Dr Lilian Wong talks about Constipation in Children

What is it?

Constipation is a common problem in children of all ages.  Constipated infants typically have bowel movements that look hard or pellet-like, and may cry while trying to move their bowels. Or, they may have fewer bowel movements than before.

Do note that because infants have weak abdominal muscles, they often strain during a bowel movement, causing them to look uncomfortable. They are unlikely to be constipated if they pass soft stool within a few minutes of straining.

As for older children, if they have fewer bowel movements than usual or complains of pain during a bowel movement, they may be constipated.  A child who always has a bowel movement every two days is not constipated, as long as the bowel movement is reasonably soft and is not difficult or painful to pass.

Why does constipation develop and how can it be prevented?

Pain — when a child has had painful bowel movements before, it can lead them to withhold  and avoid going, to avoid more pain. Sometimes, a child may develop a tear in the anus (anal fissure) after passing a large or hard bowel movement, and this pain can lead to withholding. Even infants can withhold because of pain.

Treating pain early can help prevent your child from withholding, which can lead to chronic constipation and leakage of stool.

Unfamiliar surroundings — A child may delay going if they do not have a place where they feel comfortable going, or if they are busy and ignore the need to use the toilet. This can happen when the child starts going to school and avoids going because of hygiene concerns or being embarrassed about using the toilet at school to have a bowel movement.

You can teach your child that it is a good idea to have a bowel movement when his or her body tells them it is time to do so, and reassure him or her that it is alright to use the washroom at school. This type of training from early childhood may prevent development of constipation when your child starts school.

Medical problems — Medical problems cause constipation in less than 5% of all children. The most common causes include Hirschsprung disease (an abnormality of nerves in the colon), abnormal development of the anus, problems absorbing nutrients, spinal cord abnormalities, and certain medicines.

Underlying medical problems are less likely in children who start having constipation during one of these critical periods: after starting cereal and puréed foods, during toilet training, and after starting school. During toilet training if a child is not ready or interested in using the toilet, he or she may try to avoid going to the bathroom, which can lead to constipation. Children who have had a hard or painful bowel movement are also likely to withhold, and this only worsens the problem. If your child is withholding during the toilet training process, stop toilet training temporarily. Encourage your child to sit on the toilet as soon as they feel the urge to have a bowel movement and give positive reinforcement for recognizing the urge and sitting. For all children, encourage a routine time on the toilet. The best time is often after a meal because eating stimulates the bowels.

Once your child starts school, you may not be aware if he or she has problems going to the washroom. Monitor your child’s bowel movements when the child starts school for the first time (eg, kindergarten) and after long breaks.  Ask your child if he or she has any problems trying to have a bowel movement away from home; if limited time or embarrassment is an issue, work with your child and/or school to find a solution.

Parents can help reduce the risk of constipation by being aware of the above high-risk periods, working to prevent constipation, recognizing the problem if it develops, and bringing them to their paediatric healthcare provider so that constipation does not become a bigger problem.

Dr Lilian Wong is a Singapore accredited Public Health specialist and is also US Board certified in General Paediatrics. Dr Lilian has additional training in paediatric neurology and psychiatry. She trained at Virginia Tech-Carilion Clinic and Johns Hopkins in Maryland, USA. To book an appointment please click here: https://www.imc-healthcare.com/appointments/or call: 6342 4440.

You may also find this previous article of interest from Dr Lilian Wong: An Overview of Autism

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