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Constipation in children – Symptoms and causes
Constipation in children is a common problem. A constipated child has infrequent bowel movements or hard, dry stools.
Common causes include early toilet training and changes in diet. Fortunately, most cases of constipation in children are temporary.
Encouraging your child to make simple dietary changes — such as eating more fiber-rich fruits and vegetables and drinking more water — can go a long way toward alleviating constipation. If your child’s doctor approves, it may be possible to treat a child’s constipation with laxatives.
Signs and symptoms of constipation in children may include:
- Less than three bowel movements a week
- Bowel movements that are hard, dry and difficult to pass
- Pain while having a bowel movement
- Stomach pain
- Traces of liquid or pasty stool in your child’s underwear — a sign that stool is backed up in the rectum
- Blood on the surface of hard stool
If your child fears that having a bowel movement will hurt, he or she may try to avoid it. You may notice your child crossing his or her legs, clenching his or her buttocks, twisting his or her body, or making faces when attempting to hold stool.
When to see a doctor
Constipation in children usually isn’t serious. However, chronic constipation may lead to complications or signal an underlying condition. Take your child to a doctor if the constipation lasts longer than two weeks or is accompanied by:
- Not eating
- Blood in the stool
- Abdominal swelling
- Weight loss
- Pain during bowel movements
- Part of the intestine coming out of the anus (rectal prolapse)
Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract, causing the stool to become hard and dry.
Many factors can contribute to constipation in children, including:
Withholding. Your child may ignore the urge to have a bowel movement because he or she is afraid of the toilet or doesn’t want to take a break from play. Some children withhold when they’re away from home because they’re uncomfortable using public toilets.
Painful bowel movements caused by large, hard stools also may lead to withholding. If it hurts to poop, your child may try to avoid a repeat of the distressing experience.
- Toilet training issues. If you begin toilet training too soon, your child may rebel and hold in stool. If toilet training becomes a battle of wills, a voluntary decision to ignore the urge to poop can quickly become an involuntary habit that’s tough to change.
- Changes in diet. Not enough fiber-rich fruits and vegetables or fluid in your child’s diet may cause constipation. One of the more common times for children to become constipated is when they’re switching from an all-liquid diet to one that includes solid foods.
- Changes in routine. Any changes in your child’s routine — such as travel, hot weather or stress — can affect bowel function. Children are also more likely to experience constipation when they first start school outside of the home.
- Medications. Certain antidepressants and various other drugs can contribute to constipation.
- Cow’s milk allergy. An allergy to cow’s milk or consuming too many dairy products (cheese and cow’s milk) sometimes leads to constipation.
- Family history. Children who have family members who have experienced constipation are more likely to develop constipation. This may be due to shared genetic or environmental factors.
- Medical conditions. Rarely, constipation in children indicates an anatomic malformation, a metabolic or digestive system problem, or another underlying condition.
Constipation in children is more likely to affect kids who:
- Are sedentary
- Don’t eat enough fiber
- Don’t drink enough fluids
- Take certain medications, including some antidepressants
- Have a medical condition affecting the anus or rectum
- Have a neurological disorder
Although constipation in children can be uncomfortable, it usually isn’t serious. If constipation becomes chronic, however, complications may include:
- Painful breaks in the skin around the anus (anal fissures)
- Rectal prolapse, when the rectum comes out of the anus
- Stool withholding
- Avoiding bowel movements because of pain, which causes impacted stool to collect in the colon and rectum and leak out (encopresis)
To help prevent constipation in children:
Offer your child high-fiber foods. A diet rich in fiber can help your child’s body form soft, bulky stool. Serve your child more high-fiber foods, such as fruits, vegetables, beans, and whole-grain cereals and breads. If your child isn’t used to a high-fiber diet, start by adding just several grams of fiber a day to prevent gas and bloating.
The recommended intake for dietary fiber is 14 grams for every 1,000 calories in your child’s diet.
For younger children, this translates to an intake of about 20 grams of dietary fiber a day. For adolescent girls and young women, it’s 29 grams a day. And for adolescent boys and young men, it’s 38 grams a day.
- Encourage your child to drink plenty of fluids. Water is often the best.
- Promote physical activity. Regular physical activity helps stimulate normal bowel function.
- Create a toilet routine. Regularly set aside time after meals for your child to use the toilet. If necessary, provide a footstool so that your child is comfortable sitting on the toilet and has enough leverage to release a stool.
- Remind your child to heed nature’s call. Some children get so wrapped up in play that they ignore the urge to have a bowel movement. If such delays occur often, they can contribute to constipation.
- Be supportive. Reward your child’s efforts, not results. Give children small rewards for trying to move their bowels. Possible rewards include stickers or a special book or game that’s only available after (or possibly during) toilet time. And don’t punish a child who has soiled his or her underwear.
- Review medications. If your child is taking a medication that causes constipation, ask his or her doctor about other options.
Aug. 06, 2019
- McInerny TK, et al., eds. Constipation. In: American Academy of Pediatrics Textbook of Pediatric Care. 2nd ed. Elk Grove Village, Ill.: American Academy of Pediatrics; 2017. https://www.ebscohost.com/ebooks. Accessed May 31, 2019.
- Van Mill MJ, et al. Controversies in the management of functional constipation in children. Current Gastroenterology Reports. 2019;21:23.
- Constipation in children. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation-children/all-content. Accessed May 31, 2019.
- Wyllie R, et al., eds. Functional constipation and incontinence. In: Pediatric Gastrointestinal and Liver Disease. 5th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed May 31, 2019.
- Sood MR. Functional constipation in infants and children: Clinical features and differential diagnosis. https://www.uptodate.com/contents/search. Accessed May 31, 2019.
- Constipation in children. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pediatrics/symptoms-in-infants-and-children/constipation-in-children?query=constipation in children#. Accessed May 31, 2019.
- Sood MR. Recent-onset constipation in infants and children. https://www.uptodate.com/contents/search. Accessed May 31, 2019.
- Ferri FF. Constipation. In: Ferri’s Clinical Advisor 2019. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Accessed June 3, 2019.
- Rakel D, ed. Recurring abdominal pain in pediatrics. In: Integrative Medicine. 4th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed June 3, 2019.
- 2015-2020 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://health.gov/dietaryguidelines/2015/guidelines. Accessed May 31, 2019.
- Kashyap PC (expert opinion). Mayo Clinic, Rochester, Minn. June 7, 2019.
Symptoms, Treatment and When to Call a Doctor
Constipation (con-sta-PA-shun) in infants less than one year of age is common, but it can be a source of concern for parents. Sometimes your baby is not really constipated, but must be given time to set his own schedule for having a bowel movement. Normally, an infant’s stool is soft and easily passed. Even if an infant is not constipated, his bowel movements may be irregular.
In rare cases, constipation may be caused by a lack of nerves or by structural problems in the lower large intestine. Your baby can be tested for these conditions if your doctor feels it is necessary.
Signs of Constipation
- Infrequent stools that are difficult to pass
- Straining more than normal to have a bowel movement
- Stools formed like small, hard small pebbles, stools that are soft and mushy; stools that are wide and large
- Liquid stool (like diarrhea) that may be passing around solid stool that stays inside
- Abdomen (belly) swollen with gas
- Painful cramps
- If your baby is old enough to eat strained foods, you may give him fruits and vegetables.
- If your baby is not eating jar baby food yet, you may give 2 to 4 ounces of fruit juices (prune, pear, cherry, or apple) per day. If his stools become too loose, give less juice to your baby.
- If your baby is eating rice cereal, it may help to switch to oatmeal or barley cereal. Rice cereal can cause constipation in some children.
- Do not give your baby enemas, laxatives, or suppositories unless you are told to do so by the doctor.
Your doctor has ordered the following treatments:
- Give your child the following medicine: _______________________.
- Check your child’s temperature by rectum using a lubricated rectal thermometer. This may stimulate the baby to pass stool.
When to Call the Doctor
Call your child’s doctor if any of the following occurs:
- Your baby is irritable and seems to be having abdominal pain.
- You see blood in your baby’s stool.
- Your baby’s constipation does not improve with current treatment.
If you have any questions or concerns, call your baby’s doctor at ___________________.
Constipation: Infant (PDF)
HH-I-14 7/84, Revised 3/14 Copyright 1984, Nationwide Children’s Hospital
10 Common Symptoms in Infants and Young Toddlers
An infection, trouble digesting certain foods, or too much fruit juice or milk are among the causes. If your child gets it, keep her at home and hydrated. If she’s on solids, avoid high-fiber and greasy foods. Call the doctor if she isn’t better in 24 hours, is under 6 months old, or has other symptoms, such as a fever of 101 or higher, vomiting, peeing less than usual, fast heart rate, bloody or black stool, or belly pain.
