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Functional Constipation in Kids & Teens


Constipation is one of the most common intestinal problems in children. It accounts 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 serious medical disease.

The cause of most constipation is functional. That means 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.

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. This 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
  • by avoidance of bowel movements because of pain, anal irritation, fissures (small tears in the skin), or rashes.

Functional fecal retention is the most common problem in children that come to see a pediatric gastroenterologist. It happens when the child tries to avoid having a bowel movement, often due to a frightening or painful defecation experience.

Learn about functional fecal retention here.

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

There are a number of ways to help your child avoid constipation...

  • Give attention to what your child drinks and eats
  • Help your child exercise
  • Provide guidance to prevent stool withholding
  • Set up regular times for going to the toilet

Foods to avoid 

Limit or reduce these foods in the diet...

  • High-fat foods
  • High-sugar foods
  • Processed foods such as instant mashed potatoes or already-prepared frozen dinners
  • Foods that have little or no fiber such as ice cream, cheese, meat, snacks like chips and pizza

Eating more fiber

Add fiber to the diet. 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.

Drinking more liquids

Help your child drink plenty of water and other liquids such as fruit and vegetable juices and clear soups. 

Fruit Juice: American Academy of Pediatrics Statement Advises of Possible Gastrointestinal Effects

In an article published in the May 2001 issue of Pediatrics, the American Academy of Pediatrics (AAP) released a policy statement on consumption of fruit juice by children. They define fruit juice as 100% fruit juice labeled to disclose if it comes from concentrate. The statement contains suggestions for daily consumption. It also includes a warning that too much fruit juice can cause gastrointestinal and other problems.

The AAP recommended that children between the ages of 1 to 6 years old drink no more than 4 to 6 ounces per day. For children between the ages of 7 to 18 years they recommend no more than 8 to 12 ounces per day.

The statement further advises:

  1. Fruit juice should not be given to infants before 6 months of age.
  2. After 6 months of age, infants should not get juice from bottles or cups that allow them to consume juice easily throughout the day.
  3. Infants should not get fruit juice at bedtime.
  4. All children should be encouraged to eat whole fruits.

Fruit juice contains large amounts of carbohydrate. Too much can lead to diarrhea, abdominal pain, bloating, and gas.

In the right amounts, the AAP acknowledges that 100% fruit juice can be a healthy part of a child's diet.

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, avoid too much fruit juice. That can cause problems.

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 your child...

  • Has constipation that continues or keeps coming back
  • Has constipation that interferes with daily activities
  • Complains of pain or cramping
  • Is straining with stool
  • Is irritable
  • Has soiling of underclothes

Call your doctor if you notice blood in or on the stool, diarrhea, fever, or vomiting.

The doctor will want to determine the cause of the constipation. Your child's doctor may recommend the use of laxatives.

  • Only use laxatives if your child's doctor says you should
  • Only use laxatives as directed.

Laxatives come in many forms. The doctor can help find the one best suited for your child. The doctor may recommend using laxatives or stool softeners in combination with other treatments.

The 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 ways to develop a routine and schedule for evacuation.

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

Remember

Here to Help

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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. Talk reassuringly and matter of factly about bowel habits.

Help them make healthy choices. 

Importantly, recognize the developmental stage of your child. If necessary, be sure to work with your child's physician to plan treatment that takes into account the child's point of view.

Sources

  • Levy J, Volpert D. Know thy laxatives: a parent's guide to the successful management of chronic functional constipation in infants and children. IFFGD Brochure No 828; 2004.
  • NIH Publication No. 04-4157. What I need to know about constipation. December 2003.
  • Baker SS, Liptak GS, Colletti RB, et al. Constipation in infants and children: evaluation and treatment. A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 1999 Nov;29(5):612-626. Erratum in: J Pediatr Gastroenterol Nutr 2000 Jan;30(1):109.
  • Plummer MK. Strategies for establishing bowel control. IFFGD Brochure No. 302; 2002.
  • Drossman DA, et al. (Eds). Childhood functional gastrointestinal disorders. In Rome II: The Functional Gastrointestinal Disorders. Virginia: Degnon Assocs. Second Edition, 2000.

Reference

  1. Baker SS, Liptak GS, Colletti RB, et al. Constipation in infants and children: evaluation and treatment. A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 1999 Nov;29(5):612-626. Erratum in: J Pediatr Gastroenterol Nutr 2000 Jan;30(1):109.

More Information

  • Fiber: Find out more about fiber, including a listing of common food sources.
  • For more information about Constipation, visit another IFFGD website, www.aboutConstipation.org
Last modified on January 24, 2014 at 02:32:41 PM