Constipation

This is one of the most common issues that parents are concerned about. Less than 2% of constipation in children is due to an abnormality. This blog will only address the cause and treatment of functional constipation: which is the passage of less than two stools per week without any evidence of structural or biochemical explanation.
The true definition of constipation varies with the age of the child. It is more variable in children under 1 year. Infants frequently grunt and strain while stooling as they are learning to coordinate the muscles needed to defecate. Breastfed infants may have multiple stools per day the first month of life, and then go several days without a stool and still be normal, not constipated. Formula-fed infants average two to four stools per day. Treatment for constipation under one year of age can include glycerin suppositories, but do NOT use more than 3 days without a medical evaluation. Barley cereal and vegetables as well as pear, apple or prune juice are dietary measures to ease bowel movements as instructed by your provider. Please do NOT use mineral oil, stimulant laxatives or enemas in infants unless your provider has ordered this.
Pain with stooling is the main reason for developing constipation in young children. The child makes an unconscious decision to withhold stools after having a painful or frightening bowel movement. Delaying the act of stooling makes the stool build up and become dryer and harder so the next stool is painful and unpleasant. Children then tighten their pelvic floor, contract the anal sphincter and engage in behaviors (crossing legs, stiffening legs, standing up, refusing to squat) that prevent passing that stool. A common complication of prolonged constipation is called fecal soiling. This occurs when overflowing and leaking of loose stool occurs around retained, hard stool.
Prevention of these problems is the number one goal. This is usually accomplished by good toilet training habits such as readiness of the child, making the toilet comfortable (a footstool may help) and the bathroom a pleasant environment. Too much dairy can slow motility of the intestine and fill the child so he takes in less vegetables, fruit, whole grains and water. Physical activity, adequate dietary fiber, decreased dairy products, and increased fluid intake all contribute to good bowel habits.
Treatment of functional constipation can be a long process and needs family compliance. A positive attitude and a strong supportive nature are necessary. Reward systems such as sticker charts, toileting calendars, and rewards for successes play a key role. Laxatives are often used to relieve a child of constipation. There is no evidence that the long-term use of recommended laxatives causes dependence. The goal of managing constipation is complete evacuation, sustained evacuation and weaning from medications.

Please contact your provider at East Cobb Pediatrics if you have concerns about constipation. Other resources that may help include: http://www.pottymd.com/, The Colorectal Center at the Cincinnati Children’s Hospital, and http://www.naspghan.org/, which have excellent handouts available online.

by Darlene Coyne, FNP