Call the doctor immediately if:
- A baby under 3 months has a rectal temperature of 100.4 or higher.
- A baby 3 to 6 months old has a temperature of 101 or higher.
- Or if an infant is crying, irritable, and can’t be comforted.
Watch for ear pain, a cough, lethargy, a rash, vomiting, or diarrhea. Soothe your little one with fluids, a lukewarm bath, and by dressing him in lightweight clothes. Ask your doctor about safe ways to lower a fever.
Some babies poop several times a day. Others go a few days between bowel movements. Constipation is when stools are hard and painful to pass. Your doctor may suggest that you add a few extra ounces of water or a bit of prune juice to your child’s bottle or sippy cup.The doctor may also tell you to limit dairy intake to less than 16 ounces per day, Call the doctor if the problem continues or your baby has other symptoms, such as belly pain or vomiting.
Babies have sensitive skin. Rashes can range from pimples to little white bumps (milia) to red, dry, itchy patches (eczema). To avoid diaper rash, change diapers often, and apply an ointment for protection. For eczema, skip harsh soaps and keep your child’s skin moisturized. Most rashes aren’t serious. But call the doctor if the one your baby has is painful or severe, or if he also has a fever or blisters.
Cough: Babies and Toddlers
Listen to how it sounds. A seal-like bark could be croup. Coughs with a mild fever are often from a cold. A higher persistent fever may mean pneumonia or the flu. Wheezing with a cough could be asthma or an infection. Babies with pertussis have coughing spasms and make a “whooping” sound. A cool-mist humidifier and fluids can ease the symptoms. Don’t give cough or cold medicines to babies or children younger than 4 years.
When your little one has an upset tummy, he may cry a lot, arch his back, and spit up. It can happen because of colic, reflux, trouble with certain foods, an infection, or other reasons. Some tots have problems as they try different foods. Most stomachaches are harmless and brief. But call the doctor if it doesn’t improve, or your child vomits, has diarrhea, becomes lethargic, or runs a fever.
By the time she’s about 6 months old, tiny teeth will start to poke through her gums. That often makes babies cry a lot! Give her something to chew on. A rubber teething ring that’s BPA-free works well. You can also gently massage your baby’s gums with your finger, or give her something cool to chew on, like a wet, cold washcloth. You can ask your doctor if a pain reliever such as acetaminophen is OK.
It’s normal! To help your baby not be too gassy, feed him slowly and gently burp him often. Take a burp break while feeding and after, too. If you use formula, try not to shake it a lot (to avoid bubbles).
Baby’s congested? Don’t use over-the-counter cold medicine in children under 4 years. Instead, use saline drops to thin out mucus, and then suction it out of your child’s nose with a bulb syringe. A vaporizer machine can help him breathe easier at night.
Nausea and Vomiting
It’s common — and harmless! — for babies to spit up a bit after eating. Little kids can get upset tummies, too. Keep yours hydrated. Call the doctor if the vomiting doesn’t stop in a few hours, happens in a baby who also has a fever, or if your child can’t keep down fluids.
How to Keep Your Cool
When your baby feels bad, you do, too. Try to stay calm and trust your instincts. Watch for signs that he needs a doctor or emergency medical care. Some warning signs include appetite changes, extreme fussiness, lethargy, breathing problems, rashes, a stiff neck, seizure, a high fever, and a lack of wet diapers.
9 Signs You Should Be Worried About Your Child’s Constipation
Fort Worth, Texas,
Doc Smitty explains the warning signs that your child needs help
Constipation in children is common. It affects 30 percent of kids at some point in their life, is usually short lived and not severe. Most people call this functional constipation (despite how functional or dysfunctional you feel in the midst of it).
Following our posts on the safety of Miralax and answering some frequently asked questions about Miralax use for constipation, we heard one resounding question:
“When should I be worried and when should more workup be done?”
Benign (or not concerning) causes:
- Constipation starts with a dietary change or at the time of toilet training
- Children show a stool withholding behavior
- Things resolve easily with stool softeners
But what are the warning signs? When should you be worried? Here are nine symptoms or signs that more workup should be considered for your child’s constipation:
- Constipation has been present since birth or early infancy
- Any other symptoms with constipation-fever, vomiting or diarrhea
- Bleeding in the stool or from the rectum
- Swelling or distension of the belly
- Long, narrow stools (sometimes called “ribbon stools”)
- Urinary accidents or recurrent urinary tract infections
- Poor growth or weight loss
- Other, non-belly symptoms, especially neurologic symptoms like weakness or abnormal sensation in the legs
- Abnormal findings in the lower back (birthmarks or hair along the spine)
The workup for constipation can vary depending on the child’s symptoms and exam findings. Some things that might be considered:
Imaging -Most commonly the child will undergo a barium enema which is an X-ray that is enhanced by an enema that shows up on the X-ray. If there are concerns about the child’s neurologic symptoms, an MRI of the spine can be conducted to rule out something called a tethered cord.
Blood work – Depending on the child’s symptoms, blood testing for the following could be indicated: celiac or thyroid disease, calclium and blood lead levels.
In severe constipation or constipation that does not resolve, a referral to a gastrointestinal doctor can be helpful for further workup and treatment recommendations.
Birth defects of the anus
Abnormal position of the anus
Opening of the anus that appears closer than normal to the genitals
Measurements to determine the exact location of the anus’s opening
Anal stenosis (a narrowed anus)
Delayed passage of the first BM (called meconium) during the first 24–48 hours of life
Explosive and painful BMs
Abnormal appearance or position of the anus
A blockage of the anus detected during a doctor’s examination
A doctor’s examination done soon after birth
A raw, red area on the back where the spinal cord protrudes, seen at birth
A decrease in reflexes of the legs or in muscle tone
Absence of the normal reflex of the anus (a tightening when lightly touched, called anal wink)
Plain x-rays of the lower spine
Occult spina bifida (incomplete formation of the bones of the spine)
Possibly a tuft of hair or dimpling on the skin over the defect, seen at birth
A tethered spinal cord (during fetal development, the spinal cord is stuck at the lower end of the spinal column and cannot move up to its normal position)
Problems with walking, pain or weakness in the legs, and back pain
A tumor near the tailbone (sacral teratoma) or other spinal cord tumor
Back pain, problems with walking, and pain or weakness in the legs
Infection of the spine or spinal cord
Back pain, problems with walking, and pain or weakness in the legs
Hormonal, metabolic, or electrolyte disorders
Diabetes insipidus (due to problems with antidiuretic hormone, which helps regulate the amount of water in the body)
Excessive thirst and excessive crying that is quieted by giving children water
Excessive urination of dilute urine
Urine and blood tests to measure how dilute urine and blood are (osmolality)
Blood tests to measure antidiuretic hormone levels
Nausea and vomiting, loss of appetite, weight loss, muscle weakness, and abdominal pain
Excessive thirst and excessive urination
Blood tests to measure the calcium level
Hypokalemia (an abnormally low potassium level in the blood)
Excessive urination and dehydration
Not growing as expected (failure to thrive)
Possibly use of diuretics or certain antibiotics
Blood tests to measure levels of electrolytes
In newborns, large soft spots (fontanelles) between the skull bones and slack muscle tone
Dry skin, intolerance of cold, fatigue, and jaundice
Blood tests to measure thyroid hormone levels
Delayed passage of the first BM
Poor weight gain or failure to thrive
Frequent bouts of pneumonia
Possibly genetic testing to confirm the diagnosis
Delayed passage of the first BM
Green or yellow vomit, indicating that it contains bile
A narrowed anus detected during a doctor’s examination
X-rays of the lower digestive tract after barium is inserted in the rectum (barium enema)
Measurement of pressure inside the anus and rectum (manometry)
Weight loss, poor growth, or both
Symptoms that lessen when the formula is changed
Possibly endoscopy, colonoscopy, or both
Long-standing (chronic) abdominal pain
Diarrhea and constipation that come and go
A feeling of incomplete emptying after a BM
Evaluation of BM patterns and the timing and characteristics of pain
Exclusion of other disorders by history, physical examination, and possibly blood tests, stool tests, imaging, or colonoscopy
Pseudo-obstruction (which causes symptoms of a blockage but no blockage is detected)
Abdominal pain and a swollen abdomen
Tests to assess how well the bowel functions (bowel motility studies)
Weight loss, night sweats, and fever
Abdominal swelling or pain
An abdominal mass detected during a doctor’s examination
Use of drugs that can cause constipation
A sudden reduction in the ability to suck
Sometimes consumption of honey before age 12 months
A test for botulinum toxin in stool
Possibly abdominal pain, fatigue, and irritability
Regression in development
Blood tests to measure the lead level
Constipation in Infants
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Small infants can become constipated. If your baby’s stools are dry hard pellets, or if they’re large, firm and painful, then he might be constipated.
