Constipation is a fairly common problem in children. In roughly every 100 children encountered in a given population about 30 are likely to have some issues relating to constipation. It causes not insignificant amount of worry to parents.
Constipation can either be defined in time frames – the acceptable norm is to have at least 3 bowel movements a week; and the other definition, which is also more applicable medically, is the consistency of the stool and the discomfort it causes to the child whilst passing it.
So a hard and difficult to pass stool is more likely to fit the bill of constipation rather than how frequently it is passed.
The good news is that even with this high rate of occurrence, it is rarely related to a serious medical cause – over 90% cases are related to diet and behavioral issues.
Diet – A diet that is lacking in fluids or fiber is more likely to cause constipation but it must be said that the studies done so far have only shown a weak link with this. What it means is that its important to review the amount of these in child’s diet but just focusing on increasing the water consumed is unlikely to resolve the problem fully.
Milk – too much of a good thing can be bad applies to this case well. Children that have diet rich in milk tend to suffer more constipation. It is linked with high milk consumers also being fussy eaters and hence consuming less fiber.
Behavior – children can develop the behavior of avoidance quite quickly. If the child has experienced difficulty passing stools on occasions then child can learn to associate passing poo with pain. So they tend to hold it back until they can. These are the children that run away and hide under the tables or in the corners when they need to poop! Once they have done it long enough the amount of poo in the end part of the gut, called rectum, increases in size and becomes increasingly hard to pass. This creates an ongoing cycle of hard poo –> child holding back –>stool getting harder and larger –> more painful to pass –> child holding back even more. In some advanced cases it may even lead to leakage of small parts of soft stool in the child’s undies without them being aware of it.
The things that can help parents is intervening with diet where possible, reduce milk and help the child when they observe the behavior of avoidance of passing stool in the child. Some strategies are to teaching the child to have regular times to sit on the toilet seat with a foot stool – recommendations is for about 4-5 minutes at a time and about 3 times a day, reward charts and stickers, if child noted to be displaying stool holding behavior (crossing legs, straining and simultaneously running to hide etc) then encourage them to sit on the toilet.
It is safe and in fact encouraged to use laxatives to help the children to transition from a phase of constipation to passing a soft, easy to pass bowel movement. Your GP can help in the matter of guidance of which and how much laxative to use.
Although laxatives are not the long term solution but sometimes you have to use laxatives for months, occasionally even years, before full treatment is achieved.