Constipation In Children: What To Do

Constipation, or constipation, is a relatively frequent disorder in children; it can be excruciating and stressful and often makes both children and parents nervous. It occurs when the feces descend too slowly along the colon, losing much of the water from which they are made, which is absorbed by the intestine: in this way, they become hard, and the child struggles to expel them.

1. A child may be considered constipated if he goes to the bathroom less than three times a week or if passing stool is difficult or painful  (due to hard stool)  for at least two weeks.

In most cases, constipation is functional, i.e., not linked to organic intestinal or extra-intestinal pathologies. Therefore, there is no reason to panic immediately. Some behavioral and nutritional measures can help you manage your baby’s lazy bowel.

Why Do Children Get Constipation?

The most frequent cause of constipation among children aged 2-4 years is functional fecal retention. It appears when the child, for at least three months, goes to the bathroom less than twice a week, purposely adopting a posture that does not facilitate, or even avoids, defecation. 

This happens because, following an unpleasant or painful experience related to the expulsion of feces (e.g., early or coercive potty training, interruption of games, discomfort in using school toilets, presence of anal fissures, etc.), the child may be afraid of going to the bathroom and tensions may arise when it is time to “poop.” 

Furthermore, if the child is constipated, the evacuation will be annoying or painful; this can activate a vicious circle: the more it hurts, the more the child resists retaining the stool, the more constipation increases, the more it hurts, and so on. Other prevalent causes of constipation in childhood can be:

1. Poor daily physical activity  ;
2. A diet too low in  fiber ;
3. Inadequate water consumption ( dehydration );
4. Emotional stress.
5. Symptoms of constipation
6. Frequent abdominal pain or cramps;
7. Abdominal tension and swelling ;
8. Sense of constipation or intestinal obstruction;
9. Stool hard and goatish;
10. Effort during evacuation;
11. The sensation of incomplete emptying of the intestine after passing stool;
12. Dirty panties or briefs;
13. Irritability, nervousness;
14. Lack of appetite.

Remember that some diseases may also have constipation among their signs and symptoms. This can happen in the case of cystic fibrosis,  Hirschsprung’s disease,  neuromuscular diseases, perianal fistulas typical of  Crohn’s disease,  food allergies,  celiac disease, and hypothyroidism. Therefore, if the child’s constipation continues for a long time, it is best to contact the pediatrician, who will carry out the necessary investigations.

Bowel Habits Of A Healthy Child

The following  evacuation behaviors  can be considered entirely normal :

1. The child, during the evacuation, makes sounds of effort (it almost seems like he is grunting); he may also have a red face and swollen neck veins;
2. Bowels will begin to decrease in frequency around two months to three years of age; then, you will notice that the new norm will be about one bowel movement per day.

What To Do If The Child Is Constipated

1. Increase fiber. Gradually add a little more fiber ( whole grains,  fruit, vegetables, dried fruit, etc.) into your little one’s diet every day so their intestines will have time to get used to the new diet.

• Offer at least two servings of fruit a day.
• Offer your son or daughter some prune juice  (ideally without sugar ), as it is a gentle, natural laxative that can work well. Too much sugar in children’s diet is harmful; here, you can calculate for free how much your son or daughter eats every day and how much they should eat to stay healthy.
• Offer at least two portions of seasonal vegetables every day. Children usually don’t like vegetables very much, especially the younger ones. One way to make him appreciate them more is to prepare soups or creams with lots of colorful vegetables, to be seasoned with a drizzle of raw extra virgin olive oil and a teaspoon of grated Grana Padano DOP  instead of salt. This cheese is the richest in calcium among the most commonly consumed ones, an essential mineral for the development of children’s bones and teeth; it also provides proteins with high biological value  (including the nine essential amino acids) and nutrients for correct growth such as vitamin B12, phosphorus, and zinc. Velvety soups also allow the child to consume a lot of water, an excellent ally against constipation.
• Opt for less processed grains  (e.g., whole-wheat pasta, whole-grain bread, etc.) rather than refined grains, such as cornflakes and white bread.
• Avoid foods that increase the consistency of the stool, such as too many bananas  (especially the greener and unripe ones),  apples  (especially if eaten peeled),  potatoes,  carrots, and rice, as they could have a “binding” effect on the stool of some children.

2. Increase the water. Drinking lots of water and eating lots of fiber are the first dietary behaviors to implement when constipation is present. Remember that as you increase your son or daughter’s fiber intake, you should also increase their water intake. According to the LARN (Reference Intake Levels of Nutrients and Energy), from 1 to 3 years old, children need, on average, 1200 ml of liquids per day. This recommendation includes water from all sources: drinking water, other drinks (chamomile, infusions, etc.), and food, which represents approximately 20-30% of the total. Remember that, at this age, a child should drink about five medium 200ml glasses of plain water per day.
3. Promote physical activity. Physical activity, along with the proper diet, can help reduce the amount of time it takes for food to pass through the intestines. Therefore, encourage your child to move more!

• For children aged 1 to 4 years, 180 minutes of physical activity per day  (which may also include playing ) are recommended, with at least  60 minutes of energetic activity  (e.g., jumping, running, playing football, etc.). Read this article to find out what sporting activity you can do with your children.
• Do not let your son or daughter sit still for more than an hour (e.g., in a pram, stroller, etc.). Invite the boy or girl to walk with you.
• The time spent in front of the TV – and screens in general – should be less than an hour a day, even better if less.

4. Observe whether he voluntarily retains his stool. Voluntary stool retention is perhaps the most common cause of constipation in children 2-4 years of age. Up to a certain point in life, when a child needs to defecate, he can freely use the diaper. Then, in the future in time, he will be asked to control the need to poo to potty train him. Between 18 and 36 months, in most cases, children learn to stay dry and not get dirty, following a gradual process in which it is essential that parents do not coercively impose information and new habits and that they are always accompanied by mechanisms of gratification,  never of punishment. Severe potty training can cause constipation even in children with previously utterly regular bowel movements.
5. Keep bathroom time peaceful. Eating usually causes a bowel urge (known as the gastro-colic reflex) within 30 to 60 minutes. Your child should sit on the toilet or potty after breakfast, lunch, and dinner,  even if he doesn’t feel the need to go to the bathroom. It would help if you allowed him to sit for 3 to 5 minutes – using a kitchen timer can avoid arguments about how much time has passed. For example, serve breakfast early in the morning so the child will have time to feel the intestinal urge and defecate at home before running to school.
6. Consider taking medications. There are several medications or other remedies that can help treat or manage chronic constipation in children. Medications may include laxatives or intestinal motility agents. It is essential, however,  to talk to your family pediatrician to find the proper medication for your son or daughter.

When Contacting Your Pediatrician

While constipation is generally not a dangerous health condition, there are some red flags to watch out for! Contact your pediatrician if your child, along with constipation, has: Blood in the stool;

1. Blood during cleaning of the anus;
2. Fever or vomiting;
3. Poor growth ;
4. Dehydration (dark urine, significant reduction in the number of wet diapers, dry skin, dry lips, and sunken eyes);
5. Anal fissures.

A pediatric dietitian can help you create a personalized food plan for your little boy or girl, with practical advice that adapts to his or her needs and the needs of the entire family in order to regain intestinal well-being.

Read Also: Inflamed Intestine And Back Pain: Causes And Remedies