Constipation in infants and children: what is this, causes, symptoms, diagnostics, treatment, prevention

Constipation in infants and children; Irregularity of bowels; Lack of regular bowel movements

Constipation is a common digestive problem., that affects children of all ages. This is defined as having fewer than three bowel movements per week or difficulty emptying solids., dry stool. Constipation is a common complaint among infants and children and can be caused by a variety of factors., including dietary changes, medications and comorbidities.

What is constipation in babies and children?

Constipation in infants is defined as the delay or difficulty in passing meconium., first stool after birth, what usually happens during the first 24-48 hours of life. For older children, constipation is characterized by infrequent or difficult bowel movements.. Some children may also experience abdominal pain., discomfort or bloating.

What causes constipation in babies and children?

There are several factors, which may contribute to constipation in infants and children. Some common causes include dietary changes, dehydration, mixture intolerance, lack of physical activity and certain diseases, such as hypothyroidism, Hirschsprung disease and anorectal malformations. Other factors, which may increase the risk of constipation in children, include changes in daily routine or environment, stress and some drugs.

Symptoms of constipation in infants and children

Symptoms of constipation in infants and children can vary depending on the severity of the condition.. Babies may have difficulty passing a bowel movement or the stool may be hard, dry or pebbly. They may also show signs of discomfort during bowel movements., eg, cry or arch your back. In older children, constipation can cause abdominal pain, bloating or discomfort. Some children may also experience nausea, vomiting or loss of appetite.

In the first month, babies, usually, defecate about once a day. Babies can then go for several days or even a week between bowel movements.. It is also difficult for children to defecate, because their abdominal muscles are weak. Thus, babies, usually, tense up, cry and blush, when they have a bowel movement. It does not mean, that they are constipated. If the stool is soft, then problems, probably, no.

Signs of constipation in infants and children may include:

• Restlessness and frequent spitting up (in infants)
• Difficulty with bowel movements or discomfort
• Solid, dry stools
• Pain during bowel movements
• Abdominal pain and bloating
• Big, wide stools
• Blood on stool or toilet paper
• Traces of fluid or stool on the child's underwear (may be a sign of fecal contamination)
• Less than 3 bowel movements per week (children)
• Moving the body in different positions or squeezing the buttocks

Before treating constipation, make sure, that your baby or child has problems, since:

• Some children don't have a bowel movement every day..
• Besides, some healthy children always have very soft stools.
• Some children have hard stools, but it can pass without problems.

When to contact a healthcare professional

It is important to contact a healthcare professional, if your child has not had a bowel movement for more than two days or has severe abdominal pain, vomiting or rectal bleeding. You should also seek medical attention, if your child is not gaining weight, he has a fever or feels unwell.

Questions, that your doctor may ask

When you contact a healthcare professional, he may ask questions about your child's medical history, his diet and bowel habits. They may also ask about any recent changes in your child's daily routine or environment.. Some questions, that your doctor may ask, include:

• When was the last time your child had a bowel movement??
• What does your child's chair look like??
• Your child experiences pain or discomfort during a bowel movement?
• What is your child's typical diet?
• Your child is drinking enough fluids?
• Have there been any recent changes in your child's daily routine or environment?

Diagnosis of constipation in infants and children

The diagnosis of constipation in infants and children is usually based on a physical examination., medical history and stool analysis. Your doctor may also order blood tests, X-ray or other imaging tests, to rule out any underlying disease. If your child has chronic constipation, your doctor may recommend further testing or refer you to a specialist for further testing.

Treatment of constipation in infants and children

Treatment for constipation in infants and children usually involves changing the diet, increased fluid intake and increased physical activity. Your doctor may also recommend stool softeners or laxatives., to help your child have an easier bowel movement. In some cases, your child may need surgery, to correct the underlying disease.

Home Treatments for Constipation in Babies and Children

In addition to medication, there are several home remedies., which may help relieve constipation in infants and children.

Lifestyle changes can help your child avoid constipation. These changes can also be used to treat it..

For infants:

• Give your baby more water or juice throughout the day between feedings.. Juice can help increase the amount of water in the colon.
• Children over 2 months: try giving your child 60 to 120 ml fruit juice (grape, pear, apple, cherry or prunes) twice a day.
• Children over 4 months: if the child began to eat solid food, try high fiber baby food, like peas, beans, apricots, prunes, peaches, Pears, plums and spinach twice a day.

For children:

• Let your child drink plenty of fluids every day. Your child's doctor can tell you, How many.
• Give your child more fruits and vegetables, as well as foods high in fiber, such as whole grains.
• Avoid giving your child certain foods, like cheese, fast food, prepared and processed foods, meat and ice cream.
• Stop toilet training, if your child has constipation. Resume after, how your child will no longer be constipated.
• Teach older children to use the toilet immediately after eating.

Stool softeners (eg, containing docusate sodium) can help older children. Bulk laxatives, such as psyllium, may help add fluid and bulk to stools. Suppositories or mild laxatives can help your child have regular bowel movements.. Electrolyte solutions, such as Miralax, can also be effective.

Some children may need enemas or prescription laxatives. These methods should only be used if, if fiber, liquids and stool softeners do not provide sufficient relief.

Do not give children laxatives or enemas, without consulting your doctor first.

Prevention of constipation in infants and children

Prevention of constipation in infants and children is essential, and there are several steps, who are parents and persons, carers, can take, to prevent it. These include:

• Encourage a healthy diet. Eat a diet that is high in fiber and includes fruits, vegetables, whole grains and beans. These foods can help soften stools and make them easier to pass..
• Increase your fluid intake. Encourage your child to drink plenty of fluids, especially water, to keep the body hydrated and soften the stool. Do not give your child sugary drinks or caffeine.
• Encourage physical activity. Encourage your child to be physically active and engage in regular exercise. It may help stimulate intestinal motility and support a healthy digestive system..
• Establish regular toilet habits. Encourage your child to use the toilet regularly and provide a comfortable and safe environment to do so.. It may help prevent constipation and promote healthy bowel movements..
• Elimination of any underlying diseases. If your child has an underlying medical condition, which can contribute to constipation, be sure to follow the recommended treatment plan and work with your healthcare provider, to deal with this disease.

Used sources and literature

Kwan KY. Abdominal pain. In: OlympiaRP, O’Neill RM, Silvis ML, eds. Urgent Care Medicine Secrets. Philadelphia, PA: Elsevier; 2018:chap 19.

Maqbool A, Liacouras CA. Major symptoms and signs of digestive tract disorders. In: Kliegman RM, St. Geme JW, Bloom NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 332.

National Institute of Diabetes and Digestive and Kidney Diseases. Constipation in children. www.niddk.nih.gov/health-information/digestive-diseases/constipation-children/definition-facts. Updated May 2018. Accessed September 20, 2022.

Rutter P, Gastroenterology. In: Rutter P, ed. Community Pharmacy. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 7.