One of the most frequent visits I see in my office are school age children with stomachaches. There are lots of reasons for stomachaches, but one I wanted to talk about today is constipation, which is very common but can cause extreme discomfort and frustration for a child.
What is a normal stool pattern for children? Generally, we like to see children have a bowel movement every day but sometimes it is normal for children to skip a day or two as long as the stool is still soft and easy to pass without much pain or straining. And sometimes, even kids that have a daily bowel movement can be constipated, so usually frequency of pooping is not always a great indicator of whether or not someone is constipated. I usually ask parents, or the child if they are old enough, if their stools are dry, hard, “pebble-like” or “very large…as in you cannot believe that size of poop just came out of that little kid!!!” Again, most children with constipation will have some episodes of abdominal pain. Some children also will not some bright red blood on the toilet paper when they wipe from tears (called fissures) that occur when they pass that really hard, large stool. At times, when constipation has been a long standing issue, children will have accidents, either urinary or stool. When there are stool accidents in the underwear, it can be from the child having long standing constipation that stretches the rectum and collects large, hard stools. At this point, liquid stool passes around that hard stool and leaks into the underwear because the child can no longer feel that stool coming out around that large stool sitting in the stretched out rectum.
So what are the most common causes of constipation? I will say again that constipation is very common in children. Sometimes constipation can happen temporarily due to changes in diet (introducing new foods in babies), or a recent illness that has caused a decrease in appetite. Decreased fluid intake and hot weather causing dehydration can also lead to constipation. Watch for changes in children’s bowel patterns after big changes, such as traveling, stressful situations at home or school, or avoiding stooling because of being too busy playing. The most common reason of children getting constipated is diet. Children often love to eat low fiber foods. Some children will also withhold stooling because of pain and this creates a vicious cycle of constipation—the child doesn’t want to stool because it hurts, so she holds her stool because of the pain associated with stooling and our stool becomes harder and more difficult to pass the longer it sits in the intestines. So then she tries to hold stools in even more.
So what do we do to treat constipation? The easiest way is prevention. You can prevent constipation but encouraging your child to drink lots of water and eat high fiber foods. Monitor your child’s stooling habits and make sure they are using the toilet regularly. Physical activity is also great for preventing constipation. However, even with these prevention techniques, children can still get constipated. If you are concerned about your child being constipated, we will often set up a regimen that works best for your child depending on the cause of constipation, which can include medication to help them stool. Feel free to call us if you have any questions or concerns that your child may be constipated and we can set up an appointment to discuss options for treatment and prevention.
Dr. Yohanna
Resources: American Academy of Pediatrics, healthychildren.org