Constipation in Children

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Constipation in children

Important considerations

  • Breast milk is best for a newborn till the age of 4 months. Constipation is more often seen in formula fed babies. However, weaning off from breast milk should not be delayed for a longer time.
  • Constipation is very common in premature babies probably due to poor gastrointestinal motility. Iron supplementations in these children aggravate the situation. In fact, a premature (low birth) baby has five times higher risk of developing constipation as compared to a full term baby with normal birth weight. If the baby develops vomiting or bloating of abdomen, one should consult the doctor.
  • Long standing constipation in children may be because of developmental defects like narrow anal opening, displaced anal opening or Hirschsprung’s disease (lack of nerve supply to lower portion of colon). Occasionally, some developmental tumor can obstruct the passage of stools.
  • Anal fissure (tearing of skin lining near anus while passing hard stools) is a common sequel of constipation that sets up a vicious cycle of pain while passing stools and withholding stools to avoid pain. If a child shrieks while passing stools and refuses to go to toilet, he probably has a fissure. Please see your doctor immediately. Unless fissure is taken care of, pain will prevail and so will constipation. Another similar condition is nappy rash that makes passing of stools extremely painful.
  • Faulty dietary habits and low fluid intake are important causes of constipation (without any underlying disease) among children.
  • Another important cause of constipation (without underlying disease) in children is repressive toilet training whereby he is taught to control his natural urges.
  • Constipation can cause low appetite and laziness among children. Such children may show poor growth and development and may not perform well at school.
  • It can also lead to repeated urine infections in children.

Management

The bowel habits of a child should be taken care of by the parents during their childhood itself as the diseased colon (intestines), may not respond to any therapy during adulthood.

  • The child should be encouraged to cultivate the habit of taking plenty of water and high roughage. Children have more liking for commercially available fast food. This food stuff can be modified so as to include extra roughage (e.g. lot of cabbage in noodles).
  • The child should be trained not to postpone the urge for stool. The toilet training should not be repressive.
  • In cases of chronic constipation, the parents should see a doctor, and preferably, a pediatric surgeon who can carry out relevant external/internal examination and investigations to establish the cause.
  • Laxative and enemas are preferably avoided in children; suppository is preferred. Glycerine syringing can be advised in new born babies. Not only children dread the experience of getting an enema, but enema could be disastrous if given by an inexperienced person. Very gentle type of laxative is honey which can be administered orally. The dose is 1/2 -2 tea spoons depending upon the age and weight of the child. But, before its administration, other causes of constipation should be ruled out and it should not be used more often than needed.