How to treat chronic constipation in child

Treatment for Constipation in Children

In this section:

How can I treat my child’s constipation?
How do doctors treat constipation in children?
How can I treat my child’s constipation complication?
How do doctors treat the complications of constipation in children?
How can I prevent my child from becoming constipated?

How can I treat my child’s constipation?

You can most often treat your child’s constipation at home by doing the following:

Change what your child eats and drinks

Changing what your child eats and drinks may make his or her stools softer and easier to pass. To help relieve symptoms, have him or her

eat more high-fiber foods
drink plenty of water and other liquids if your child eats more fiber

Read about what your child should eat and drink to help relieve constipation.

Have your child drink plenty of water and other liquids to help prevent constipation.

Change your child’s behavior

Changing your child’s bowel movement patterns and behaviors may help treat constipation.

Ask your potty-trained child to use the toilet after meals to build a routine.
Use a reward system when your child uses the bathroom regularly.
Take a break from potty training until the constipation stops.

How do doctors treat constipation in children?

Your child’s doctor may recommend giving your child an enema or laxative to help treat his or her constipation. Most laxatives are over-the-counter medicines taken by mouth until your child’s bowel movements are normal. Your child’s doctor may recommend stopping the laxative once your child has better eating and bowel habits. You should not give a child a laxative unless told to do so by a doctor.

If your child is taking an over-the-counter or prescription medicine or supplement that can cause constipation, your child’s doctor may recommend stopping it, changing the dose, or switching to a different one. Talk with your child’s doctor before stopping any medicines.

How can I treat my child’s constipation complication?

Your doctor may recommend treating your child’s hemorrhoids or anal fissures by

making changes in his or her diet to prevent constipation
using an over-the-counter enema or laxative suggested by your child’s doctor
having him or her take warm tub baths to soothe the area

Changing your child’s bowel movement patterns and behaviors may help treat constipation.

How do doctors treat the complications of constipation in children?

Doctors may be able to treat complications of constipation in children during an office visit. Your child’s doctor may recommend at-home treatments, too.

For a child age 2 or older, your doctor may recommend giving mineral oil. Your child will take the mineral oil by mouth or through an enema.

Your child’s doctor may be able to treat rectal prolapse during an office visit by manually pushing the rectum back through the child’s anus. Helping a child prevent constipation is the best way to prevent rectal prolapse.

How can I prevent my child from becoming constipated?

You can help prevent constipation in your child with the same things that treat constipation

provide enough fiber in your child’s diet
have your child drink plenty of water and other liquids
make having a bowel movement part of your child’s routine

Learn more about how you can help prevent constipation in your child by changing what he or she eats and drinks.

Last Reviewed May 2018

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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

Constipation in Children: Symptoms, Treatment and Resources

Treatment for constipation and soiling has three phases – clean out, maintenance, and reestablishing toileting behaviors.

Clean-Out Phase

The clean-out phase is designed to clear the stool plug out of the colon. This can be done with medicines taken by mouth, enemas and suppositories given in the rectum, or a combination of both. Small children who have holding behaviors because of painful bowel movements or fear of passing stools may do better with medicines given by mouth. Although gentle enemas are effective, they may make the child even more fearful.

Hard stool is very difficult and painful to pass. Your child’s clean-out phase may be started with large doses of mineral oil to soften the stool. Mineral oil is not absorbed and gradually seeps through the hard stool and softens it. It may take several days of mineral oil to soften a large amount of packed stool. Mineral oil is dangerous only if it gets in the lungs. This is why it should not be given to infants or children who have trouble swallowing. Mineral oil can be given by enema or by mouth. Since mineral oil has an oily feel to it, most children will take it better when it is mixed with another food. Some of the easier ways to give it include putting it in milk shakes, pudding, applesauce, ice cream, chocolate milk and in juice “slushies.”

Once your child’s stool is soft, your doctor or nurse practitioner may suggest that you add other medicines by mouth or rectum. It is very important to remove the entire stool plug during the clean-out phase or the next phase will not work as well.

Your child should be on enough medicine to prevent a stool plug from forming. Children on the proper therapy usually have one to three loose to very soft stools every day. If children on therapy go two to three days without a bowel movement, their therapy should be increased. Soiling usually means a stool plug rather than too much medicine.

Maintenance Phase

Once the clean-out phase is complete, your doctor or nurse practitioner will tell you what medicine your child will take every day. Small children who are afraid of painful bowel movements will receive medicine to soften their stool. Mineral oil is very effective for this, because it helps the stool slide out more easily. Fiber, which helps keep water in the stool, may also help wit this. The richest source of fiber is usually found in breakfast cereal. To find how many grams of fiber your child needs each day, add 5 to your child’s age. For example, a 3-year-old child needs about 8 grams of fiber every day.

Some laxatives are salts that hold water in the stool. Examples include Milk of Magnesia and Miralax. Other laxatives work by fermenting sugars and producing gas. These include apple juice, lactulose and maltsupex. These are not very good treatments, because they may cause gas cramps. Other laxatives may cause stretched and weakened muscles to contract. These include senna and bisacodyl. Your doctor or nurse practitioner can suggest the treatment that will work best for your child.

