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How do I know if my child is constipated?

Your child is constipated if one or more of the following are true:

• He or she has fewer than 3 bowel movements a week.
• The stools are hard, dry and unusually large.
• The stools are difficult to pass.

If your child is having trouble with constipation for 2 weeks or more, it is called chronic constipation

What causes constipation?
The majority of children with constipation does not have a medical disease or disorder causing the constipation. Rarely, a disorder causes infants and children to have significant problems moving their bowels.

The most common cause in a child older than 18 months is their willful avoidance of the toilet (for various reasons). For example, toddlers are often so involved in their play that they lack time or patience for toilet breaks. They may have had a prior painful or frightening experience that makes them want to avoid the bathroom. Over time, their brain learns to ignore repeated urges by the colon to visit the bathroom. As stool remains in the colon, the colon will absorb water out of the stool, making it hard and dry. This hard stool is even more difficult or painful to pass, which causes the child to continue "holding it."

Changes in diet, or a different diet affect bowel habits. Constipation may also begin when you change your baby from breast milk or baby formula to whole cow's milk, and when your switch from baby food to solid food. Breastfed infants will generally have more stools per day. Their stools vary more in frequency when compared to bottle-fed infants. Teenagers and toddlers who eat a lot of sugar and desserts are prone to difficult passing of their stools.

Any intense changes in a child—such as illnesses causing fever, a long time in bed, eating less, or dehydration—may decrease frequency of stools or may harden stools.

A number of medical disorders can cause chronic constipation.

Hypothyroidism (lowered activity of the thyroid gland) is a condition that causes decreased activity of the intestinal muscles along with many other symptoms True constipation in infants and children that has been present since birth may be from Hirschsprung's disease. In this rare congenital condition, a segment of the colon lacks ganglion cells (a type of nerve cell). The affected colon cannot receive directions from the brain to work properly. Most infants with Hirschsprung disease display symptoms within the first few weeks of life. They may be underweight or small for their age. They may vomit and pass small stools, which are described as ribbon-like. Hirschsprung's disease is generally more common in boys and in babies with Down syndrome. If Hirschsprung's disease is suspected, you need to take your child to a specialist (pediatric surgeon) for further tests.

Cystic fibrosis, for many reasons, causes constipation in children by many mechanisms. Children with disorders of the nervous system (such as cerebral palsy, mental retardation, or spinal cord problems) display a high rate of constipation.

Some medications can make children more likely to be constipated. Common contributors include over-the-counter cold medications and antacids. Antidepressants, anticonvulsants, chemotherapy medications, or narcotic pain medications (such as codeine) can also constipate.

Symptoms
Children often exhibit characteristic behaviors while trying to keep from having a bowel movement. Infants having painful bowel movements may extend their legs and squeeze their anal and buttock muscles to prevent passage of stool. Toddlers often rise up on their toes, rock back and forth, and hold their legs and buttocks stiffly.

Other signs that children are constipated are these:

Vague abdominal pain around the navel (belly button) or even severe     abdominal pain
Decreased appetite, nausea, or vomiting
Urinary incontinence, frequent urination, or bedwetting
Reappearing urinary tract infections

What can I do if my child is constipated?
There are many things you can do to help your child:

Diet--You can start by increasing the amount of fluid your child drinks every day. If your baby is eating cereal, you can try adding a little prune juice to it. If you have an older child, make sure they are drinking plenty of water, fruits and vegetables that are high in fiber.

Bowel habit training--Your child should be taught not to wait to have a bowel movement. To establish a regular bowel habit, ask your child to sit on the toilet for at least 10 minutes at about the same time each day, preferably after a meal. While your child is sitting on the toilet, you might let your child read a story book or listen to the radio.

Medicine--Many laxatives are available to treat constipation in children. The choice of laxative depends on the age of your child and how serious the constipation is. Ask your family doctor to suggest a brand name and tell you how much to use.

Start a reward program--Begin rewarding your child for just sitting on the toilet. For example, if your child sits on the toilet at the planned time, reward your child with a favorite activity. If your child has a bowel movement, give your child praise and a reward. Try not to use food as a reward. Some children like to be awarded with stickers. Older children like to add up points for a larger reward, such as a trip to a movie theater.

If the constipation doesn't get better, or if you think your child has chronic constipation, take your child to see your family doctor. Constipation can sometimes be a sign of a more serious problem.

When to Seek Medical Care
If none of the home care measures is working, call the doctor. He or she may prescribe a laxative. The type of laxative depends on the age of the child and the exact problem. You may need to make an appointment with a doctor.

If the child has significant abdominal pain, nausea, vomiting, decreased appetite, fever, or bloody diarrhea, he or she needs to see a doctor immediately. Many of these symptoms can be related to constipation. Some of them, however, can indicate a serious medical condition.

Complications of untreated constipation

• Anal fissures
• Fecal impaction
• Bowel obstruction
• Fecal incontinence
• Megacolon
• Volvulus
• Rectal prolapse
• Urinary retention

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