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FAQ – Children’s Constipation

What is constipation?

Bowel patterns vary from child to child, just as they do in adults. What's normal for your child may be different from what's normal for another child. Most children have bowel movements one to two times per day. Other children may go two to three days or longer before passing a normal stool. For instance, if your child is healthy and has normal stools without discomfort or pain, ­having a bowel movement every three days may be your child’s normal bowel pattern.

Children with constipation may have stools that are hard, dry, and difficult or painful to pass. These stools may occur daily or be less frequent. Although constipation can cause discomfort and pain, it's usually temporary and can be treated.

Constipation is a common problem in children. It's one of the main reasons children are referred to a specialist, called a pediatric gastroenterologist.

What causes constipation?

Constipation frequently occurs for a variety of reasons.

  • Diet. Changes in diet, or not enough fiber or fluid in your child's diet, can cause constipation.
  • Illness. If your child is sick and experiences appetite loss, a change in diet can throw their system off and lead to constipation.
  • Medicine. Constipation may be a side effect of some medicines.
  • Medical Conditions. Constipation may result from certain medical conditions, such as hypothyroidism (underactive thyroid gland).
  • Withholding. Your child may withhold stool for several different reasons. Children often withhold to avoid pain from passing a hard stool. Children who might be dealing with independence and control issues may also withhold—this is commonly seen between the ages of two and five years old. It is not uncommon to see children withhold while at school, at a friends house or camp because of embarrassment or being uncomfortable using a public toilet. Your child may also withhold simply to continue playing.
  • Other changes. In general, any changes in your child's routine, such as traveling, hot weather, or stressful situations, may affect overall health and how bowel functions.

If constipation goes untreated, it may worsen. The longer the stool stays inside the lower intestinal tract, the larger, firmer and drier it becomes. It then becomes more difficult and painful to pass.
Your child may hold back stool because of the pain. This creates a vicious cycle.

What are the symptoms of constipation?

Symptoms of constipation may include:

  • Many days without normal bowel movements.
  • Hard stools that are difficult or painful to pass.
  • Abdominal pain, such as stomachaches, cramping, or nausea.
  • Rectal bleeding from tears, called fissures.
  • Soiling.
  • Poor appetite.
  • Cranky behavior.

You may also notice your child crossing their legs, making faces, stretching, clenching the buttocks, or twisting their body on the floor. It may look as if your child is trying to push the stool out, but instead is actually trying to hold it in.

How is constipation treated?

Constipation is treated in different ways. Your child's doctor will recommend the best treatment plan for your child’s situation. In some cases, the doctor may require further testing, such as x-rays, before recommending treatment. In most cases, no tests are needed.

My child has diarrhea, but yesterday said they couldn’t have a bowel movement. What is encopresis?

If your child withholds stool, the large stool buildup can cause rectal stretching when having a bowel movement. Your child may no longer feel the urge to pass a stool until it is too big to be passed without the help of an enema, laxative or other treatment. It is not uncommon for liquid resembling diarrhea to leak out onto your child’s underwear. This happens as liquid can only pass around the stool. This is often confusion to both parents and pediatrician, as the liquid is not diarrhea. This problem is called encopresis.

How Does DocuSol® Kids work?

The DocuSol® Kids formulation functions as a stool-softening, hyperosmotic laxative by drawing water into the bowel from surrounding body tissues. The docusate sodium acts as a softener by preparing the stool to readily mix with watery fluids. The increased mass of stool promotes a bowel evacuation by stimulating nerve endings in the bowel lining and initiating peristalsis. Not only does it soften and loosen the stool, but it initiates a normal stimulus. DocuSol® Kids provides a natural, replicated bowel movement.

Does My Child’s Diet Make a Difference?

  • Babies. Constipation is rarely a problem in younger infants. It may become a problem when your baby starts solid foods. Your child's doctor may suggest adding more water or juice to your child's diet.
  • Older children. When a child or teen is con¬stipated, it may be because their diet doesn't include enough high-fiber foods and (or) water. Your child's doctor may suggest adding higher-fiber foods to your child's diet and may encourage him to drink more water. These changes in your child's diet will help relieve the abdominal pain caused from constipation.

Is medicine needed to treat constipation?

In some cases, your child's doctor may prescribe medicine to soften or remove the stool. Consult your child’s physician about options such as DocuSol® Kids to provide relief. After the stool is removed, your child's doctor may suggest ways you can help your child develop good bowel habits to prevent stools from backing up again.

How can constipation be prevented?

Because each child's bowel patterns are different, become familiar with your child's normal bowel patterns. Make note of the usual size and consistency of her stools. This will help you and your child's doctor determine when constipation occurs and how best to treat it (best treatment options). If your child doesn't have normal bowel movements every few days or is uncomfortable when stools are passed, she may need help in developing proper bowel habits.

You can…

  • Encourage your child to drink plenty of water and eat higher-fiber foods.
  • Help your child set up a regular toileting routine.
  • Encourage your child to be physically active. Exercise, along with a balanced diet, provides the foundation for a healthy, active life.

How Much Fiber is Enough

The American Academy of Pediatrics (AAP) recommends that people between the ages of 2 and 19 years old eat a daily amount of fiber that equals their age plus 5 grams of fiber. For example, 7 grams of fiber are recommended if your child is 2 years of age (2 plus 5 grams).

Will Fruit Juice assist with Constipation?

The AAP policy statement on consumption of fruit juice by children contains suggestions for daily consumption and a warning that too much fruit juice can cause gastrointestinal and other problems.1 They define fruit juice as 100% fruit juice labeled to disclose if it comes from concentrate.

