine. Regularly set aside time after meals for your child to use the toilet. If necessary, provide a footstool so that your child is comfortable sitting on the toilet and has enough leverage to release a stool.
• Remind your child to heed nature's call. Some children get so wrapped up in in play that they ignore the urge to have a bowel movement. If such delays occur often, they can contribute to constipation.
• Review medications. If your child is taking a medication that causes constipation, ask his or her doctor about other options.

Alternative medicine

In addition to changes in diet and routine, various alternative approaches may help relieve constipation in children:

• Massage. Gently massaging your child's abdomen may relax the muscles that support the bladder and intestines, helping to promote bowel activity.
• Acupuncture. This traditional Chinese medicine involves the insertion and manipulation of fine needles into various parts of the body. The therapy may help if your child has constipation-related abdominal pain.

Source: http://www.mayoclinic.com

Lifestyle and home remedies

Often, simple changes in diet and routine help relieve constipation in children:

• A high-fiber diet. A diet rich in fiber can help your child's body form soft, bulky stool. The recommended intake for dietary fiber is 14 grams for every 1,000 calories in your child's diet.

  For younger children, this translates to an intake of about 20 grams of dietary fiber a day. For adolescent girls and young women, it's 29 grams a day, and for adolescent boys and young men, it's 38 grams a day.

  Offer your child high-fiber foods, such as beans, whole grains, fruits and vegetables. But start slowly, adding just several grams of fiber a day over several weeks to reduce the amount of gas and bloating that can occur in someone who's not used to consuming high-fiber foods.

• Adequate fluids. Water and other fluids will help soften your child's stool. Be wary of offering your child too much milk, however. For some children, excess milk contributes to constipation.
• Adequate time for bowel movements. Encourage your child to sit on the toilet for five to 10 minutes within 30 minutes after each meal. Follow the routine every day, even during holidays and vacations.
• Be supportive. Reward your child's efforts, not results. Give children small rewards for trying to move their bowels. Possible rewards include stickers or a special book or game that's only available after (or possibly during) toilet time. And don't punish a child who has soiled his or her underwear.

Source: http://www.mayoclinic.com

Risk factors

Constipation in children is more likely for kids who:

• Are sedentary
• Don't eat enough fiber
• Don't drink enough fluids
• Take certain medications, including some antidepressants
• Have a medical condition affecting the anus or rectum
• Have a family history of constipation

Source: http://www.mayoclinic.com