Constipation In Children

 

Nearly 10% of all sick visits to the pediatrician’s office are due to abdominal pain, and constipation is the biggest reason why. Common complaints in children include infrequent bowel movements (less than two per week), and stools that are hard, dry, lumpy and difficult or painful to pass. Lynsey R. Zuar, D.O. and Lindsay A. Thompson list other symptoms that can be present in children who are constipated:

Other symptoms of constipation include straining with bowel movements, large stools, abdominal distention, nausea, vomiting, poor appetite, urinary accidents, frequent urinary tract infections, and psychological distress. More confusing symptoms include fecal accidents (loose stool leaking around a hard stool). Thankfully, 90% of constipation in children has no underlying organic cause. Surprisingly, constipation can occur in children with regular bowel movements, making it hard for parents to recognize.

 

Pediatric gastroenterologists Patrick T. Reeves, M.D. and Christine Wassdorp Hurtado, M.D. describe what normal poop looks like:

Different children poop different amounts and number of times each day. Some poop one time a day and others may go after every meal (three or so times per day).

The most important aspect of pooping is the character (or “softness”) of the poop. You can use the Pediatric Bristol Stool Form Scale for Children (see below) to determine if your child’s poops are the correct softness. The goal is to poop a Type 3 or a Type 4 on the scale.

 

 

Stool withholding behavior is the most common reason why children become constipated:

Functional constipation usually results from withholding behaviors: a fear of pain or discomfort from pooping, or a lack of awareness of the body’s signs for needing to poop, have led to significant discomfort for the child. For example:

• Your child may try not to go because it hurts to pass a hard stool. (Diaper rashes can make this worse.)

• Children aged 2 to 5 years may want to show they can decide things for themselves. Holding back their stools may be their way of taking control. This is why it is best not to push children into toilet training.

• Sometimes children don’t want to stop playing to go to the bathroom.

• Older children may hold back their stools when away from home (such as camp or school). They may be afraid of or not like using public toilets.

 

In addition to asking parents to encourage greater water intake and more fiber in their children’s diet, pediatricians often will treat constipation aggressively if kids develop hemorrhoids and anal fissures. Fecal streaking — when smears or small bits of stool appear in the child’s underwear — and overflow diarrhea that can’t be controlled (encopresis) are signs of more advanced constipation and require an urgent response to resolve the problem.

Drs. Zuar and Thompson reassure parents that laxatives pediatricians typically prescribe have been proven effective and safe for treating constipation in children:

Laxatives or stool softeners in large doses are the first steps of treatment. This is important because if a smaller dose is started first, symptoms could get worse, making it harder to successfully wean off medications. Osmotic laxatives increase the water content of stool to make it softer. Some examples include polyethylene glycol (MiraLAX), milk of magnesia, magnesium citrate, and lactulose. Stimulant laxatives stimulate the intestines to increase water and electrolytes and these examples include sennosides (Senokot) and bisacodyl (Dulcolax).

 

Increasing fiber content in the diet has many lifelong health advantages in addition to helping prevent and treat constipation. Dr. Reeves and Hurtado recommend that children eat at least 5 servings a day of fruits and vegetables as well as other foods like whole grains (oatmeal, brown rice, bran cereal and other whole wheat foods) and legumes (beans and lentils).

How much fiber should kids be eating every day? Adding 5 to your child’s age will give parents the right amount of grams of fiber. For example, a 5-year-old should eat at least 10 grams of fiber every day. (Adults should aim for at least 25 grams per day.)

Steven Reinberg suggests easy ways to boost dietary fiber:

• Leave the skins on fruits and vegetables

• Use whole wheat flour

• Replace white bread and cereals with whole grains

• Add fruit to whole-grain cold or hot cereals

• Add fruit, nuts or whole-grain granola to yogurt

• Add vegetables to scrambled eggs, omelets or pasta

• Aim to offer whole grains that have at least 3 grams of fiber per serving

• Choose whole fruit instead of juice

• Include fruit and vegetables with every meal

• Put veggies, like lettuce, tomato or avocado on sandwiches

• Add beans to soups and salads

• Add bran to baked goods

• For snacks, offer air-popped popcorn, whole-grain crackers, fruit or vegetables.

 

Read “What Parents Should Know About Constipation in Children” on JAMA Pediatrics Patient Page here.

 

source https://www.thepediablog.com/2023/02/27/constipation-in-children/