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10/25/2008 - by eMedicineHealth
Constipation in Children
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Constipation occurs commonly in children, affecting up to 10% at any given time.
Still, only 3% of parents actually seek advice from the doctor for this condition. Constipation
describes the infrequent passage of stools (bowel movements) or the passage of hard stools. Any
definition of constipation depends upon comparison to how often the child normally passes stools
and to the normal consistency of his or her stools.
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Many children normally pass stools as far apart as every few days.
Regardless, you should treat hard stools that are difficult to pass and those that happen only every three days as
constipation.
Infants and children with constipation are treated differently than adults because
patterns of bowel movements change from the time they are born until they reach the age of 3 or 4 years. The
majority of children with constipation do not have a medical disease or disorder causing the constipation. Rarely,
a disorder causes infants and children to have significant problems moving their bowels.
Many things can contribute to constipation.
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.
At school they may be concerned with lack of privacy or the cleanliness of the
bathroom.
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. In adults, high-fiber diets have been shown to improve
bowel function. In children, however, high-fiber diets have not been proven to improve constipation. Infants and
children who eat well-balanced meals typically are not constipated.
Breastfed infants will generally have more stools per day. Their stools vary more in frequency when compared to
bottle-fed infants. For example, breastfed infants produce anywhere from 5-40 bowel movements per week; whereas
formula-fed infants have 5-28 bowel movements per week. Switching the type of milk (or formula) can also cause
constipation.
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. All newborns should be tested for hypothyroidism as part of the
newborn screening blood test (heel prick or Guthrie test). This condition is usually diagnosed when a baby is very
young but can occur at any age.
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
(gastroenterologist or pediatric surgeon) for further tests.
Diabetes is common medical problem associated with
constipation.
Alterations in electrolytes levels, such as calcium or potassium, can changes bowel
habits.
Although other symptoms of lead poisoning will be more obvious, children with chronic
lead exposure may have constipation.
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 because they spend prolonged time in one
position, experience abnormal colon movement, or lack coordination in moving their bowels.
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.
Other possible causes of constipation are depression, coercive toilet training,
attention deficit disorders, and sexual abuse.
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