Surprisingly, the frequency of the infant’s bowel movements are not very important, as long as they are soft. Some infants make a bowel movement only once every few days; if the baby is otherwise healthy, then this is probably normal.
A baby’s stomach muscles are not very strong, so the baby may have to push in order to produce a stool. Often, parents will worry when the baby cries or seems to strain with a bowel movement; they may notice that the belly seems “hard.” Again, if the stool is soft, then this is normal, and needs no treatment.
Constipation does not cause any symptoms other than the hard stools, some fussiness, and occasionally a mild increase in spitting up. Persistent vomiting, fever, or congestion are not caused by constipation; if a fussy baby has these or other symptoms, an exam is needed; do not assume that the baby is simply constipated.
(Occasionally, a small amount of bright red blood can be seen on the outside of the stool. This is common with constipation; usually, close inspection of the anus under a bright light will reveal a small fissure or abrasion. This is not dangerous by itself, but it’s a sign that the constipation needs treatment.)
On the other hand, true constipation in infants certainly needs to be treated. Babies can (and do) learn that having a hard stool causes pain, and sometimes they try to avoid it, resulting in stool withholding behavior. This behavior is difficult to treat, so it’s best to treat the constipation as soon as it’s noticed.
What causes constipation in an infant? Usually, we never find out. Occasionally a milk protein intolerance is the cause, and the problem might resolve by changing to soy or a different formula. More commonly, especially with infants less than 2 months old, the baby needs to be fed more frequently, even as often as every 1½ to 2 hours or more. But most of the time, the constipation appears to be a random occurrence.
Many folk remedies for constipation might be recommended to parents. Unfortunately, most of them don’t work. For example, increasing the water intake does not help constipated infants; dehydration is rarely the cause of constipation, because breast milk and formula are about 85% water anyway. Apple juice generally does not help. Herbal remedies are generally of no value. Massaging the abdomen might soothe the baby, but it does not help pass stool.
But in the short term, there are several treatments that do help constipated infants. Rectal stimulation with the tip of a thermometer can stimulate a reflex that causes the baby to stool. Prune juice or pear juice can help; they contain non-absorbable sugars that draw more water into the colon, which softens the stool.
An “infant size” glycerin suppository (from the drug store) can be helpful. The waxy kind can be pushed into the rectum, up to your first knuckle; the body’s heat will melt the suppository, which lubricates the stool and stimulates the colon reflex. Or, you can obtain liquid “glycerin suppositories” in a small plastic tube; the tip is inserted in the rectum, and the bulb is squeezed to release the glycerin into the colon. Either of these may be used, as often as every 20 minutes until the infant stools. But if you get no result after the 3rd application, further suppositories probably won’t help. In unusual circumstances, an infant Fleets enema is can be used, but young infants rarely need an enema.
If the baby’s constipation is persistent, it is easily treated. I recommend Miralax® or a generic version, the same medication that an adult would use. Once or twice a day, you can dissolve a teaspoon or two in an ounce or so of water or the baby’s milk, and give it to the baby in a bottle, syringe or spoon. Once you start the Miralax, it’s best to continue it every day until the baby has gone 2-3 weeks without having any hard stools at all. Stool softeners like Miralax are absolutely not habit-forming. Some infants and children need daily Miralax for many months in order to prevent constipation; the Miralax has no side effects, and there is no reason to withhold or reduce it until the child can form soft, easily passed stools on his own.
Copyright © David M. Epstein MD, April 2010
Fever Due To Constipation – Can Constipation Cause
Can constipation cause fever?
Before answering whether or not constipation causes fever, we must understand when and why an individual develops a fever.Fever is basically having a temperature above the normal range due to an increase in the body’s temperature set-point. A fever can be caused by many medical conditions ranging from viral, bacterial and parasitic infections such as the common cold, urinary tract infections, meningitis, malaria and appendicitis among others. In these conditions your body can be compared to a state of war, where there are cells called inflammatory mediators that are fighting the infectious agent. These produce agents called pyrogens which in turn reset the temperature set point at an area of your brain called Hypothalamus. But then if constipation would cause a fever, how would it?
So basically Constipation refers to abnormally infrequent bowel motions and/or pain or difficulty when passing small, hard stools.At the Centre for Digestive Diseases long standing research in this area has indicated that the most likely cause of the common variety constipation found in the majority of patients is caused by an infection with a bacterial agent that has entered the bowel through the mouth and has begun to coexist with normal human bowel flora. Its presence in the bowel flora is marked by the production of molecules within the bowel which affect the enteric nervous system so partially paralysing the bowel. If the constipation agent produces severe paralysis the bowel may not empty for days or weeks.The actual causative agent or agents are yet to be detected. However it has been proposed that a bacteria called clostridium is implicated.
Now this bacteria works by producing a toxin which is a neurotoxin. Presence of this toxin alerts your body to produce inflammatory mediators which cause the fever as explained above.
Hence constipation is often said to be caused due to a chronic bacterial infection and this can be associated with fever, in simpler words constipation as such might not cause a fever per se but could be associated with it.
But this is not the only proposed theory regarding the same.Common complications of constipation include
→ Fecal impaction that is a solid, immobile bulk of human feces that can develop in the rectum due to altered bowel movements
→ Swollen veins in your anus (hemorrhoids),torn skin in your anus (anal fissure), intestines that protrude from the anus (rectal prolapse).
These conditions also rarely could lead to a fever,hence complications of constipation such as fecal impaction,anal fissures, rectal prolapse etc could be implicated in the causation of fever in this condition.
So if you are a victim of constipation and have developed a fever off late, there could be a relation between the two and it is advised you consult a physician.
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Constipation refers to abnormally infrequent bowel motions and/or pain or difficulty when passing small, hard stools. As such constipation doesn’t cause fever but the underlying reason for the constipation to occur can cause fever. Bacterial, viral and parasitic infections when they are the underlying cause it is possible to develop fever and for it to be associated with constipation. If you develop fever and if it is associated with constipation you should visit the ER at the earliest. These following steps may help you with relief of constipation:
– Dehydration can make you constipated, so make sure to drink enough water. Aim to drink 3 liters of water per day.
– Eat high soluble fiber such as oat bran, barley, nuts, seeds, beans, lentils , peas, fruits, prunes, etc.
– Exercise regularly(30-45mins/day)
– Coffee can help stimulate the gut and get relief from constipation.
– You can have laxatives if your stools are loose which will help with the constipation.
– Eat probiotics or probiotic enriched food.
Have laxatives to get relief from the constipation
If condition persists or worsens visit the ER at the earliest
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Disclaimer : The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
Disclaimer : The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
90,000 🧬 Constipation in children under one year old
Usually, parents of babies are worried about the exact opposite problem – too frequent bowel movements. Therefore, not everyone immediately understands what to do if a baby under one year old has constipation.
Gastroenterologist, hepatologist at GMS Clinic Sergey Vyalov gave an interview to the Internet portal parents.ru and spoke about constipation in children under one year old.
Constipation, aka adiarrhea, stool retention, dyscolia, caprostasis, difficult bowel movement is not a universal condition with unambiguous characteristics.Each person, including a child, has his own indicators of the norm and deviations from it, associated with age, intestinal microflora, diet, state of mind and hormonal background, concomitant diseases. And yet there are a few common points of reference.
What is constipation?
Specialists diagnose constipation if the baby does “big” things:
- regularly and without problems, but at the same time dry and hard feces are excreted;
- with difficulty – the child has to push, the feces do not come out on the first try;
- less often than 5 times a day.
In the first six months of life, constipation is a rather rare phenomenon, rather, on the contrary, in the period from 0 to 6 months, 6-10 bowel movements per day are considered the norm. In breastfed children, defecation occurs more often, in artificial people – less often.
Up to 6 months constipation – rare
Usually, parents of babies in the first months of life are alarmed by the opposite of constipation – too frequent bowel movements. But in a baby, regardless of whether he feeds on breast milk or formula, the intestines should work this way – in a mode that is considered diarrhea for older children and adults.
