Topic Overview

Constipation occurs when stools become hard and are difficult to pass. Some parents are overly concerned about how often their child has bowel movements, because they have been taught that a healthy child has a bowel movement every day. This is not true. The frequency of bowel movements is not as important as whether the child can pass stools easily. Your child is not constipated if his or her stools are soft and pass easily, even if it has been a few days since the last bowel movement.

Newborns younger than 2 weeks should have at least 1 or 2 bowel movements a day. Babies older than 3 to 4 weeks can go 2 days and sometimes longer between bowel movements. It's usually okay if it takes longer than 2 days, especially if your baby is feeding well and seems comfortable. Breastfed babies are more likely to have frequent stools and may have a stool as often as every feeding. Constipation is likely to occur when a baby changes from breast milk to formula, especially if this change happens during the first 2 to 3 weeks of life.

As babies grow older, the number of bowel movements they have each day gets less and the size of their stools gets bigger. A child age 3 or 4 years may normally have as many as 3 bowel movements a day or as few as 3 a week.

It is important for parents to recognize there are many "normal" patterns for bowel movements in children. Some children may appear to have trouble passing a stool. The child's face may turn red, and he or she may strain to pass stool. If the stool is soft and the child does not seem to have other problems, this is not a concern.

Most children will occasionally become constipated. The problem is usually short-lived and does not cause long-term problems. Home treatment is usually all that is needed to relieve occasional constipation. Causes of constipation include:

• Changes in diet, such as when a child starts eating more adult foods.
• Not drinking enough fluids. Sometimes the normal amount of fluid a child drinks is not enough, such as when the weather gets hot or the child increases his or her physical activities.
• Not taking the time to have a bowel movement. A child may be so interested in play that he or she ignores the need to have a bowel movement.
• Reluctance to use the bathroom. A child might become constipated when he or she is in a new environment, such as when travelling.
• Changes in daily routine, such as when travelling or after starting school.
• Medicines. Many medicines can cause constipation.

Constipation may occur with cramping and pain if the child is straining to pass hard, dry stools. He or she may have some bloating and nausea. There may also be small amounts of bright red blood on the stool caused by slight tearing (anal fissure) as the stool is pushed through the anus. All of these symptoms should stop when the constipation is relieved.

Chronic constipation

For reasons that can't always be identified, some children often develop constipation that does not get better or go away with treatment (chronic constipation). The most significant factor may be the painful passing of a hard, dry stool. After a while, the child may be unable to resist the urge to have a bowel movement and will pass a large mass of stool. The child may have to "push hard" during the bowel movement, which may be painful. Passing the stool relieves the pressure and pain until another mass of stool collects, and the cycle is repeated. Fear of pain may cause the child to try to hold the bowel movement.

Other causes of chronic constipation may include:

• A crack (fissure) around the anus, which can make bowel movements painful and cause the child to resist passing stools. Fissures are a common problem that gets worse every time the child passes a large stool.
• A brief illness with poor food intake, fever, and little or no physical activity, which may upset normal bowel habits.
• Emotional problems or toilet training problems, which can lead to voluntarily withholding stools. A child may have fought the toilet training process or been pushed too fast. Struggling with parents for control may cause a child to hold stools back as long as possible.
• Change in environment. At school, children may withhold stools because they are afraid or embarrassed to use school bathrooms, their schedules are too busy for them to take time for a bowel movement, or school activities interrupt their normal bowel movement time.

The child may be unable or unwilling to pass the stool regardless of its size. Liquid or loose stool may leak out, soiling the child's underwear. When this occurs in a child who is past the age of normal toilet training, it is called encopresis.

Chronic constipation usually requires several months of treatment and co-operation between the parents, the child, and the doctor to overcome the problem. Don't be discouraged if the problem comes back during these months. The rectum is made of muscle tissue; when a child has had chronic constipation, the muscle becomes stretched. It may take several months to get the muscle back into shape.

In rare cases, constipation in children may be caused by other health problems, such as:

• Cystic fibrosis.
• Hirschsprung's disease.
• Lead poisoning.
• Overactivity of the parathyroid gland (hyperparathyroidism).
• Underactivity of the thyroid gland (hypothyroidism).
• Spinal cord injury.