Mild constipation may be treated with diet changes. Increased fiber may soften stools. Sugary drinks that ferment (such as apple and fruit juice) may be used as well. Prune juice has the advantage of fiber as well as natural senna. Extra water or fluids generally don’t reach the colon.

Children with soiling or more severe constipation usually require medication. However, making changes in your child’s diet at the same time may help wean them from medications more quickly. Getting children, especially toddlers, to eat the diet we would like may be difficult, but the extra effort will be rewarded with happier children.

This chart lists some of the pros and cons of various treatments:

Medication	Action	Advantages	Problems
Mineral Oil	Lubricates	Cheap; stools easy to pass	Do not use with infants; Oily Feel
Milk of MagnesiaTM	Holds Water	Cheap; stools easy to pass	Taste
Senna	Stimulates	Strengthens muscle	May cause cramps
Bisacodyl	Stimulates	Strengthens muscle	May cause cramps
Maltsupex	Produces Gas	None	Cost
Lactulose	Produces Gas	None	Cost
MiralaxTM	Holds Water	No taste	Cost

Treatments That Should NOT be Used in Children:

Fleets Phospho-Soda enemas should not be used in children. They can severely disturb electrolyte balance when held in the colon.
Milk and molasses or a lactulose enema can cause a distended (puffed out) belly above a stool plug with possible tearing. Therefore, these are not recommended for children with chronic constipation.

Reestablishing Regular Toileting Behaviors

Once your child is having soft, comfortable bowel movements on a regular basis, the next step is to get their regular toileting schedule back on track. Many times, this routine has been disrupted due to the child’s fear of having a painful bowel movement, or because they are less likely to sense when they need to use the toilet for a bowel movement.

Our team includes behavioral specialists who provide additional care for patients with encopresis. These specialists help your child:

Get a regular toileting routine started
Have less anxiety around having a bowel movement
Reduce their stool withholding behavior
Have less conflict with their parents over the problem
Feel that they are part of the treatment team

causes, symptoms and treatment

The problem of difficult bowel movements or, simply put, constipation is one of the most common digestive problems in both adults and children ^5-7 .

What is constipation?

Normally, constipation refers to the absence of a bowel movement for a certain period, but in children under the age of 6 months, the appearance of hard stools is also considered constipation ⁷ .

What is considered constipation in children ^1.7 :

In children under six months of age who are breastfed, the stool should be after each feeding, but at least twice a day.
In children of preschool and school age, constipation is possible if there is no stool during the day.
They also speak of constipation if the child goes to the toilet several times a day, but at the same time he strains very much, and the stool comes out in small portions and looks like "nuts".

To determine the “norm”, one should take into account not only the frequency of the stool, but also its shape, consistency ⁷ .

What is chronic constipation?

The presence of at least two of the following symptoms is a sign that the child is constipated ⁷ :

painful defecation;
bowel cleansing occurs two (or less) times a week;
a large amount of feces accumulates in the rectum;
difficulty in defecation due to the large diameter of the feces;
conscious retention of a chair. nine0018

Frequency of these symptoms ^1.7 :

for a child over 4 years of age: at least once a week for two months;
for a child under 4 years old: for one month.

There are different types of constipation in children. The tactics of their treatment is determined by the doctor based on the course, duration, mechanism of development of constipation and the degree of its severity. At the same time, it should be understood that the most common cause of constipation in children is not inflammation or pathology in the intestines, but dysmotility of the colon ⁷ .

Why is chronic constipation dangerous?

With constipation, even intoxication is possible, which is extremely dangerous for the child's body. In addition, there is a risk of the feces turning into a solid substance, which leads to the formation of cracks in the anus and, as a result, acute pain when trying to defecate ⁷ .

Prolonged lack of bowel movements can also be a sign of intestinal obstruction. At the same time, the child is in an extremely restless state, refuses to eat, he often has a fever, vomiting and even bloody discharge from the anus ⁷ .

How can chronic constipation be solved in children?

The treatment of constipation takes time and must necessarily begin with the correction of nutrition and the development of the correct "toilet regimen" ⁷ .

Give your child enough water to drink according to their weight.
For the prevention of constipation, it is recommended for infants to do a tummy massage, which can be read about here.
It is also important to develop a conditioned reflex to defecate in the baby, for this the following actions are performed: in the morning, immediately after waking up, the child should drink non-cold water, about half an hour later - have breakfast. nine0018
It is worth accustoming a child to defecate at the same hour, and for this you need to strictly adhere to the daily routine. It is optimal when planting on a pot occurs after breakfast.

However, these methods are not always enough to get rid of constipation in a baby. In this case, you can try the laxative Duphalac® with a high safety profile ² .