There should be no other option, at least until the introduction of complementary foods at 4–6 months. After all, the baby receives mostly liquid food, the waste of which has the same consistency and leaves the intestines, without encountering any obstacles in the way – the baby has not yet learned how to control the sphincter that restrains the excretion of feces.
The baby’s intestines have just begun to “get acquainted” with microorganisms that come from the mother’s milk, from her skin (the baby licks the nipple), from the environment.Not all new “partners” are accepted: there are rejected ones, those who have not taken root, and so on. Inspection and rejection are accompanied by loose, unstable stools.
Too frequent bowel cleansing does not need correction and treatment if the child is gaining weight and developing correctly. Normal appetite and sleep, gas, lack of fever and other signs of illness indicate that parents have nothing to worry about. If the baby’s mother, tired of changing diapers 10 times in one day, wants to change the situation and asks the doctor to prescribe fixing medications to the baby, then, unwittingly, she will condemn her baby to chronic constipation.
Not according to the rules
Nevertheless, in the first 6 months, constipation in babies is not excluded. It can be called by:
- microflora transmitted from the mother;
- insufficient liquid volume;
Let’s say a woman has too many methane-producing bacteria in her stomach and intestines that cause constipation. They grow rather slowly, ferment, emitting carbon dioxide, which contributes to flatulence and bloating.With this deviation, the woman lives, adapted and learned to solve the problem with the intestines in one way or another. Noticing the same in the child, she decides that the baby has inherited her features and “saves” him by the same means, making a mistake. Babies should not be given laxatives, especially those containing senna. The body of the crumbs gets used to such drugs too quickly and without them it can no longer cleanse the intestines.
Constipation in a baby up to 6 months is also provoked by a lack of fluid and hormonal changes.At 6 months, the baby should receive a lot of moisture – about 140 ml per day per kilogram of weight. A child who is breastfed gains this rate at the expense of mother’s milk and does not need additional sources of fluid (but only in the absence of a predisposition to constipation). Little artificial people are drunk from the moment they switch to the mixture.
If a woman is stressed or nervous, then her levels of the stress hormone cortisol increase. Through breast milk, saliva or sweat, the substance enters the baby’s body and also provokes constipation.
Even if the mother does not breastfeed the baby, the microorganisms that cause constipation sooner or later reach the crumbs’ gastrointestinal system and make negative changes in it.
Constipation after the introduction of complementary foods
The kid grows, improves his skills, and it’s time to introduce him to new food products. These circumstances, on the one hand, help to establish peristalsis, and on the other, increase the risk of constipation.
By the age of six months, the baby is already trying to control bowel movements, because he realized that after it there are unpleasant sensations – itching, burning and other discomfort in the areas where feces enter.In order not to experience discomfort, the child tries to restrain the urge. At first, he does not succeed, since the rectum has already learned to work – to reflexively contract and push out waste. And after a couple of months everything works out, the baby wins and enters the path leading to chronic constipation. To take the baby out of this vicious circle, the mother must minimize the duration of the baby’s skin contact with feces and expand his diet by mastering complementary foods.
Proteins, fats and carbohydrates that make up the food are absorbed in the small intestine, and do not reach the large intestine, where feces are formed.The same cannot be said about fiber. While the baby is drinking breast milk or formula, this component of the dishes is not familiar to him. Even if a nursing woman herself consumes a lot of plant foods, the baby does not get anything. Fiber, as already noted, is not absorbed in the intestines, does not enter the bloodstream, which means that it is not in breast milk. For the first time, a baby is getting fiber with complementary foods by trying his first 25 grams of puree from squash, carrots and other vegetables. Plant fibers literally attract all waste products, as a result, feces are formed, which help the intestines to master the correct peristalsis.In this part of the gastrointestinal tract, in the intestines, there are many muscles, they must learn to contract consistently – to strain and relax in order to squeeze waste out.
The next new product should be introduced one month after the previous one. The novelty is likely to cause more frequent and loose stools at first. If it does not have a green color and does not foam, you do not need to run to the doctor and ask to prescribe a fixing agent. Be patient, after a while the innovation will be mastered and bear fruit.Instead of liquid and shapeless, yellow-white feces, you will see brown feces formed.
There are other causes of constipation in babies. Unfortunately, it is much more difficult to deal with them, since these are developmental pathologies, diseases, injuries.
Acute constipation. It develops for anatomical reasons, for example, due to obstruction of the colon, or with intussusception – the introduction of one part of the intestine into another, which causes blockage of the lumen.Against the background of complete well-being, the baby suddenly becomes restless, cries, refuses to eat. The attack ends as unexpectedly as it began, but after 3-5 minutes it repeats and intensifies: one or two vomiting appears with an admixture of green bile. If the stool leaves, then blood impurities are visible in it. After 5-6 hours, the stool stops, and bloody discharge is released from the rectum. At the same time, the baby’s belly is soft. The temperature is most often normal. The child may even faint.With such symptoms it is necessary to call an ambulance.
Hirschsprung’s disease. It is based on a violation of the innervation of the colon – the central nervous system cannot control this part of the gastrointestinal tract. As a result, processed food accumulates in the intestines. The picture of the disease is quite diverse. If only the short part of the intestine is affected, then constipation forms gradually, and it is possible to do without surgical intervention for a long time.When a longer segment is affected, the absence of stool is fraught with serious condition and immediate surgical intervention is required.
Infectious attack. If in the first months of life the baby suffered an intestinal infection, the nerve cells in the large intestine may die, which will lead to a delay in the act of defecation, the accumulation of feces and the development of constipation. With dysentery, the so-called toxic megacolon (a sharp expansion of the large intestine) is possible. The child develops impaired consciousness and repeated vomiting.The abdomen increases sharply due to the greatly expanded intestines. The complication requires urgent surgical attention.
Problems with the central nervous system. Injuries during childbirth and the syndrome of infantile cerebral palsy also affect the work of the gastrointestinal tract, since they are associated with various complications, for example, impaired swallowing, regurgitation, and vomiting.
Vasculitis. Vascular inflammation also spreads to the nerve plexuses and sensitive cells located in the intestinal wall.
Disorders in the endocrine system. With hypothyroidism (lack of thyroid function), the movement of contents through the intestines slows down. With dysfunction of the parathyroid glands, constipation occurs due to a violation of mineral metabolism, with diabetes mellitus it becomes a consequence of damage to the nerve plexuses of the intestines or dehydration of the child’s body.
Constipation medication. Read the instructions carefully before giving your child any medication prescribed by your doctor.For example, anemic remedies containing iron can cause constipation. Compliance with the rules of admission will help to avoid it – directly with meals, a decrease in iron doses when introducing foods high in iron into the diet – buckwheat, apples, herbs. Special attention should be paid to constipation resulting from treatment with non-steroidal anti-inflammatory drugs, antipsychotics, sorbents and antibiotics that cause intestinal dysbiosis.
Diseases and conditions accompanied by constipation are not so common in infants.Many pediatricians do not remember them right away. Before getting to the truth, they prescribe a lot of unnecessary drugs, forgetting about effective intestinal examinations, such as X-rays.
Constipation in children. Prevention. Diet therapy
Constipation is widespread among both adults and children (5-30% depending on diagnostic criteria).Symptoms become chronic in more than 30% of patients, cause not only discomfort and pain to the child himself, but also disrupt the quality of life of his family.
Constipation is a condition manifested by an increase in the intervals between bowel movements (compared to the individual norm) or systematically delayed, difficult and / or insufficient bowel movement. Constipation also includes stool with “gruel”, but after bowel movements were absent for up to 3 days.
Constipation can be associated with functional or organic causes (abnormalities, inflammation).In children, 90-95% of constipation is functional. The peak incidence of functional constipation occurs at 2-4 years, when the child begins to potty / toilet train.
The main causes of functional constipation
- Incorrect diet for a nursing mother
- Insufficient drinking regime of a child with artificial feeding
- Insufficient drinking regime of a breastfed child with the introduction of complementary foods
- Early transfer of a child to artificial feeding
- Fast transfer of a baby from one formula to another (less than 7 days)
- Poor nutrition of the child (for a long time the child receives food with a large amount of proteins, fats and insufficient dietary fiber, abuse of drinks containing a large amount of astringent substances – tea, coffee, cocoa)
- Excessive use of children’s hygiene products or the development of an allergic reaction of the skin of the perianal region
- Consequences of perinatal damage to the nervous system
- Rickets, vitamin D deficiency
- Thyroid dysfunction (failure – hypothyroidism)
- Food allergy, primarily cow’s milk protein allergy
- Forced potty training, a period of adaptation to new conditions (nursery, kindergarten)
- Physical inactivity – sedentary lifestyle
- Mental trauma or stress
- Systematic suppression of the urge to empty the bowels, associated, for example, with the start of attending kindergarten, school, etc.p.
