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10/25/2008 - by eMedicineHealth
Constipation in Children
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.
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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