The American Academy of Family Physicians defines constipation in children as one or more of the following: fewer than three bowel movements per week; dry, hard or unusually large stools; and/or stools that are difficult to pass. Risk factors include a low-fiber diet, certain kinds of behavioral traits and other kinds of medical problems. Constipation that lasts longer than two weeks is considered chronic and should be evaluated by the child’s doctor. She will likely recommend some combination of the following treatments:
Fluids
Increasing fluid intake constitutes a first-line treatment for chronic constipation. Fluids, especially plain water, combat excessive water resorption from the colon; however, given in excess, fluids can cause other problems, such as water intoxication and displacement of other nutrients from the diet. Parents and caregivers should increase the child’s daily fluid intake by small amounts—10 to 20 percent, or one to two servings per day. For infants, according to the American Academy of Pediatrics, parents and caregivers should always consult the child’s doctor before giving fluids others than breast milk or formula.
Fiber
According to the American Dietetic Association, the average American adult consumes only 60 percent of the recommended daily value for fiber. Unfortunately, children tend to follow in the footsteps of their parents. Parents and caregivers should replace white rice, bananas and refined grains with foods rich in fiber, including whole grain breads and cereals, brown rice, fresh and dried fruits—especially prunes, apricots and figs, vegetables and legumes such as navy, kidney and pinto beans. In some cases, report pediatric gastroenterologists Judith M. Sondheimer and Shikha Sundaram in the 2009 edition of “Current Diagnosis and Treatment: Pediatrics,” no other treatment will be required.
Bowel Habit Training
According to the American Academy of Family Physicians, chronic constipation sometimes develops when young children ignore the urge to have a bowel movement. The problem may be triggered by a previous painful bowel movement, reluctance to use school or daycare toilet facilities, reluctance to ask for help using the bathroom or even a desire to avoid interruption in other activities such as playtime. Bowel habit training entails behavioral techniques such as sitting the child on the toilet for at least 10 minutes after every meal or at specific times during the day, performing relaxing activities such as reading a book or listening to music while on the toilet and teaching the child not to ignore the urge to have a bowel movement.
Medications
The American Academy of Pediatrics warns against using medications for constipation, except as directed by the child's doctor. According to Drs. Sondheimer and Sukharam, commonly prescribed stool softeners include barley malt extract, polyethylene glycol solution and dioctyl sodium sulfosuccinate. In severe cases, stimulant laxatives such as pharmaceutical grade extracts of senna fruit may be indicated for a few days only. More frequent use can actually make chronic constipation worse by making the colon dependent on the drugs.
References
- “Current Diagnosis and Treatment: Pediatrics, 19th ed.;” W.W. Hay et al.(eds); 2009
- American Academy of Family Physicians: Constipation in Children
- American Academy of Pediatrics: Constipation
- American Dietetic Association: Health Implications of Dietary Fiber