- Taking some drugs
- Constipation in family members
Frequency of defecations in children of different ages
|Age||The number of bowel movements per week||The number of bowel movements per day|
0 – 3 months
5 – 40
5 – 20
|6 – 12 months||5 – 28||1.8|
|1 – 3 years||4 – 21||1.4|
|4years and older||3 – 14||1.0|
In addition to stool frequency, attention should be paid to its nature.For a more objective assessment, the “Bristol scale of feces forms” is convenient, since it is the form of feces, and not the frequency of stools, that corresponds to the time of intestinal transit to a greater extent.
Bristol Feces Scale
In accordance with this scale, 3 and 4 the form of feces is regarded as normal, and 1 and 2 indicate delayed transit (constipation). Quite often, in practice, there are situations when a child has a defecation frequency within the normal range, but the stool is dense, fragmented, in a meager amount.These signs indicate incomplete bowel movement and are considered constipation manifestations.
The consistency in newborns and infants should be mushy. From 6 months to 1.5 – 2 years, feces can be either formalized or mushy. From the age of two, the chair should be decorated.
Signs and symptoms of constipation
- abdominal pain, often bursting, aching, sometimes colicky
- changing the shape and consistency of the chair
- excessive flatulence
- unpleasant odor of gas and stool
- there may be pain during bowel movements
- straining during bowel movements
- there may be blood in the stool – on the surface of feces or in the form of traces on a napkin (indicates an anal fissure)
If you do not eliminate constipation and do not establish bowel movement, then there is a risk of coprostasis (the formation of fecal stones) and fecal intoxication:
- loss of appetite
- lack of energy
- general malaise
- depression, irritability
- nausea, vomiting
- skin symptoms – dryness, rash, peeling
- fecal incontinence, spotting stool
- retention and incontinence of urine due to pressure from the overflowing intestine on the bladder
- bleeding from cracks, hemorrhoids
Constipation treatment includes the following goals:
one.Normalization of stool consistency (soft, painless stools)
2. Regularity of bowel movements (prevention of re-accumulation of feces)
Constipation treatment is a sequential, complex, individualized process and consists of several stages:
- child and parent education
- correction of nutrition and drinking regime
- elimination of existing coprostasis with medication
- maintenance therapy
It is necessary to exclude factors that provoke and contribute to constipation (normalization of the motor and food regime, discontinuation of medications that can cause constipation, identification of a food allergen, exclusion or confirmation of neuromuscular disease, celiac disease, etc.).P.).
Lifestyle normalization includes:
- conditioned reflex development
- active lifestyle
- light abdominal massage skills training
- for small children – laying out on the stomach, bending the legs towards the stomach.
Education is the first step in the treatment of functional constipation.It must be remembered that the episodes of calamification and encopresis (fecal incontinence) are not arbitrary and should not be blamed on the child, who may already be frightened and disoriented. In some cases, when the intra-family situation is difficult, the help of a family psychologist may be needed.
It is important to understand that the treatment of functional constipation can be lengthy, based on trust in the doctor, partnership and requires patience. Modern laxatives allowed in children will not make the intestines “lazy”, will not cause “addiction”, they enter the bloodstream in minimal quantities or are not absorbed at all and are safe when taken for a long time.
Correction of the behavior of a child with constipation is based on the development of a regimen of going to the toilet in order to achieve regular bowel movements. Defecation should be at the same time every time. The urge to defecate is based on the gastrocecal reflex, which manifests itself in the morning 1 hour after eating. A child with constipation needs to spend 3-10 minutes in the toilet (depending on age). It is necessary to plant the child on a potty or offer to visit the toilet after each meal.
A prerequisite for effective bowel movements is to provide good support for the legs (a low bench on which the child can place their feet), which contributes to an increase in intra-abdominal pressure.
If defecation fails, the child should never be punished, and vice versa. The daily frequency of bowel movements can be recorded in a diary, which can be reviewed during routine visits to the doctor.
Treatment of constipation should begin with lifestyle changes, which include adjustments in diet, drinking regimen, and physical activity.
Calculation of fluid volume for healthy children
Children under 1 year old should drink at least 100 ml of water per day.
For healthy children weighing from 10 to 20 kg the need for water is calculated using the formula:
100 ml (volume of water for children under 1 year old) + 50 ml for each kg with a body weight over 10 kg.
For example, with a mass of 12 kg: 100 ml + 2 x 50 ml = 200 ml.
A child weighing 20 kg should drink water: 100 ml + 50 x 10 = 600 ml
For children weighing over 20 kg , the following calculation formula is proposed:
600 ml (volume of water for a child weighing 20 kg) + 20 ml for each kg with a weight over 20 kg.
For children over 3-5 years old you can use the calculation of the amount of water: 30ml / kg mass
Principles of dietary therapy for constipation:
- satisfaction of physical needs for nutrients and energy
- elimination of excessive consumption of proteins and fats, which can inhibit intestinal motility
- dietary fiber fortification
- normalization of intestinal microflora with pro- and prebiotics
If the child is breastfed, then the mother’s nutrition is corrected (restriction of foods that contribute to gas formation).With artificial feeding, special mixtures are shown. In case of constipation associated with an allergy to cow’s milk protein, medicinal mixtures are prescribed if the child is artificially fed. If the baby is breastfed, cow’s milk and products based on it are completely excluded from the mother’s diet.
After the introduction of “thick” complementary foods – boiled water is necessary for all children, regardless of the type of feeding.
For older children, it is recommended to eat foods rich in plant fiber.We do not recommend “greasy food”, puree, “snacks”, “food on the go”. Food should be crumbly, meat / poultry / fish – “piece”. A “bulky” breakfast is required to stimulate the “gastrocecal reflex”.
The main source of coarse fiber vegetable fiber, which contains a large amount of dietary fiber, is cereal bran, rye bread, as well as a number of vegetables and fruits. According to the principles of evidence-based medicine, there was a statistically significant increase in stool frequency and improvement in stool consistency with the use of fiber compared to placebo.
Bran, as the main source of vegetable fiber, is recommended to be added to the second and third dishes, after pouring it with boiling water and settling for 20 minutes. Bran can also be used between meals with plenty of liquid. For school-age children, the total amount of liquid when taking bran should be at least 1.5-2 liters per day, otherwise they perform mainly the role of sorbents, absorbing liquid from the intestines, thereby increasing constipation.The dose is selected individually, it is recommended to start with 1 teaspoon 2-3 times a day, with a gradual increase to 40 g per day. When the effect is achieved, the dose is reduced and limited to one dose.
The American Academy of Pediatrics (2009) recommends a fiber intake of 0.5 g / kg / day (maximum 35 g / day) for all children. Fiber intake below the minimum recommended value has been proven to be a risk factor for chronic constipation in children.
However, long-term intake of large amounts of plant fibers due to fermentation by the intestinal microflora is naturally accompanied by bloating and flatulence.
Children with constipation are shown taking cool liquids on an empty stomach (drinking and mineral water, juice, compotes, kvass); honey, xylitol or sorbitol may be added to enhance the laxative effect. It is very beneficial for the intestines to increase the intake of juices containing sorbitol / sorbitol, such as juice from plums, pears, apricots, peaches and apples,
In case of “sluggish” bowel function (hypomotor constipation), cool mineral water of medium and high mineralization is used, such as Essentuki 17, Batalinskaya, Arzni, Donat Magniya, etc. with spastic constipation (hypermotor constipation, the shape of the stool is often type 1) – warm and low mineralization (Essentuki 4).Calculation of mineral water – 3-5 ml / kg per day.
You should limit milk in its pure form and in dishes, as flatulence may occur with the appearance or intensification of abdominal pain. It is better to replace whole milk with dairy products – kefir, acidophilus, yogurt, yoghurts, etc.
The diet of children with constipation includes dishes rich in vegetable fiber – salads from fresh vegetables, greens 2-3 rubles per day, baked apples, stewed vegetables, diluted vegetable and fruit juices with pulp.Food is prepared mainly in unmilled form, steamed or boiled in water.
It is preferable to take raw vegetables and fruits (in the absence of contraindications). Tomatoes, squash, pumpkin, carrots, beets, leafy lettuce, cauliflower, apples are especially recommended. Dried fruits (prunes, dried apricots, figs) are given soaked and as part of cooked dishes. White cabbage, young green beans, green peas are allowed if tolerated.It is good to add parsley, dill, celery to various dishes and salads.
