Functional Constipation in Kids & Teens

Constipation is one of the most common intestinal problems in children, accounting for 3% to 5% of all visits to pediatricians. Constipation is a symptom that signals something is wrong; it is not a disease. Fortunately, most constipation in infants and children is not caused by any serious medical disease. The cause of most constipation is functional, meaning there is no sign of injury or infection, blood, or anatomic abnormality to explain the very real symptoms. Children need help from their parents, and sometimes from a health care professional, to prevent or manage constipation.

How is Constipation Defined

There is no precise definition of constipation that fits all people. Constipation in children can be defined as the passage of painful stools or a reduction in frequency of stools. An important feature in this definition is the child's perception of pain or difficulty in passing stool – regardless of frequency. The experience of pain when evacuating can lead to avoidance of having a bowel movement.

Mean Average Frequency of Bowel Movements (BMs) in Children[1]

Age	BMs per Week*
0 - 3 months	5 - 40 (breast milk) 5 - 28 (formula)
6 - 12 months	5 - 28
1 - 3 years	4 - 21
4 years	3 - 14
* Approximately mean ± 2 SD

In healthy children the number of bowel movements changes with age and diet. Newborns may average several bowel movements a day. In a few healthy breastfed infants there may be weeks between bowel movements, but the stools are soft. By around age 4 a child may average one bowel movement a day.

Nonetheless, it is not correct to assume that a bowel movement every day is "normal." There really is no "right" number of bowel movements. Each person's body finds its own normal number of bowel movements, which depends on many factors. In general, 2 or less normal bowel movements per week may be a sign of constipation.

What Causes Constipation

Constipation in children is generally caused by a change in diet and fluid intake, during toilet training or a deviation from usual toileting routines, or avoidance of bowel movements because of pain such as anal irritation, fissures (small tears in the skin), or rashes. Other factors can play a role in causing painful bowel movements, such as changes in daily routine, stressful events, or postponing using the toilet when the urge to have a bowel movement is felt.

At one time or another, almost everyone gets constipated. In most cases, it lasts for a short time and is not serious. By understanding factors that cause constipation, steps can be taken to help prevent it.

Preventing or Treating Constipation

Giving attention to what your child drinks, eats, and how much exercise your child gets, can often help prevent or relieve constipation. Providing guidance to prevent stool withholding, and helping establish regular times for going to the toilet are also important. Here are some steps you can take.

Eating more fiber

Fiber helps form soft, bulky stool. It is found in many vegetables, fruits, and grains. Be sure to add fiber a little at a time to let the body get used to it slowly. Limit high-fat, high-sugar foods and foods that have little or no fiber such as ice cream, cheese, meat, snacks like chips and pizza, and processed foods such as instant mashed potatoes or already-prepared frozen dinners.

Drinking plenty of water and other liquids such as fruit and vegetable juices and clear soups

Liquid helps keep the stool soft and easy to pass, so it's important to drink enough fluids. Try to drink liquids that contain no caffeine; caffeine (found in many soft drinks) tends to dry out the digestive system.

In infants older than 6 months, juices containing sorbitol, such as prune, pear and apple juice can decrease constipation. However, too much fruit juice can cause gastrointestinal and other problems. Be sure to limit its consumption appropriately.

Exercising

Regular exercise helps the digestive system stay active and healthy. A person does not need to be athletic. A bike ride or a 20- to 30-minute walk every day can help. Encourage your child to exercise daily.

Allowing enough time to have a bowel movement

It is important not to ignore the urge to have a bowel movement. Waiting only makes constipation worse. Try getting your child up early enough in the morning to give them time to use the bathroom before school. Regular, unhurried time on the toilet after meals, particularly breakfast or dinner, can help.

Talking to a doctor

Call your child's doctor if you notice constipation is persistent or recurrent; that symptoms interfere with your child's daily activities; blood in or on the stool; diarrhea; fever; vomiting; straining with stool; your child complains of pain or cramping; irritability; decreased appetite; or soiling of underclothes.

The doctor will want to determine the cause of the constipation. Possibly in combination with other treatment approaches, your child's doctor may recommend the use of laxatives. Only use laxatives if your child's doctor says you should, and then only as directed. Laxatives come in many forms and your child's physician can help find the one best suited for your child. The doctor may recommend using laxatives or stool softeners in combination with other treatments.

Your child's doctor may also help you develop a bowel training program for your child. Children may delay using the toilet for a variety of reasons, including being in school or busy with activities. Bowel retraining works by teaching new skills or strategies to develop a routine and predictable schedule for evacuation.

Be sure to tell the doctor about any medicines your child may be taking, including prescription and over-the-counter. Some medications can cause constipation.

Conclusion

As your child gets older, he or she may find it embarrassing to talk about bowel movements. But children need to know that a bowel problem like constipation happens to virtually everyone now and then. Help them make healthy choices. Talk reassuringly and matter of factly about bowel habits. Importantly, recognize the developmental stage of your child and, if necessary, be sure to work with your child's physician to plan treatment that takes into account the child's point of view.