Constipation is a very common condition in childhood. A child who is constipated will have hard and dry stools which are difficult and painful to pass.
This information is for children with constipation. Constipation in babies has different causes and treatments and has not been covered in this article.
What do normal stools look like?
All children have different stool patterns, some pass a stool once a day whereas others may pass a stool after each meal. It is important to know your child’s stool passing pattern as this will make it easier to know if he or she is constipated. The most important aspect of a ‘normal’ stool is the softness – it should look like a soft sausage or snake or fluffy/mushy pieces (Goal is type 3 or 4).
Types of constipation in children
There are two types of constipation:
- Organic constipation: which is the passing of painful stools due to diseases. This is a rare cause of constipation but will be investigated if the constipation persists.
- Functional constipation: is the most common cause and happens when children hold back passing their stools. Other causes include diet (not often a primary reason but a diet low in fibre can worsen constipation), illness (post diarrhoea), and changes in environment.
Reasons children hold back from passing stools?
- Fear of pain or discomfort when passing a stool.
- Lack of awareness that he or she needs to pass a stool.
- Wanting to be in control, especially children aged 2-5 years. In this situation it would be best not to pressure your child into potty training.
- Some children don’t want to stop playing to go to the bathroom.
- Feeling uneasy going to the toilet in a strange or different environment.
How does constipation happen?
If your child has been constipated for a few days, the stools get ‘stuck’ in the large intestine (colon) causing it to stretch. An over-stretched colon cannot work properly, resulting in more of the stool getting ‘stuck’.
This causes more pain when your child tries to pass a stool, which may cause the child to withhold going to the toilet. Signs that your child is withholding going to the toilet include tensing up, crossing legs or tightening leg and bum muscles when they feel like they need to go to the toilet. By withholding going to the toilet the constipation worsens and medicine will be needed to help relieve it.
Sometimes the child will develop something called overflow diarrhoea. It may look like the constipation has resolved itself, but in fact it is old stool that becomes more liquid and bypasses the old stool and leaks out. When this happens, medical intervention is necessary.
How is constipation treated?
- Diet can help with mild constipation.
- Focus on increasing intake of fibre containing foods such as:
- fruit and vegetables (5 per day): include the skins of fruit where safe and give whole fruit rather than fruit juices
- high fibre starchy foods: oats, all bran flakes, wholewheat or high fibre breads, high fibre crackers. Reading labels: excellent sources of fibre = 5g or more per serving and good sources = at least 3g per serving
- Chia seeds or flax seeds,
- Lentils, beans, and chickpeas
- The three “P”s: prunes, pears, and plums
Please remember to adapt the foods accordingly for your child’s age to prevent choking.
- Water is very important for the general functioning of your child’s body.
- As you increase fibre intake it is very important to increase the amount of water they drink, otherwise they will become more constipated.
Change in the way your child sits on the toilet
Sitting correctly on the toilet or potty is very important in passing stools properly. Sit with knees higher than the hips (a stool may be helpful so that their feet are not dangling in the air). Lean forward, with elbows on their knees. Relax and bulge out stomach and straighten spine.
Good toilet habits
- Talk about going to the toilet in an open way – try normalising doing a ‘poo’. It’s a natural bodily function that we do.
- Do not make a big deal about the smelliness of stools – this could embarrass your child and make them resistant to go to the toilet.
- Make sure there is enough time in the morning or during the day for your child to sit on the toilet – do not make them feel rushed.
- We should all try a remove the stigma of needing to pass a stool in a public place.
There are many laxative medications available to treat children with functional constipation. These include stool softeners, osmotic laxatives, stimulant laxatives, secretagogue laxatives and rectal therapies. These treatments should be discussed with your doctor before starting to use them.
It is very important to seek medical advice if your child has not passed a stool in a few days, has an enlarged abdomen, is vomiting, in pain or if you are worried that your child has a blockage.