If, after reading the article, you still have questions or you do not understand how to apply the recommendations in your particular case, we invite you and your child to be examined by a pediatric gastroenterologist at the DDC. For the convenience of parents, you can make an appointment with a pediatric gastroenterologist at the Pediatric Diagnostic Center on weekdays and Saturdays.
We will be happy to help!
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90,000 Constipation in a child – causes, symptoms, diagnosis and treatment of constipation in children in Moscow at the children’s clinic “SM-Doctor”
Description of the disease
Constipation – a decrease in the amount or complete absence of bowel movements.The problem is diagnosed and treated by a family doctor, pediatrician or gastroenterologist.
About the disease
Constipation (constipation) is not an independent disease. The problem is characteristic of dysfunction of the intestine, the result of which is the impossibility of adequate release from the feces. In a child, the stool is reduced (usually less than 1 time in 2 days) or completely stops, and straining is required.
Constipation is most often a consequence of diseases of the gastrointestinal tract (GIT).At the heart of the problem is a violation of peristalsis. Depending on the nature of this dysfunction, constipation can be:
- spastic, when there is too strong contraction of the intestinal muscles with the impossibility of further movement of feces outward;
- atonic, when the intestinal wall is completely relaxed and cannot contract to remove food debris from the body.
Constipation occurs quite often in children, especially at the stage when the child is just starting to go to kindergarten (psychological etiology of constipation).It is important to recognize it early and initiate appropriate treatment. Otherwise, the risk of developing serious complications increases – intestinal obstruction, autointoxication, the addition of bacterial flora.
Symptoms of constipation
Constipation itself is an isolated symptom that can accompany a number of gastrointestinal diseases. The accompanying clinical picture may change depending on the etiology.
The key characteristics of constipation are a decrease in the number of bowel movements up to 2 times a week or their complete absence, a feeling of incomplete bowel movement.
Additional signs that often accompany constipation are:
- abdominal pain – the nature depends on the type of damage to the intestinal wall, while the child can feel both constant aching pain and short-term cramping attacks;
- nausea, flatulence, vomiting;
- loss of appetite, weight loss;
- slight increase in body temperature.
If the cause of constipation in a child is a surgical pathology, then the clinical picture may also include fever, general weakness, rapid fatigue, and a sharp pain in the anterior abdominal wall.
If there are stool disorders, the parents should consult the child with a doctor. If constipation becomes chronic, then children become irritable, sleep poorly, are capricious, and their appetite suffers. Against the background of impaired intestinal functionality, deterioration in the quality of hair, skin and nails may join.
Causes of constipation
The pathogenetic basis for the development of constipation is a dysfunction of the muscular membrane of the intestine with a deterioration in its peristalsis. The reasons can be both infectious diseases provoked by a certain pathogen, and exacerbation of pathologies of other organs and systems.
The most common causes of constipation in children of different ages:
- Poor nutrition. If the baby from the first days receives heavy food containing a lot of protein, then there is every chance of the rapid development of constipation. For infants, in order to prevent stool disorders, it is very important to try to maintain breastfeeding. Artificial formula increases the risk of developing constipation.
- Lack of water in the body. If the child drinks little, then the feces in the intestines become hard and are hardly excreted from the body.
- A side effect of certain medications. Antibiotics can negatively affect the intestinal flora, which sometimes provokes constipation.
- Psychological aspects. Sometimes in children, against the background of psychoemotional stress, intestinal peristalsis slows down and there is a conscious suppression of the act of defecation. So, not every child goes to the toilet at a party, cafe or kindergarten.
- Anomalies in the development of the digestive tract. With congenital malformations, even a newborn may experience constipation associated with a primary dysfunction of the intestine.
Chronic diseases of other organs and systems also provoke a slowdown or acceleration of peristalsis. This causes constipation or diarrhea in the child, respectively.
Diagnosis of constipation
“SM-Doctor” is an advanced medical center specializing in the diagnosis and treatment of gastrointestinal diseases accompanied by constipation. Modern equipment and highly qualified personnel contribute to the fastest and most objective establishment of the causes and mechanisms of constipation in a child.
The specialist establishes the presence of defecation disorders for a specific age at the stage of a conversation with the patient or parents. To confirm the diagnosis, the following examinations can be prescribed:
- general analysis of blood and urine;
- biochemical blood test;
- feces for helminth eggs;
- ultrasound of the abdominal organs;
- Irrigography – an X-ray method that is used if there is a suspicion of intestinal obstruction;
- CT / MRI of the abdominal organs.
If necessary, the doctor will refer the child to consultations with related specialists. This approach allows you to comprehensively solve the problem of constipation and prevent its occurrence in the future.
Treatment of constipation
Treatment of constipation in children of different ages is aimed at improving intestinal motility and facilitating its release from feces. To achieve these goals, at the first stage, non-drug methods are used, namely, lifestyle modification:
- normalization of nutrition with an increase in the amount of vegetables and fruits in the daily diet;
- increase in the volume of consumed fluid;
- refusal from “heavy” food (fast food, a large amount of meat, sweets).
Taking laxatives in children is undesirable. On the one hand, this is associated with the risk of side effects, and on the other hand, there is a likelihood of addiction. Therefore, it is so important to identify the cause of constipation and act on it. However, there are groups of drugs that are used at the first stage to normalize the passage of feces through the intestines. These are stool volume-increasing agents (for example, based on polyethylene glycol) – they work after about 24 hours; and drugs “quick response” (for example, glycerin suppositories), which accelerate peristalsis, the effect develops in 10-15 minutes.
Prevention of constipation is based on a balanced diet, adequate fluid intake and timely treatment of other gastrointestinal diseases.
“SM-Doctor” is a clinic where every child who has encountered constipation is provided with a full range of services for the detection and treatment of primary pathology of any genesis. Our own laboratory, modern equipment and highly qualified personnel contribute to a quick and high-quality solution to the problem. Turn to professionals so that your little one feels the ease of liberation!
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90,000 Constipation in children ➣ Causes and effects
Constipation in children is a very common problem. Fortunately, in most cases, constipation in children is temporary.
Encouraging your child to make simple dietary changes, such as eating fiber-rich fruits and vegetables and drinking more water, can significantly relieve constipation.
Symptoms of constipation in children
Signs and symptoms of constipation in children may include:
- Less than three bowel movements per week
- Hard, dry and difficult-to-pass bowel movements
- Pain during bowel movement
- Stomach pain
- Blood on the surface of hard stools
If your child is afraid that a bowel movement might harm, he or she may try to avoid it. You may notice your child crossing their legs, squeezing their buttocks, twisting their body, or tightening their facial muscles while trying to hold a chair.
When to see a doctor
The child should be taken to the doctor if constipation lasts more than two weeks or is accompanied by:
- high temperature
- lack of appetite
- blood in feces
- abdominal edema
- weight loss
- pain during bowel movements
- rectal prolapse
Causes of constipation in children
Constipation most often occurs when waste or bowel movements move too slowly through the digestive tract, causing the stool to become hard and dry.
Many factors can contribute to constipation in children, including:
Your child may ignore the urge to have a bowel movement because he or she is afraid of the toilet or does not want to take a break from play. Some children refuse to live away from home because they are uncomfortable using public toilets.
Pain on stool, caused by large, hard stools. If the child is painful to go to the toilet, he or she may try to avoid repeating the unpleasant experience.
Questions of toilet training. If toilet training becomes a battle of will, your child may rebel and ignore the natural urge to defecate. This can quickly become an involuntary habit that is difficult to change.
Lack of fiber-rich fruits and vegetables or liquids in your child’s diet can cause constipation. One of the most common cases of constipation in children is switching from an all-liquid diet to one that includes solid foods.
Any change in your child’s lifestyle, such as hot weather, travel, or stress, can affect bowel function.Children are also more likely to experience constipation when they first go to school outside the home.
Allergy to cow’s milk or eating too much dairy products (cheese and cow’s milk) sometimes leads to constipation.
In rare cases, constipation in children indicates an anatomical abnormality, metabolic or digestive system problems, or other condition.
Complications of constipation in children
Although constipation can be very uncomfortable in children, it is usually not a sign of serious illness and is temporary.
