I thank Dr. Madhu Lata Pandey for contributing this article
Constipation is when a child has a hard stool, trouble pushing stool out, or does not go to the toilet regularly. There is a lot of difference in the firmness and frequency of normal bowel movements in children.
Breastfed babies may have a stool following each feed, or only one stool each week. Formula (powder milk) fed babies and older children will usually have it at least every two to three days. Babies have weak abdomen muscles so straining at the stool isn’t necessarily alarming, even when the infant cries or gets red in the face. Also because they are lying down on their back while passing stool it becomes difficult.
What causes constipation in children?
- Natural tendency– some children have slow gut movement, which causes constipation.
- Bowel habits– such as ignoring the urge to pass a motion. Many young children are too busy playing and put off going to the toilet. The stool then becomes harder and larger. Toilet time should be set aside three times a day, every day, to allow for regular, undisturbed visits to the toilet.
- Holding-on behavior– a child may begin to ‘hold on’ after a painful or frightening experience, such as doing a hard stool when they have a painful condition in the anus like anal fissures. Holding on further hardens the stool, and makes the next one even more painful.
- Change in toilet environment– new school toilets, or being told to hold on when they feel the urge to go
- Diet– a diet high in processed foods and low in fresh fruits and vegetables. Read “Complementary feeding after 6 months of age-5 Latest evidence-based principles“
- Disease– in a very small number of children. Hypothyroidism (low level of thyroid hormone) is a common cause
- Often, constipation runs in families.1 Children suffering from long-term constipation often have family members who also have constipation.
Home remedies for constipation
1. Dietary changes
The following remedies are for infants with constipation who are older than four months:
- Fruit juice – If your infant is at least four months old, you can give certain fruit juices to treat constipation. This includes prune, apple, or pear juice (other juices are not as helpful). Do not give juice every day for more than two weeks. Too much juice can be unhealthy for children’s overall diet and growth.
- High-fiber food items– If your infant has started eating solid foods, you can substitute barley for rice. You can also offer other high-fiber fruits and vegetables (or purées), including apricots, sweet potatoes, pears, peaches, plums, beans, peas, broccoli, spinach, or flax seeds. You can mix fruit juice (apple, pear) with cereal or the fruit/vegetable purée. On the other hand, bananas may increase constipation. In fact, the green banana is used in the treatment of persistent diarrhea.
- When iron therapy is going on–Iron drops may sometimes cause constipation. Therefore, infants and children who are on iron sometimes also need extra diet changes or treatments to make sure that they do not get constipated. On the other hand, leafy vegetables and cabbage interfere with iron absorption. Giving fruits and vegetables in the evening and iron after the morning meal sorts out this issue.
If your child has been constipated for a short time, changing what he or she eats may be the only treatment needed. You can make these changes as often as needed so that the child has soft and painless bowel movements.
What can you do?
Because each child’s bowel patterns are different, become familiar with your child’s normal bowel patterns. Make a note of the usual size and consistency of her stools. This will help you and your child’s doctor determine when constipation occurs and the best way to treat it. If your child doesn’t have normal bowel movements every few days or is uncomfortable when stools are passed, he or she may need help in developing proper bowel habits.
- Encourage your child to drink plenty of water and eat high-fiber foods.
- Help your child set up a regular toileting routine.
- Encourage your child to be physically active. Exercise along with a balanced diet provides the foundation for a healthy, active life
2. Toilet training tips
If your child develops constipation while learning to use the toilet, stop toilet training temporarily. It is reasonable to wait two to three months before restarting toilet training. When you resume, encourage your child to sit on the toilet as soon as he or she feels the urge to have a bowel movement and give positive reinforcement (a hug, kiss, or words of encouragement) for trying, whether or not the child is successful. Avoid punishing or pressuring your child.
Encouraging healthy toilet habits— If your child is toilet trained, encourage him or her to sit on the toilet for approximately 10 minutes once or twice a day after eating.
Use foot support-(eg, a stool), which should be high enough that the child’s knees are slightly above his or her hips
When to worry about constipation?
- Not eating well
- Failure to gain weight or weight loss.
- Abdominal distention
- Anal fissure
- Blood in stool
If your child has any of the above symptoms along with constipation, get him/her checked by a Pediatrician.
To conclude, constipation is a very common problem in children. The most common causes are behavioral and dietary, and hence can be managed by addressing these factors. There are red flags of underlying disease when the child needs to be shown to a Pediatrician.
About the author
Dr. Madhu Lata Pandey
MBBS (Kerala) DCH(Kolkata) DNB(Peds)
Observership in Peds Gastroenterology and Nutrition (SGPGI Lucknow)
Consultant Pediatrician and Neonatologist
Links to books on infant and child feeding