Duphalac® Mild Laxative

Duphalac® is a dual action laxative. On the one hand, Dufalac® gently cleanses the intestines, and on the other hand, normalizes its microflora due to the prebiotic action ² . Thus, Duphalac® restores proper bowel function and regular stools for a long time ^2.3 .

In addition, Duphalac® has a high safety profile and can be used in children from birth ² . It is non-addictive* and can be used for as long as needed ^2.4 . Duphalac® also contains only lactulose and purified water, so the risk of allergies is minimized ² .

Chronic constipation in children - symptoms and treatment

Changes in the functioning of the child's intestines are closely related to the growth of the digestive system and the whole organism. The most rapid changes occur in the first six months of life. The intestines begin to work correctly, the baby learns to go to the toilet, control muscles and push for a successful bowel release.

The next important step is the introduction of complementary foods. The composition of food changes, and accordingly, the work of the intestines. Gradually, new products are introduced and, finally, in the second year of life, the child switches to regular food. With a change in diet comes a change in the frequency and consistency of stools ¹ .

A child older than a year learns not only to empty his bowels, but also to control this process, getting used to the potty. During adolescence and adolescence, the digestive system and intestines also grow, but more gradually.

Children may fail at any of these stages and present with symptoms of chronic constipation.

Studies conducted in five federal districts of the Russian Federation showed that virtually every second child (52%) suffers from constipation during the first four years of life, and with the same frequency both boys and girls ¹ . Therefore, it is so important to recognize the problem in time and take measures to normalize the work of the child's intestines.

How to understand that constipation in a child has become chronic?

In children of the first months of life there is no clearly defined norm for the frequency of stools. It is believed that the frequency of stool in a child should be at least 3 times a week ¹ .

But not everything is so simple. If the stool frequency is within the normal range, other symptoms should not be forgotten. Lumpy, hard, scanty stools, a feeling of incomplete bowel cleansing, prolonged straining without results, and pain during a trip to the toilet may indicate constipation ^5.6 .

The term "chronic constipation" most often refers to frequent or persistent bowel dysfunction, recurring at least once a week for more than 1 month in children over 4 years of age and more than 1 month in children under 4 years of age ^{2. 6} .

Factors affecting the occurrence of constipation in a child

The following causes can lead to the occurrence of constipation in children and its subsequent transition to a chronic form ^1-3 :

Wrong diet of a nursing mother if the baby is breastfed
Fast transfer from one adapted formula to another (less than 3 days)
Early transition from breast milk to adapted milk formulas
Adjustment of the intestines to new foods and the introduction of complementary foods
Insufficient drinking regimen of a child with artificial feeding and with the introduction of complementary foods, regardless of feeding
Underfeeding
Prolonged and indiscriminate use of microclysters and suppositories, mechanical means to stimulate the bowels
Incorrect and untimely process of potty training a child
Increased shyness, a sense of false shame, suppression of the urge to go to the toilet.

Over time, these factors and causes become identical to the factors and causes of constipation in adults. nine0005

Treatment of chronic constipation in children

Treatment of chronic constipation in children requires a comprehensive approach. You need to act in several directions at the same time ^1.6 :

First, you need to balance the diet, increase the amount of fiber and fluid intake (read more about nutrition for constipation in the article "Nutrition for children prone to constipation").
Secondly, increase the child's physical activity through exercise or exercise therapy. By the way, you can perform therapeutic exercises with your child in order to form a healthy habit for the whole family (you can learn more about this topic in the article “Gymnastics for Children”). Also, for the prevention of constipation, it is recommended to massage the tummy (for more details, see the article “Massage for the Prevention of Constipation”). nine0018
Thirdly, to normalize the intestinal microflora of the child, since dysbacteriosis can often cause constipation and restoring a healthy balance can be more important than ever.
Fourthly, the normalization of the nervous system, if the child is faced with significant stress (for example, went to kindergarten, etc.), since the psychological state has a significant impact on the normal functioning of the intestines (more details can be found in the article "How to help child to solve the problem of constipation caused by social or psychological causes"). nine0018
Fifth, sometimes the above measures are not enough and it is necessary to resort to the use of laxatives. Especially popular among mothers are microclysters due to the speed of action. However, one should be very careful here, since microclysters work only in the rectum and act as an "emergency" remedy for the correction of acute situations, which is not recommended to be taken for a long time ^{5. 6} . Therefore, it is recommended to take osmotic laxatives to treat constipation ⁶ (more details can be found in the article “What is the danger of frequent use of microclysters for children?”).

One of the main conditions for the successful treatment of chronic constipation in children is the achievement of the desired stool consistency and regular, preferably daily bowel cleansing. To do this, it is necessary to form in the child the habit of going to the toilet at the same time. The optimal time will be the morning hours ⁷. Recovery and strict adherence to the daily routine will help facilitate the process of forming a habit. In the morning, immediately after waking up, the child should drink a glass of water at room temperature, after about half an hour - have breakfast. nine0005

Proper nutrition, sufficient fluids, reduction of stress, introduction of physical exercises (massage and gymnastics for constipation) ⁸ can act as both prevention and treatment at the same time.