However, if constipation becomes chronic, complications may include:
- Painful fissures of the skin around the anus (anal fissures)
- rectal prolapse (when the rectum exits the anus)
- Stool retention (preventing bowel movements due to pain that causes the affected stool to build up in the colon and rectum)
What to do to help prevent constipation in children:
Offer your child high fiber foods such as fruits, vegetables, beans, and whole grains.A diet rich in fiber can help your child develop soft, bulky stools. If your child is not used to a high fiber diet, start by adding just a few grams of fiber a day to prevent gas and bloating.
The recommended fiber intake is 14 grams for every 1000 calories in your child’s diet.
For young children, this means consuming about 20 grams of fiber per day. For teenage girls and young women, that’s 29 grams per day.And for boys and young men it is 38 grams per day.
Increase the amount of fluid consumed. Make sure your child drinks at least 1 liter of clean water a day.
Encourage your child to be physically active. Regular physical activity helps to stimulate normal bowel function.
Set aside time after meals for your child to use the toilet regularly. Provide a footrest if needed to help your child sit comfortably on the toilet.
Remind your child to heed the call of nature. Some children are so addicted to play that they ignore the urge to have a bowel movement. If such delays occur frequently, they can contribute to constipation.
Reward your child’s efforts, not results, and do not punish if they stain their underwear.
If your child is taking medications that cause constipation, talk with your doctor about other treatment options or changing medications.
Pavlenko Svetlana Vasilievna, pediatrician, pediatric gastroenterologist of the International Innovation Clinic
Chronic constipation / Diseases / Clinic EXPERT
Blessed is he who early in the morning
Has a chair without compulsion.
Tom and food to his liking
And any delights.
K. Batyushkov, 1838
Constipation (constipation syndrome) is a condition in which a person has no more than three bowel movements per week, and there are also difficulties with the passage of feces.
Typically, patients complain of constipation under the following conditions:
- with changes in stool consistency (hard, lumpy)
- with difficulty passing feces
- with a feeling of incomplete emptying of the intestine
- if it is necessary to straining strongly during bowel movements
- if impossible fully empty the intestines.
Most often, intestinal constipation is a temporary condition, which can be eliminated through nutritional correction. Irregular bowel movements do not always mean constipation.
Symptoms of chronic constipation
Symptoms of constipation are usually the following:
- The need to straining during bowel movements
- Abdominal bloating
- Hard, hard, dry stools
- Feeling of incomplete emptying of the intestines after defecation
- The need to remove feces from the rectum manually, support the pelvic floor with fingers and similar manipulations
- Less than three bowel movements per week.
contents of the abdomen while straining
Types and causes of chronic constipation
Depending on the causes of constipation, it can be primary or secondary.
Primary constipation can be as follows:
- With normal intestinal transit (most common). The reasons for this type of constipation can be as follows:
- Unhealthy diet
- Irritable bowel syndrome (IBS).
- With delayed intestinal transit (usually young women).This type of constipation occurs due to functional changes:
- Dyssynergy of the pelvic floor muscles (violation of their functions)
- Changes in the structures of the anorectal region (for example, perineal prolapse syndrome and rectal prolapse).
The causes of secondary constipation (i.e., arising from the development of a factor) can be as follows:
- obstruction created by a neoplasm or narrowing of the intestinal lumen, preventing the normal passage of feces
- metabolic disorders (hypercalcemia, diabetes mellitus, etc.))
- Diseases of the nervous system
- Various systemic pathologies
- Mental disorders
- Other causes.
Diagnosis of constipation in our clinic includes:
Treatment of chronic constipation
Treatment of constipation in our clinic gastroenterologist begins with recommendations for adjusting the patient’s dietary habits and lifestyle. To relieve the symptoms of constipation, the following drugs are used:
- plant fibers that increase the volume of intestinal contents
- stool softeners (laxatives)
- osmotic laxatives
- prokinetic drugs
The need for taking certain medications for constipation should be determined only by a doctor.
If you are suffering from constipation, you should not neglect the consultation of a gastroenterologist, as this can negatively affect your health.
With the right treatment, the prognosis is usually good.
It is noted that long-term constipation increases the risk of developing intestinal cancer , therefore patients with this problem should be monitored by a gastroenterologist and regularly undergo colon examinations.
Advice and prevention
For a problem such as frequent constipation, doctors recommend that patients increase their intake of foods rich in dietary fiber (fiber), which help normalize the stool, increasing its volume and softening the consistency. Fiber also helps maintain a healthy gut, reducing the likelihood of diverticulitis and hemorrhoids.
It is recommended for every person to visit a gastroenterologist annually for preventive purposes, even if they feel well.
Frequently Asked Questions
Can Senna be taken for a long time?
Long-term use of senna drugs is contraindicated, as it leads to addiction of the intestine to this group of drugs, which requires an increase in their dose. Long-term use of senna leads to intestinal atony and constipation resistant to any therapy, and causes the development of inflammation in the intestines.
Is constipation dangerous if the general well-being does not suffer?
Everything that nature intended to be excreted from the body should be excreted regularly! With the accumulation of feces, intestinal irritation occurs, a violation of its function is aggravated, inflammation, diverticula (protrusion of the intestinal wall), neoplasms, general symptoms of poisoning (weakness, lack of appetite, nausea) may develop.
If constipation is more than 20 years old, does it make sense to treat it?
Of course it does, since this is a long-term imbalance in digestion, which requires clarification of the cause and the development of non-drug and medicinal remedies for correction.
Are there drugs for long-term maintenance therapy of constipation?
Yes, lactulose-based preparations are the safest.
Story No. 1
Patient Shch., 23 years old, turned to the EXPERT Clinic to a gastroenterologist with complaints of general weakness, constipation for 1.5 years.With a careful collection of the anamnesis of the disease, it turned out that during pregnancy (3 years ago) they talked about dysfunction of the thyroid gland, but the patient did not carry out treatment, since nothing bothered her. The examination revealed abnormalities in the hormonal status of the thyroid gland, caused by autoimmune thyroiditis with a decrease in organ function, which is often accompanied by constipation.
The patient was referred for a consultation with an endocrinologist, who prescribed therapy to correct the hormonal levels of the thyroid gland.Against the background of the therapy, the normalization of organ function was observed, and in parallel, the patient began to notice the normalization of the stool and general well-being. Thus, a detailed study of the disease and the facts of the anamnesis of life allowed the doctor not to go towards treating the symptom, but to understand the reason, which made it possible to quickly achieve the desired results.
History No. 2
Patient M., 67 years old, turned to the EXPERT Clinic with complaints of prolonged constipation during the last year. In general, the state of health did not suffer.Long-term use of laxatives did not lead to a lasting effect. When examining the patient, no significant deviations from the norm were found, but taking into account the rather short period of complaints and the age of over 45 years, the doctor became alert to cancer.
The patient was referred after a preliminary laboratory examination (in the clinical analysis of blood there was a decrease in hemoglobin, an increase in ESR, and in the study of feces with a hypersensitive test “Colon-View” for occult blood, a positive reaction was revealed) for an endoscopic examination of the intestine – a colonoscopy, where intestinal swelling.Subsequently, the man was successfully operated on as planned and continues to be monitored by a gastroenterologist and oncologist.
Constipation in children
When should I see a doctor if my child has stool retention? Should constipation in children be treated, when and how? Irregular bowel movements – could this be a normal variant? These and many other questions concern parents practically from the first days of a child’s life. Irregular bowel movements in children are one of the most common reasons for visiting a pediatrician.
Symptoms of constipation in a child
The frequency of bowel movements varies depending on the nature of the diet, the amount of fluid consumed and other circumstances. It is necessary to understand that each child is individual, and each organism has its own norm and symptoms that can signal a problem.
The pediatrician diagnoses “Constipation” if the child has bowel movements less than 3 times a week, if there is difficulty in defecation, strong prolonged straining, accompanied by pain, if the consistency of the feces is hard, lumpy.
If the above symptoms bother the child for more than a month, then over time, a decrease in appetite, nausea, abdominal pain, general malaise (the child wants to lie down) is possible. Behavioral reactions are also often noted: irritability, fussiness, anxiety. Against the background of prolonged constipation, the child may experience fecal incontinence in the form of calorification. In rare cases, the appearance of persistent, progressive constipation in a young child may be due to anomalies in the development of the intestine.Constipation in children can be functional or occur secondarily against the background of another disease.
In children of the first year of life without congenital pathology from the organs of the gastrointestinal tract, the frequency of stool can be from 1 time in 3-4 days to 6-8 times a day (stool after each feeding). Stool frequency is not that important. It is important that the stool is independent and free of blood. When introducing complementary foods, it is important to know that your baby’s stool can normally change in color and consistency on an almost daily basis.It depends on the amount and composition of the introduced complementary foods.