For children between the ages of 1 and 6 years old, the AAP nutrition committee recommends fruit juice consumption of no more than four to six ounces per day, and 8 to 12 ounces for children between the ages of 7 to 18 years old.

The statement further advises:

  1. Fruit juice should not be given to infants before six months of age.
  2. After six months of age, infants should not get juice from bottles or cups that allow them to consume juice easily throughout the day.
  3. Infants should not get fruit juice at bedtime.
  4. All children should be encouraged to eat whole fruits.

The statement cautions that consuming large quantities, because fruit juice contains large amounts of carbohydrates, can lead to diarrhea, abdominal pain, bloating, and flatulence.

Water is the predominant component of fruit juice. Carbohydrates, including sucrose, fructose, glucose, and sorbitol, are the next most prevalent nutrient in juice.

In appropriate amounts, the AAP acknowledges that 100% fruit juice can be a healthy part of a child's diet.

More recently, the AAP has added the recommendation that for children older than six months, fruit juice offers no nutritional benefits over whole fruit (for children six months and older). Whole fruits also provide fiber and other nutrients. Infants should not be given fruit juice at bedtime, nor as a treatment of dehydration or management of diarrhea.2

References

1 American Academy of Pediatrics, Committee on Nutrition. The use and misuse of fruit juice in pediatrics. Pediatrics. Vol. 107 No. 5 May 1, 2001 pp. 1210-1213. (doi: 10.1542/peds.107.5.1210)

2 American Academy of Pediatrics. Where We Stand: Fruit Juice. http://www.healthychildren.org/English/healthy-living/nutrition/Pages/Where-We-Stand-Fruit-Juice.aspx, Updated 7/9/2014 (Accessed Dec 19, 2014)

What are the signs of constipation in children?

  • Children who produce stools that look like pebbly rabbit droppings.
  • Toddlers who routinely strain to pass hard stools.
  • Stool accidents.
  • In a child who is toilet trained (potty trained), holding stools.
  • A protruding abdomen and a decrease in appetite.
  • Having (Experiencing) pain during a bowel movement.

Constipation in Pediatric Patients

25–30% of young children struggle with constipation.

Research shows that children with chronic constipation have a worse quality of life than those with more serious medical conditions, such as inflammatory bowel disease and gastro-esophageal reflux disease.

A recent European study published in The Journal of Pediatrics showed that 25% of children with the condition continue to have symptoms as adults. Researchers believe the numbers in the United States may be similar, if not worse.

Constipation increases the risk of urinary tract infections.

Constipation in Children with Disabilities

Why does an established bowel care program matter?

Chronic constipation is a common problem in children with disabilities and should be addressed effectively at an early stage in their multidisciplinary management.

Cerebral Palsy: Fecal incontinence, or encopresis, and constipation are common bowel and bladder problems among adults or children with cerebral palsy.

Spina Bifida: Due to nerve damage between the spinal cord and the bowel system, bowel incontinence and constipation are associated with spina bifida.

Constipation is often associated with bouts of diarrhea because the soft and runny stools that are stuck above the “hard stools” that cause constipation cannot be processed by the bowel properly and will flow around the hard material causing a bout of diarrhea.

Chronic constipation also stretches the bowel and leads to weakened sensation. This stretching can take years to get back to normal.

Constipation and Urinary Tract Infections in Children

What is a UTI?

The urinary tract is made up of the kidneys, ureters, bladder, and urethra, and each plays a role in removing wastes from the body. The kidneys filter the blood and produce urine; the ureters carry the urine from the kidneys to the bladder; and the bladder stores the urine until it is eliminated from the body through the urethra.

UTI is fairly common in children. Every year, 1–3% of school-age girls will have a UTI. A UTI happens when bacteria from outside of the body travels up the urethra into the bladder, and in some cases the kidneys, causing inflammation. Normally, urine contains no bacteria. When bacteria or other microorganisms enter the urethra, they cause irritation and inflammation. This inflammation can then back track to the bladder, and if left untreated, track even further back to the kidneys. The most common bacteria causing UTI is E.coli, found normally in the stool.

Signs and symptoms:

These vary depending on the child’s age and on which part of the urinary tract is infected. In younger children and infants, the symptoms may be very general. Children may seem irritable, begin to feed poorly, or vomit, as well as:

  • Cry more often
  • Have a fever
  • Not “acting themselves”
  • Foul smelling urine
  • Appear weak
  • Weight loss

In older kids, symptoms can reveal which part of the urinary tract is infected. In a bladder infection, the child may have:

  • Complaints of pain in the abdomen or in the back where the kidneys are
  • Pain or crying on passing urine
  • Needing to pass small amount of urine frequently
  • Needing to wake up often in the night to go to the toilet
  • Wetting clothes or the bed
  • Smelly, cloudy or even blood-stained urine
  • Fatigue

Risk Factors for UTI

There are many conditions that may predispose children to recurrent UTIs. These include gender, anatomical abnormalities, genetics, and bladder and bowel dysfunction.

  • UTIs are common in girls after the first year of life, partly because they have a shorter urethra compared to boys that allows bacteria from the rectum to reach the bladder.
  • Uncircumcised boys have a higher incidence of UTIs.

Always share with your pediatrician if your child has been constipated to ensure the child’s UTI is not associated with prolong constipation issues.

Disclaimer: The material contained is for reference purposes only and obtained through public domain. Each healthcare facility and consumer shall employ their own practice guidelines. DocuSol® Kids and Alliance Labs does not assume responsibility for patient care or the accuracy of the process of information presented. Consult a physician to use by critically ill patients. Copyright 2019