Constipation is generally understood as difficulty or reduced frequency in defecation. It is fairly common in children, affecting up to 30% of the population under 18. In most pediatric cases, constipation can begin when there are changes in the diet or routine, during toilet training, or after an illness.

There are two kinds of constipation in children–organic or functional. Organic means there is an identifiable cause. Fortunately, more than 95% of cases in healthy children one year or older is functional, meaning that while constipation may be an issue, there is usually no worrisome cause behind it.

Functional constipation, in children age 4 and up is defined by the presence of at least two of the following symptoms occurring at least once per week, for at least one month and that are not explained by another medical condition:

  • Two or fewer defecations per week
  • At least one episode of fecal incontinence per week
  • History of retentive posturing or excessive volitional stool retention (stool withholding)
  • History of painful or hard bowel movements
  • Presence of a large fecal mass in the rectum
  • History of large-diameter stools that may obstruct the toilet
The peak prevalence of constipation is typically during the preschool years. Although constipation is common, it is important to evaluate affected children to identify potential organic causes of constipation. If an organic cause cannot be addressed, then studies show that children benefit from prompt and thorough treatment interventions, typically within 3 months of the onset of symptoms.

Tardy or scanty intervention may result in stool-withholding behavior with worsening constipation and psychosocial consequences.

Common organic causes of constipation include cow’s milk or other dietary protein intolerance, celiac disease and hypothyroidism. Other rare but urgent causes can be Hirschsprung’s disease, spinal dysraphism, sacral teratoma, infantile botulism, Cystic fibrosis, lead poisoning or intestinal obstruction.

Treatment of constipation differs according to the cause of the problem. Some children may only require changes in diet such as an increase in fiber, fresh fruits, or in the amount of water they drink each day. Other patients may require medications such as stool softeners or laxatives. A few children may require a bowel clean-out to help empty the colon of the large amount of stool.

It is often useful to start a bowel training routine where the child sits on the toilet for five to ten minutes after every meal in order to encourage good behavior habits. If you feel your child is dealing with constipation, don’t hesitate to request an evaluation from a pediatric gastroenterologist.

Dr. Mariana S.J. Middelhof is a board-certified pediatric gastroenterologist with Gastro Health and sees patients in our Wellington office located at 1157 State Road 7, Wellington, Florida 33414.
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