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Constipation in Children and Infants

Constipation can be a troubling problem for both, children who are suffering from it as well as their parents. If it turns chronic, the child become irritable, loses its appetite, and appears uncomfortable. It is therefore vital to deal with it early on.
AptParenting Staff
Last Updated: Feb 23, 2018
Constipation is a common condition that affects many people worldwide, including children. Although it is usually not something to worry too much about, many parents find themselves getting anxious over the infrequent bowel movements of their children. The digestive system of babies goes through several transitions till they are about 2 or 3 years old. Infants are breast-fed (or infant formula) till they are 6 months old, after which, they are gradually weaned off milk and fed solid food. This is also the time when their potty training begins. There are many children who resist this transition, which is reflected in change in bowel movement.
Normal Bowel Movement
There are no fixed criteria for how frequent bowel movement should be, for both infants and children. A child may have less frequent bowel movement as compared to other children of the same age, and yet be healthy. Some things to remember while looking out for the signs of constipation in very young children are:
  • Breast milk is easily digested by babies, so normal breast-fed babies do not usually suffer from constipation. Infant formula takes more time to get digested.
  • Bowel movements in newborn babies can vary a lot. They may pass stools almost as often as they feed, or they may go 3 to 4 days without doing so.
  • More important than the frequency of bowel movements is the ease with which they occur, and the consistency of the stools. If the infant is not constipated, soft, easily-passed stools, even if they are infrequent, are normal.
  • For babies who are being fed solid food, the consistency, color, and smell of the stools depends on what has been fed to them. It also depends on whether they are taking in adequate quantity of fluids.
  • If the stools are harder in consistency, difficult to pass, and the frequency with which they are passed is also reduced, it is reasonable to assume that the child is constipated.
  • When it comes to the frequency, all children differ from one another. However, if they are deviated from what is normal for them, and pass stools less frequently, they may be suffering from constipation.
Causes of Constipation
Healthy children may suffer from constipation due to unknown reasons, or due to other factors. Children who are suffering from some medical condition may have constipation secondary to it. Children who avoid passing stools when they feel the urge to do so often become constipated. There are many reasons why they may do so, such as:
  • Some children feel uncomfortable in unfamiliar surroundings, so they may skip going to the toilet when they are away from home.
  • If they previously had a painful episode of passing stools, they may resist doing so again. This leads to the accumulation of stools in the colon, which become harder due to the absorption of water from them
  • If a child has had a traumatic experience in connection with passing stools, like getting scolded or beaten, then he or she is likely to resist doing it again.
  • Anal injury, such as a fissure that makes it painful for the child to pass stools, can cause him or her to resist defecation.
  • Dietary fiber is essential in food because of its bulk-forming properties. It prevents stools from becoming hard and dry. If a child's diet lacks fiber, he is prone to becoming constipated.
  • Inadequate intake of fluids can lead to constipation. It is important for a child to drink water and not just beverages like carbonated drinks and fruit juices which have a lot of sugar in them.
  • Children who are not physically active are at risk of becoming constipated.
  • Some disorders of the nervous system, like cerebral palsy, Hirschsprung's disease, or others involving the spinal cord can cause constipation.
  • Hypothyroidism makes all the body's processes slow down, including intestinal movements. Hence, children suffering from this also suffer from constipation.
  • A lot of medicines have constipation as a side effect, because they slow down bowel movements.
  • Other conditions that cause constipation are cystic fibrosis, depression, lead poisoning, and dehydration.
Different approaches, depending on how severe the constipation is, and the cause underlying it, are used:
  • Different types of laxatives are used for treating constipation in the short term. Their use should not be made a habit though, nor should they be substituted for a fiber-rich diet and adequate intake of water. Osmotic laxatives, that act by drawing water into the colon, help soften the stools. Stimulant laxatives increase bowel movements, moving stools forward. Laxatives should never be stopped suddenly, because constipation returns quickly with sudden discontinuation.
  • If the stools are impacted and backed up in the colon, and if they cannot be cleared by conventional methods, then the bowels are cleared by surgery.
  • For severe cases of constipation, an enema (introduction of a large volume of fluid in the colon via the anus) is used to clear the bowels.
  • Surgery is performed to correct problems resulting from congenital abnormalities that are causing constipation.
Fecal Impaction
This is condition in which a huge bulk of very hard stools builds up in the rectum. Because of its bulk and consistency, it cannot be passed from the bowel even with effort. The bowel, in such a condition, is said to be impacted. It often occurs when children resist the urge to pass stools for various reasons. The stools remain in the colon, and more stools accumulate behind this large mass. When this occurs, the softer stools bypass the hard, impacted stools in front, and soil the clothes. The child is unaware of this because the rectum is constantly dilated from the hard stools, and the urge to defecate is reduced.

A large dose of laxatives may clear the impaction. If laxatives fail, the child may have to be hospitalized, where an enema is first administered to clear the bowels. If the impaction cannot be cleared by this, surgery may be performed to remove the impacted feces from the colon.
Constipation is not a serious problem, and in most instances, is entirely preventable. A high-fiber diet, with plenty of water and physical activity, are the right means to ensure that constipation does not occur in children.
Disclaimer: This article is for informative purposes only, and should not be used as a replacement for professional medical advice.
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