Woman carrying young girl with down syndrome.

Constipation is a common ailment that affects 25-30% of young children and toddlers. It is the cause of nearly 8% of pediatric outpatient visits and 25% of referrals to gastroenterology specialists.

Children with Down syndrome face unique challenges when it comes to constipation and it’s important to be aware of what to look for and how to help.

What is Children’s Constipation?

Every child has a different definition of what is ‘normal’ for their bowel patterns, so it’s best to be on the lookout for less frequent bowel movements than usual combined with stool that is hard, dry, lumpy, and/or difficult to pass.

Signs your child may be constipated include:

  • Less bowel movements than usual for your child
  • Stool that is hard, dry, looks like ‘pebbles’, and/or is difficult to pass
  • Soiling and stool leakage
  • Abdominal discomfort, including cramps, pain, and/or nausea
  • Reduction in appetite
  • Irritable behavior
  • Bloated and/or protruding abdomen
  • Painful bowel movements

Constipation and Children with Down Syndrome

Constipation is common in children with Down syndrome. Lower muscle tone, decreased mobility, dehydration, and diet are some of the more common causes.

Structural and functional differences in children with Down syndrome can exacerbate or contribute to the risk of children’s constipation.

Infant Small Bowel Obstruction

If there is an obstruction in the small bowel, food cannot properly pass to the large intestine.

A complete obstruction occurs when part of the bowel doesn’t form completely and a partial obstruction can occur when the bowel forms but is narrower than it should be.

Obstructions in infants typically present in the first few days after birth. Vomiting and failure to have bowel movements are the primary symptoms of a small bowel obstruction. Vomiting is typically present even with a less severe obstruction.

Hirschsprung’s Disease

Approximately 2-15% of children with Down syndrome are born with Hirshsprung’s disease, which is the absence of nerve cells in the lower bowel. It can affect the lower bowel to varying degrees and it inhibits the ability to evacuate stool.

If only a small portion of the lower bowel is affected, symptoms of Hirschsprung’s disease can be easy to miss in infants and babies. If a child with Down syndrome has persistent constipation despite lifestyle/dietary changes and laxative use, Hirschsrung’s disease may be the cause.

Abnormalities of the Anus

An imperforate anus, or a lack of an anal opening, is more common in newborns with Down syndrome. When this occurs the condition is corrected surgically immediately following birth.

Less severe cases may involve a narrower anal opening (anal stenosis) and this can be a contributing factor behind constipation for children with Down syndrome.

Celiac Disease

Up to 16% of children with Down syndrome have Celiac disease, which is caused by an allergy to the protein gluten. Gluten is typically found in wheat, barley, rye, and other grains. The inability to process gluten can lead to abnormal stools and symptoms include diarrhea, foul-smelling and/or bulky stools, swollen stomach, fatigue, and irritability. To diagnose this condition, all children with Down syndrome between the ages of 2-3 should be screened for Celiac disease through a simple blood test.

Feeding Problems

It is common for babies with Down syndrome to have feeding difficulties due to low muscle tone, lack of coordination, and difficulty swallowing. This can interfere with the proper nutrition required to maintain regular bowel movements.

Hypothyroidism

Children with Down syndrome are more susceptible to hypothyroidism, which is when the thyroid gland dysfunction interferes with several of the body’s metabolic processes, including passing stool.

Relieving and Preventing Constipation in Children with Down Syndrome

Functional and structural differences in children with Down syndrome make relieving and preventing constipation key for a child’s health, wellness, and quality of life.

If you believe your child is suffering from constipation, the first step should always be to consult with a pediatrician.

Typically, the first course of action is to examine lifestyle and dietary habits. It’s important to be sure your child is adequately hydrated, consumes a balanced diet with plenty of fiber, and participates in a regular fitness routine.

It’s also helpful to avoid or reduce foods and beverages that can contribute to the risk of constipation, including those that are high in unhealthy fats, sodium, and sugar.

Avoid processed foods as much as possible, and ensure your child is consuming plenty of fruits, vegetables, legumes, and nuts/seed (provided no nut allergy is present). Reducing dairy, red meat, and binding foods like bananas and rice may also help.

See our article on home remedies you can try to help alleviate and prevent children’s constipation for more ideas!

If diet and lifestyle changes do not alleviate your child’s constipation, your pediatrician may recommend a laxative. Stool softeners are typically the first course of action, as they are gentle on the system and have few side effects. It’s important to understand the different types of laxatives available and the potential risks and benefits of each one.

DocuSol® Kids Can Help!

Sometimes, despite all the best efforts with nutrition, hydration, and exercise, kids need a little help relieving constipation.

DocuSol® Kids is a first-of-its-kind mini enema containing a non-irritating stool-softening laxative that works by drawing water into the bowel from surrounding body tissues, replicating a normal bowel movement. This unique formulation provides children ages 2–12 fast, predictable relief of constipation within 2 – 15 minutes.

DocuSol® Kids was designed for easy use at home. The DocuSol® Kids tube is designed to offer a minimally invasive, soft, and flexible tip, avoiding any scratching or irritation to the skin. Just a 5-milliliter tube delivering 100mg of docusate sodium, the medication provides fast relief in just a few, easy steps!

Learn more about DocuSol® Kids on our website, including where to buy, doctor tips, family resources, and frequently asked questions.

Disclaimer:

The material contained is for reference purposes only. Alliance Labs, LLC, and Summit Pharmaceuticals do not assume responsibility for patient care. Consult a physician prior to use. Copyright 2021 Summit Pharmaceuticals and Alliance Labs, LLC.

Sources:

https://www.sciencedirect.com/science/article/pii/S0022347614008798

https://dsagsl.org/wp-content/uploads/2019/02/gastrointestinal_problems.pdf

https://www.ndss.org/resources/gastrointestinal-tract-syndrome/

https://www.massgeneral.org/children/down-syndrome/understanding-constipation-in-people-with-down-syndrome