Constipation in a child needs more attention than it does in adults. A newborn in the first week of life typically passes about four soft stools per day; however, the frequency of stools may decrease to around three per day in the first three months. Babies who are breastfed are rarely constipated, and have more and bulkier stools compared to formula-fed babies. The frequency continues to decrease as the child grows, and by the age of 2 they typically only form one to two stools per day.

But, no two kids are alike, so frequencies between individual children can differ. Passing a stool a few times a day to once every few days is normal, as long as the stools are usual in consistency and can be passed without discomfort or straining.

Symptoms

Any change in stool size or consistency is a signal something is off, but there are other, more obvious signs as well. For example, a baby who cries while trying to pass stools could be constipated.

Furthermore, a constipated child typically adopts a different posture when trying to pass stools: babies will tighten their backs and buttocks, while toddlers arch the back, squat, or stand on their tiptoes. Older children may shy away from going to the toilet altogether, which could signal a fear to pass stools due to the distress and pain experienced while trying to do so.

Other signs include a lack of bowel movements for several days and blood-streaked stools. A child who sees a change in their stools along with abdominal pain, a refusal to feed and disinterest in favorite foods, and a feeling of vomiting might be constipated. Children also become cranky when constipated.

Causes

Constipation can have many causes. Formulas containing iron can cause hard stools. Once a child is eating table foods, a lack of fruits and vegetables (which are both high in fiber) can bring on constipation. Sometimes it develops when the child, who does not want to interrupt playing or knows that it is going to hurt to pass stools, tries to withhold the bowel movement. Constipation can also develop if parents begin toilet training too early. A sudden change in diet or the introduction of new foods is another common cause for constipation.

Constipation can also be caused by medicines the child is taking, such as cough syrups containing codeine. Rarely, medical illnesses such as an under-functioning thyroid gland, stomach or intestinal malformations, spinal cord abnormalities, or dehydration can be associated with chronic constipation.

Taking Care of Your Child

Having your child drink plenty of fluids, especially milk, juice, and water, can help with constipation. Fiber-rich fruits and vegetables, as well as whole grains and beans, add bulk to the stool and facilitate bowel movements. Over-the-counter fiber supplements can also help.

It is also important to assist the child on the toilet. A responsible adult should escort the child to the toilet and encourage them to move their bowels for few minutes. Prolonged “pushing” should be avoided as this can result in bulging hemorrhoids. This should be attempted after each meal, or at least twice or three times a day.

If constipation continues a trip to a family medicine doctor or pediatrician may be necessary. The doctor will inquire about both the regular and current bowel routine, examine the abdomen, and also sometimes pass a gloved finger gently into the anus to check for the presence of any hard stools in the rectum.

An X-ray can be done to check for shadows of hard stool in the intestines. Occasionally, before the X-ray is done, an enema with a type of contrast dye, called barium, may be used to help visualize the rectum and colon.

Typically, these procedures are enough to diagnose constipation. The extensive and invasive testing is usually reserved for the most severe cases of constipation.

Sometimes, a procedure called an anoscopy is performed where a flexible tube with a mounted camera is inserted through the anus to take a look at the intestines from inside.

Furthermore, a sample of rectal tissue may be collected. This enables the doctor to examine nerve cells in the tissue. Transit studies can also be done to study bowel movements. To conduct one, the child ingests a capsule containing markers that show up on X-rays taken over the next few days. Eventually, the capsule is passed in the stool.

Treatment

In young infants, glycerine suppositories can be safely used and provide gentle lubrication which assists in softening hard stools. In infants 4 to 6 months and older, prune or pear juice added to formula can help soften stools as well. Conversely, one should avoid feeding rice and apple foods to constipated infants and toddlers, as both can tend to harden stool. If constipation persists for long in older children, the doctor will recommend fiber supplements or stool softeners. If the hard stool becomes impacted in the rectum, a laxative may be prescribed to facilitate intestinal motility. Do not give laxatives to a child without it being recommended by a doctor.

If the problem is especially severe, the doctor may recommend using an enema to “clean” the bowels.

Prevention

Constipation in children can be prevented by following a consistent toilet routine and eating a balanced diet containing fruit, vegetables, and whole grains. Fiber is an important dietary component that makes stool bulky and easy to pass. Foods that contain fiber include vegetables, beans, high-fiber cereals, and fruits. Mashed bananas or pureed fruits can be added to rice for smaller children. Meats and cheeses should be limited or avoided, as they tend to firm up stools and can worsen constipation.

Liquids are also important for preventing constipation. The child should be allowed to drink lots of water, as well as their favorite juices and soups. The child also should be encouraged to play and run around and keep active.