Causes of constipation in children
Older children often have so-called “psychological” & nbsh3; constipation – after stool retention and painful bowel movements, there is fear, fear of emptying. In this case, the parents may notice that the child is trying to restrain the urge to defecate – to lie down, cross his legs, hide, become restless. & Nbsh3; For & nbsh3; children & nbsh3; 1.5-2 years old, one of the reasons for psychologically caused constipation can be & nbsh3; negative attitude to the pot – & nbsh3; attempts to teach the child to hygiene too early.The center of defecation control is formed in the brain by about 1.5 years, it is from this age that you should start putting the child on the potty at least 2 times a day for 5-10 minutes after eating (toilet training).
Physiological stool retention in older children is more often associated with a busy daily routine. In community settings, toilets do not provide a child with privacy, and children become accustomed to delaying bowel movements.
Functional constipation in a child responds well to treatment.Not always only drug treatment will be able to cope with the problem. Frequent use of enemas, suppositories (suppositories) not only does not solve the problem, but even worsens the situation, causing addiction. Treatment of true constipation is a systematic approach to the child’s lifestyle, his relationship with his parents and the world around him.
Inclusion in the daily diet of fruits and vegetables rich in dietary fiber, flour and coarse grains, vegetable oils, on the contrary, accelerates the passage and makes the stool more regular.
The large intestine is able to actively absorb water, but if a person drinks a little, the stool will be dry and dense. Therefore, the most important condition for a normal stool is to drink plenty of fluids. It is better if it is natural water.
The most important condition for normal bowel function is physical activity. Patients with constipation especially need an active lifestyle, playing sports, walking, running, swimming.
Drug therapy is the second step, which should be resorted to only if the above measures are not effective enough.Your pediatrician will help you find a solution to the problem, taking into account the individual characteristics of the child.
90,000 ᐈ Urgent conditions in children: first aid ~ 【Kiev】
It is imperative to call a doctor in the following cases, if your child has:
- Dehydration of the body.
- High temperature.
- Difficulty breathing.
- Excessive drowsiness, seizures, confusion or wanton aggression.
- Abdominal pain.
- Sudden groin pain in boys.
- Signs of bacterial meningitis.
- Blood in the stool.
- After the vaccination, a change in the general condition sometimes occurs.
If the child starts to vomit, it is necessary to pause for about 30-40 minutes before giving him anything to drink. Then give the child a few small sips of plain clean water: boiled, filtered or mineral water without gas.If possible, go to the pharmacy and purchase any saline solution (Gastrolit, Regidron, Humana electrolyte). If vomiting does not recur after 15 minutes, continue giving water in portions every 15 minutes. Stop eating for about 4 more hours. If the vomiting persists, the baby may become excessively dehydrated. Therefore, in this case, be sure to call the pediatrician.
If vomiting does not stop for more than 24 hours, and especially if it is not accompanied by diarrhea, you need to call an ambulance.Vomiting and fever in the absence of diarrhea can be signs of many dangerous diseases: appendicitis, streptococcal sore throat, or urinary tract infection. If the vomit contains traces of blood or mucus, or vomit is greenish in color, this may indicate damage or obstruction of the intestine and requires emergency medical attention.
Dehydration of the body
Dehydration can be dangerous. Especially very quickly dehydration occurs with diarrhea and vomiting.Sometimes children with severe angina tend to drink less fluids because it hurts them to swallow, which can also lead to dehydration. In these cases, it is important, little by little, but constantly, to give the child clean water, as if vomiting. Signs of dehydration: the child urinates less than 3 times a day, he may have a headache, drowsiness, as well as dry lips or tongue, the fontanelle in infants is slightly pressed. The symptoms listed above require an urgent call to the doctor.
An increase in body temperature to 39.4⁰C may indicate a severe bacterial infection.Call the doctor right away, no matter what age your child is. If the child is not yet 3 months old, then immediately consult a doctor at a temperature of 37.8⁰C, if the child is 3 to 6 months old – at a temperature of 38.3⁰C.
In general, not only the fact of a high temperature is important, but also the behavior and condition of the child in this case. If you gave your child an antipyretic (paracetamol), and for an hour after that he is still crying or naughty or behaving unusually (for example, he cannot wake up in any way), you should urgently call a doctor, even if the temperature was no more than 38 degrees.If the child’s temperature has subsided, he is lively and calm, the doctor can be called in a planned manner. Especially if the high temperature lasts more than 24 hours.
Shortness of breath
Difficulty breathing can be the cause of many diseases. Noisy or hoarse breathing is a sign of croup, an asthma attack, or a swallowed foreign body. Croup is a respiratory illness most often accompanied by a barking cough that gets worse at night.Difficulty breathing with croup occurs on inhalation and may be relieved by inhaling warm water vapor from a strong shower or cool outside air. Try to provide first aid and call a doctor at the same time. You should also see a doctor for any symptoms of shortness of breath, if it lasts more than 20-30 minutes.
Excessive drowsiness, convulsions, confusion or unreasonable aggression
These conditions can be caused by many reasons, but they all require a doctor’s call.
Convulsions are usually characterized as rhythmic jerking of the head or other parts of the body. Some of the causes of seizures can be a head injury or high fever. If the convulsions do not stop longer than 2-3 minutes, then you need to call an ambulance.
Head injuries are common in young children.
If a child has bruised his head, carefully monitor his condition for at least 4 hours after bruising. For many children, head injury is accompanied by drowsiness and headache, and occasional vomiting may occur.You can let your baby sleep during those 4 hours, but you should wake him up every half hour to make sure the baby can be easily awakened. In case of loss of consciousness, convulsions, unusual behavior or frequent vomiting, be sure !!! call a doctor.
Accidental ingestion of medicine or poison requires immediate medical attention. Try to give the child plenty of water and a sorbent, for example, Enterosgel or Smecta.
Stomach pain can have a variety of causes, from constipation to indigestion or stomach flu.It is necessary to see a doctor if the pain persists for a long time and is accompanied by a complete loss of appetite, greenish vomiting, or bloody diarrhea. If the pain is so severe that the child cannot walk or bends in half, a doctor should be called immediately.
Pain upward from the navel is often associated with digestive problems, indigestion, gas, or psychological anxiety (stress). Pain in the lower region of the navel may be associated with a bladder infection.Constipation can cause acute pain in the left lower abdomen . Well, acute pain in on the right side of can be caused by appendicitis, and this is a reason to call a doctor.
Sudden groin pain in boys
In the first weeks or months of a baby’s life, a protrusion is determined in the groin area. In boys, it can descend into the scrotum. When screaming, crying, walking, sneezing, urging to stool, the swelling increases in size. However, in a horizontal position, the protrusion sometimes disappears and is easily and painlessly adjusted into the abdominal cavity.
In 20% of cases, a sudden infringement of the hernial contents may occur. This means that the intestine is stuck in the inguinal canal, the blood vessels bend and overlap.
As a result, severe pain, nausea, vomiting, and anxiety of the child occur.
In this case, urgent surgical treatment is indicated. Therefore, do not waste time and call either a pediatrician or an ambulance at home !!!
Signs of bacterial meningitis
The main early symptoms of meningitis are fever, headache with vomiting, a stiff neck with a tendency to throw the head back, and a reddened and painful throat.They usually occur after acute respiratory infections of the respiratory tract.
In children under 2 years of age, meningitis usually leads to an increase in body temperature, lack of appetite, vomiting, irritability, seizures. The child is constantly crying. The skin over the fontanelle becomes tense and the fontanelle may bulge. Unlike adolescents and adults, children in the first year of life do not always develop a stiff neck. Therefore, if the child has the above symptoms, be sure to urgently call a pediatrician or an ambulance at home
Blood in stool
If there are traces of blood in the stool, you should always consult a doctor.Depending on in which part of the gastrointestinal tract bleeding occurred, the color of the blood may be different. A newborn baby can swallow the mother’s blood during childbirth or from the breast during feeding. In this case, the blood is usually black and mucous. At the same time, there are no other symptoms and the child looks healthy.
Inflammation of the small and large intestines can cause bloody, watery stools. Bloating may be observed, the child looks extremely weak, painful.
Check the child’s diet for the last 24 hours. It is likely that the child was eating red food (such as beets or red-dyed jelly) that might look like blood.
Dark-colored stools may occur with certain medications. Such as iron supplements, for example. Although the causes of bloody stool can be minor, such as minor trauma to the bowel or anus from constipation, medical attention is necessary to rule out more serious causes.