Constipation in children is a prevalent issue, characterized by infrequent bowel movements or hard, dry stools.

Common Causes

• Early Toilet Training: Starting toilet training too early can contribute to constipation.
• Dietary Changes: Modifying a child's diet can also lead to constipation.

Thankfully, most cases are temporary. Simple dietary adjustments, such as increasing fiber intake from fruits and vegetables and ensuring adequate water consumption, can significantly help. With a doctor's approval, laxatives may also be an option.

Symptoms

Signs that your child may be constipated include:

• Fewer than three bowel movements per week
• Hard, dry stools that are difficult to pass
• Pain during bowel movements
• Stomach pain
• Traces of liquid or pasty stool in the underwear, indicating stool backup
• Blood on the surface of hard stool

Children may avoid bowel movements due to the fear of pain, often showing behaviors like crossing legs, clenching buttocks, or making faces.

When to See a Doctor

While constipation in children is typically not serious, persistent cases (lasting more than two weeks) or those accompanied by:

• Fever
• Loss of appetite
• Blood in stool
• Abdominal swelling
• Weight loss
• Pain during bowel movements
• Rectal prolapse

Causes

Constipation occurs when stool moves too slowly through the digestive tract, becoming hard and dry. Factors contributing to constipation include:

• Withholding: Fear of the toilet or not wanting to stop play.
• Painful Stools: Large, hard stools can lead to withholding to avoid discomfort.
• Toilet Training Issues: Starting training too early or making it a power struggle can cause withholding.
• Diet Changes: Switching from an all-liquid diet to solid foods, or insufficient fiber and fluid intake.
• Routine Changes: Travel, stress, or starting school.
• Medications: Certain antidepressants and other drugs.
• Cow's Milk Allergy: Allergies or excessive dairy intake.
• Family History: Genetic or environmental factors.
• Medical Conditions: Rarely, it could indicate an anatomical, metabolic, or digestive issue.

Risk Factors

Children are more prone to constipation if they:

• Are sedentary
• Eat low-fiber diets
• Don't drink enough fluids
• Take certain medications
• Have medical conditions affecting the anus or rectum
• Have neurological disorders

Complications

Chronic constipation can lead to:

• Anal fissures
• Rectal prolapse
• Stool withholding, leading to impacted stool and leakage (encopresis)

Prevention

To prevent constipation:

• High-Fiber Diet: Incorporate more fruits, vegetables, beans, and whole grains. The recommended fiber intake is 14 grams per 1,000 calories.
• Fluid Intake: Encourage plenty of water.
• Physical Activity: Regular exercise helps bowel function.
• Toilet Routine: Set regular times for toilet use, especially after meals, and consider a footstool for comfort.
• Respond to Urges: Encourage children to use the toilet when they feel the need.
• Supportive Environment: Reward efforts, not just results, and avoid punishment for accidents.
• Medication Review: Discuss alternatives if medications cause constipation.