Constipation in Children

Patient Leaflets Team

  • Reference Number: HEY1006/2022
  • Departments: Emergency Department, Paediatrics
  • Last Updated: 14 January 2022

Introduction

This leaflet has been produced to give you general information about your child’s condition.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for your child.

What is constipation?

Constipation is a common problem amongst children. This is the passing of hard stools with difficulty and less often than normal. Normal bowel opening could be from every other day up to 3 times a day.

Sometimes there may be blood in the nappy or on the tissue due to a small tear in the back passage. Other symptoms your child may display include tummy ache, poor appetite, generally unwell, fidgeting, restlessness, irritable, unhappy.

Early treatment is important to stop constipation from becoming a long-term problem.

What causes constipation?

There are many causes of constipation. These includes a lack of fibre in the diet, not drinking enough water, stool holding and emotional changes (for example after a change in routine or situation)

Stool holding is where children can frequently feel the need to go to the toilet but hold on, resisting this feeling. This means the stool gets large and is more difficult or painful to pass, leading to a cycle of reluctance to open the bowels.

Reasons for stool holding include previous painful motion, sore back passage or a tear in the back passage which is also very painful or they may dislike unfamiliar toilets such as in a new school for example.

How is constipation treated?

The mainstay of treatment for constipation is laxatives. Macrogols are commonly used as laxatives, i.e. to treat constipation, in both children and adults; these retain water in the bowel, softening the stools.

Stimulant laxatives (senna/bisacodyl) – encourage the bowel to pass the stool. These are normally added if macrogols have not worked.

Treatment is normally given for several weeks, even after the constipation has eased. This helps establish a regular bowel habit. Then a gradual reduction will be needed to eventually remove the laxatives – your doctor should be able to help you manage this.

For laxatives to work, your child must also be drinking plenty of fluids. If this treatment does not work, then further medical help should be sought.

How parents can help prevent constipation

Make sure your child eats plenty of fibre and drinks lots of water. This bulks and softens stools. Foods which are high in fibre are fruit, vegetables, cereals and wholemeal bread.

Bottle-fed babies can be given water between feeds. Make sure the bottles of milk are made up correctly, as described on the tin.  If not, this can cause constipation along with other health problems.  Older children should also be given lots of water. Fizzy drinks, juices and milk are filling and prevent children from having a healthy appetite, where they would eat more fibre.

Note: fruit juices sometimes have a laxative effect and can help if constipation is occurring.

Good toilet hygiene can help – try to establish a regular habit. Encourage your child to go to the toilet at regular intervals, including before leaving the house if they are nervous about strange toilets.  Reward systems such as sticker charts are helpful if your child is prone to holding on. Praise after going and avoid punishing or getting stressed over accidents.

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