Framingham Pediatrics | Constipation

Constipation is a condition in which bowel movements occur less frequently than usual or stools tend to be hard, dry, large, and difficult or painful to pass.

Constipation is common in children and usually without long-term consequences; however, it can diminish a child’s quality of life, cause emotional problems, and create family stress. Rarely, constipation is a sign of a more serious health problem.

Causes

Constipation may occur at any time or under any circumstance, but is often associated with specific life changes.  These include starting solid foods, introducing cow’s milk, while toilet training and when starting school especially for the first time.

Many children inadvertently make constipation worse by withholding stool.  Reasons for stool withholding include:

• Stress about potty training
• Exertion of control
• Embarrassment or discomfort using a public bathroom
• Desire to not interrupt play
• Fear of a painful or unpleasant bowel movement

Withholding stool results in hard, large, dry, difficult to pass stools.  Delaying a bowel movement sometimes results in a large mass of stool in the rectum called a fecal impaction. Stool builds up behind the impaction and may unexpectedly leak, soiling a child’s underwear. Parents often mistake this soiling as a sign of diarrhea.

Signs/symptoms

Symptoms of constipation in children may include:

• Fewer bowel movements than usual
• Postures that indicate the child is withholding stool, such as standing on tiptoes and then rocking back on the heels of the feet, clenching buttocks muscles, and other unusual dancelike behaviors. Parents often mistake such postures as attempts to “push.” 
• Abdominal pain and cramping
• Painful or difficult bowel movements
• Hard, dry, or large stools
• Stool in the child’s underwear

Management/prevention

Primary management of constipation involves:

• Dietary changes
  • Increase fiber (see the table below for high fiber options).  For the picky eater fiber gummies or other soluble fiber sources are available
  • Increase fluid – you do not need to give your child more than the recommended daily fluid amount for their age, but ensuring proper hydration reduces constipation
  • Fruit juices – small amounts of apple, pear, peach or prune juice may help constipation (you want to use unfiltered/pulpy juices)
  • Limit fast foods, fatty foods, and drinks with caffeine
  • Limit whole milk to 16 ounces a day for the child over 2 years of age, but do not eliminate milk altogether. Children need the calcium in milk to help their bones grow strong
  • Offer meals on a regular schedule
• Increasing exercise
  • Increasing the amount of exercise your child gets can also help with constipation by helping the normal movements the intestines make to push food forward as it is digested
• Proper bowel habits
  • Sit on the toilet at least twice a day for at least 10 minutes, preferable after meals
  • Do not criticize or scold a child if they are unable to have a bowel movement
  • Try a sticker chart or reward system for motivation and encouragement
• Medications
  • Do NOT use any medications without consulting your provider!
  • Different medications are available for the long term management of constipation as well as for the short term relief of acute symptoms.If the above suggestions have not helped, call our office to discuss medication options with your provider