Constipation is a condition in which there are problems with emptying the bowel. Constipated children have stools that are hard and less regular than usual. Constipation is very common, affecting up to 1 in 10 children. In 95 per cent of cases, there is nothing wrong with your child’s body and the condition can be easily treated with no lasting effects.
Signs and symptoms
Children less than three years of age usually pass more than one stool a day. Stools may be less frequent for children that are breastfed, but if they are soft your child is not constipated. Children three years and older usually pass one stool per day.
Your child is likely to be constipated if they have:
- large, hard or painful stools
- stools that are less regular than usual.
A constipated child may:
- avoid passing a stool
- seem to hold off passing a stool for as long as possible
- pass small amounts of liquid stool into their underwear (known as faecal incontinence).
The symptoms of constipation can start suddenly or happen over a period of time.
Children can develop constipation when there is a change to their routine or a significant event in their life (e.g. starting day care, kindergarten or school, toilet training or the arrival of a new sibling).
Sometimes children that seem to be “straining” to pass a stool are really trying to stop the stool from passing.
How is it diagnosed?
Your GP can diagnose constipation by examining your child and talking to you. Tests are not required. Very rarely, constipation is caused by a problem with your child’s body. If your doctor suspects this is the case, they will refer your child to a specialist.
What is the treatment?
Constipation is mainly treated with medicine (laxatives) and a toileting program. Constipation needs to be managed properly early to avoid social or emotional problems.
Care at home
Make sure your child has a diet that is high in fibre and fruit (prune or pear juice can be useful) and encourage plenty of fluids.
You should not try toilet training your child while they are having problems with constipation
Laxatives allow stools to pass more easily through the bowel. Your doctor will tell you the dose that is needed. Your child should keep taking laxatives for as long as they are having constipation issues. Laxatives are not harmful for your child, even if taken for several months. Stopping the medicine too early is the most common reason for the treatment not working.
You can buy laxatives from your local pharmacy. Laxatives that contain Macrogol 3350 (called Osmolax and Movicol) are the best choice. They are powders that you can mix with a drink. Osmolax does not have any flavour so can be easily hidden in your child’s drink. Movicol has flavour added which may or may not suit your child’s tastes.
Other laxatives may contain lactulose (sweet liquid such as Duphalac) or docusate (such as Coloxyl drops often used in children under three years of age).
Develop a routine with your child where they sit on the toilet for a few minutes and attempt to pass a stool about 15 minutes after breakfast, lunch (or afternoon tea if your child goes to school) and dinner. This is called sitting practice.
The correct sitting position is important. Smaller children may need a toilet seat insert and a stool under their feet. Encourage your child to tighten their tummy muscles while sitting on the toilet (e.g. by blowing up a balloon).
Provide praise or a small reward for sitting practice even if they are not able to pass a stool. A sticker chart can also be useful to keep track of the progress. Do not punish your child for soiling.