Constipation in children – an overview

Constipation in children is extremely common.

Often, a good diet and plenty of fluids are all that is required to rectify the problem. Some children, however, develop chronic constipation. The normal frequency of passing stools in children varies. For example, in breastfed infants, passing stools every five to seven days may be normal. Other infants may pass small stools as much as ten times per day.
For older children the normal range can vary between three times per day to once every three days. Other features that raise concern about constipation can be difficulty passing stools; pain when passing stools; reluctance to go to the toilet; large, hard stools and small, hard pellet like stools.

Diets low in fibre and fluids usually make constipation worse. Some children exhibit a reluctance to use the toilet. This may be because they have had a previous experience of passing a hard, painful stool, and are reluctant to repeat the experience. Some children may fear using public toilets or the restrooms at school. Many medicines and some medical conditions such as Hirschprung’s disease can cause constipation, but the most common cause is stool holding. This is where the child holds on to stools, not sensing when the rectum is full, causing the rectal area to expand; there may be some leakage around the stools, and soiling of underwear. In these cases, the use of laxative agents over a period of time allows the rectal area to shrink back to normal size, so that the child can recognise when it is full, and so go to the toilet normally.

So how is constipation treated? Diet changes, including avoiding constipating foods like bananas, peaches and pears; increasing water intake, and /or juice intake (prune, pear or apple juice). Sometimes a laxative like Lactulose or magnesium oxide may be necessary.

Children less than one year old should be treated differently for constipation. A child less than one year old suffering from constipation should be seen by their doctor to establish whether there is a medical problem causing the constipation. Usually slightly increasing water intake, or giving the baby a small amount of juice per day is enough to deal with the constipation. Large amounts of water or juice in young babies can be dangerous, so if in doubt, talk to your family physician.