Overview

Constipation means that stools have become hard and are difficult to pass. Some parents are overly concerned about how often their child has bowel movements. That's because they've been taught that a healthy child has a bowel movement every day. But this isn't true. How often a child has bowel movements isn't as important as whether the child can pass stools easily. Your child isn't constipated if their stools are soft and pass easily. This is true 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 3-4 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. They may have a stool as often as every feeding. Constipation is likely to occur when a baby switches from breast milk to formula. This is even more likely if the 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 smaller and the size of their stools gets bigger. A child age 3 or 4 years may have as many as 3 bowel movements a day or as few as 3 a week.

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

Most children will be constipated now and then. The problem usually doesn't last long or cause long-term problems. Home treatment is usually all that's needed to relieve constipation that occurs now and then. Causes of constipation include:

• Changes in diet, such as when a child starts to eat more adult foods.
• Not drinking enough fluids. Sometimes the normal amount of fluid a child drinks isn't enough. This can happen when the weather gets hot or the child gets more active.
• Not taking the time to have a bowel movement. A child may be so interested in play that they ignore the need to have a bowel movement.
• Reluctance to use the toilet. A child might become constipated when they are 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. The child 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 aren't always known, some children often have constipation that doesn't get better or go away with treatment (chronic constipation). This may be because of the painful passing of a hard, dry stool. After a while, the child may not be able 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. Then 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. It can make bowel movements painful and cause the child to resist passing stools. Fissures are a common problem that may get worse every time the child passes a large stool.
• A brief illness with poor food intake, fever, and little or no physical activity. This can upset normal bowel habits.
• Emotional problems or toilet training problems. They can lead to withholding stools on purpose. 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.
• A change in environment. At school, children may withhold stools for several reasons. Maybe they are afraid or embarrassed to use school washrooms. Or maybe their schedules are too busy for them to take time for a bowel movement. Or maybe their school activities interrupt their normal bowel movement time.

The child may not be able or willing 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's 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 gets 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.
• An overactive parathyroid gland (hyperparathyroidism).
• An underactive thyroid gland (hypothyroidism).
• A spinal cord injury.

Self-Care

Here are some tips for caring for your child who is constipated.

• Make sure your child drinks enough fluids.
• Give your baby the right amount of extra fluid if you are using formula.
  • If you are switching from breast milk to formula or are only using formula, give your baby no more than 30 mL (1 fl oz) to 60 mL (2 fl oz) of water and no more than 2 times each day for the first 2 to 3 weeks. Be sure to give your baby the suggested amount of formula for feedings plus the extra water between feedings. Don't give extra water for longer than 3 weeks unless your doctor tells you to. Don't give plain water to a baby younger than 2 months.
• If your child is older than 6 months, add fruit juices, such as apple, pear, or prune juice, to relieve the constipation. Don't give more than 125 mL (4 fl oz) a day and don't give water for more than a week or two.
  • After age 6 months, give 7 mL (0.5 Tbsp) to 30 mL (2 Tbsp) of prune juice. Increase the amount slowly over time.
  • At age 9 months, add 22 mL (1.5 Tbsp) to 45 mL (3 Tbsp) of strained prunes each day.
• Add baby foods with a high fibre content.

  High-fibre foods include cooked dried beans or peas (legumes), apricots, prunes, peaches, pears, plums, and spinach.

• For children age 12 months and older, add high-fibre foods.

  A diet with enough fibre (20 to 35 grams each day) helps the body form soft, bulky stool.

  • Give your child at least 250 mL (1 cup) of fruit a day. Choose whole fruit instead of fruit juice.
  • Give your child at least 250 mL (1 cup) of vegetables a day.
  • Include high-fibre foods, such as beans or whole grains, in your child's diet each day.
• Gently massage your child's belly.

  This may help relieve discomfort. You can also have your child lie on their back, legs flexed onto their belly. Then rotate your child's legs in a clockwise direction.

• Try a bath or suppositories to relieve rectal pain.
  • Give your child a warm bath in the tub. This may help relax the muscles that normally keep stool inside the rectum (anal sphincter) so your child can pass the stool.
  • If your child is age 6 months or older and the warm bath doesn't work, use 1 pediatric suppository. It can lubricate the stool and make it easier to pass. Use a suppository only once. If constipation isn't relieved or occurs again, talk with your doctor.
• Don't give laxatives or enemas to children without first talking to your doctor.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• Constipation or changes in the stool that continue after a few days to 1 week of home treatment.
• New or worse rectal pain.
• New or worse blood in the stool.
• Uncontrolled leakage of stool.
• Symptoms occur more often or are more severe.

Preparing For Your Appointment