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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52


Constipation is a very uncomfortable intestinal problem in which bowel movements occur less frequently than normal, stools tend to be hard and dry in consistency and are difficult and painful to pass. If your child passes stools infrequently, only every 3-4 days, their stools are soft and they do not cause any pain or discomfort when passed, it is unlikely they are constipated. Normal bowel patterns vary from 4 times a day to once every 4 days (Collins, 2003; Leary, 1990; NDDIC, 2008).


Constipation is a common condition in children that rarely has any long-term consequences and is seldom a sign of a more serious health problem. However, it may have an impact on your child’s quality of life, cause emotional problems, and create family stress (NDDIC, 2008).


Causes and risk factors

·                Constipation may occur due to stool withholding. Children may voluntarily choose to respond to the urge to defecate or ignore it. The deliberate withholding of faeces may occur due to stress about potty training, embarrassment about using public bathrooms, not wanting to interrupt play time, or the fear of having a painful or unpleasant bowel movement.

·                Stool withholding may eventually lead to chronic constipation because delayed bowel movements, result in hard, dry stools, that are difficult and painful to pass. Because of the pain and discomfort, your child may hold on to the stools for longer and a vicious cycle begins.

·                Sometimes a mass of stools develops in the rectum. This is known as faecal impaction. When the fluid surrounding the hard stools unexpectedly leaks out into your child’s underwear, she has a condition known as encopresis. Paradoxically, many parents mistake encopresis for diarrhoea.

·                In some children the passing of hard stools may cause a tear in the anal wall. This is known as an anal fissure and it may be evident by a few drops of blood on the stool, on toilet paper or in the nappy.

·                Dietary factors: A diet low in fibre and insufficient water intake may produce constipation. In infants, a change in formula may result in changes in stool consistency. Bottle-fed infants generally tend to get constipated more frequently than their breast-fed counterparts. Rice, bananas and milk tend to be constipating in some children.

·                Behavioural factors: changes in daily routine, such as starting school, going on holiday or moving house, can cause constipation in your child.

·                Lifestyle factors: a lack of exercise may make your child’s bowels sluggish.

·                Medication: certain medications such as antacids, antihistamines, anticonvulsants, certain cough medications and iron supplements may initiate constipation.

·                Diseases: including Hirschsprung disease, diabetes and Down syndrome.

·                Illness: Temporary constipation may be caused by dehydration, resulting from an illness involving vomiting and diarrhoea (Collins, 2003; Leary, 1990; NDDIC, 2008; Norgine Ltd, 2010).


When to consult your doctor

Consult your doctor if your child has constipation symptoms for more than a week, experiences pain on defaecation or you suspect chronic constipation. Your child should see the doctor sooner if her constipation is accompanied by any of the following symptoms which may be indicative of a more serious health problem:

·         fever

·         vomiting

·         blood in stool

·         a swollen abdomen

·         weight loss/loss of appetite

·         painful tears or cracks in the skin surrounding the anus (anal fissure)

·         soiling her clothes

·                intestines coming out the anus (rectal prolapse) (Collins, 2003; Leary, 1990; NDDIC, 2008; Norgine Ltd, 2010)


Your doctor will ask questions about your child’s diet, recent illnesses and history of symptoms. He will perform a physical examination and may need to perform a rectal examination to check for any abnormalities and for the presence of faecal impaction (Collins, 2003; NDDIC, 2008).



Treatment for constipation depends on your child’s age and the severity of the problem. The best way to treat constipation is to try to identify the cause and eliminate it if possible. Treatment generally involves dietary changes, the use of laxatives or stool softeners, and developing healthy bowel habits. Do not give your child laxatives without your doctor’s advice (Collins, 2003; NDDIC, 2008; Norgine Ltd).


Dietary changes

Ensure your child has plenty of fluids to help alleviate and prevent constipation. From 6 months of age ensure that your child has foods that are high in fibre in the form of fruit, vegetables and whole grains. Older children may be given other foods that act as natural laxatives such as prune juice, corn syrup and bran cereal. If your child has chronic constipation, temporarily remove potentially constipating foods such as rice, cheese, bananas, chocolate and sometimes milk.



Stimulant laxatives and stool softeners are frequently prescribed to help clear a faecal impaction, allow an anal fissure to heal and to restore regular bowel movements. It may take at least one month of using stool softeners for your child to regain confidence in her intestinal signals. The soft stools produced by laxatives allow an anal fissure to heal in approximately 6 weeks. In severe cases, an enema or suppository may be required to clear out the faecal impaction.


Toilet training

Infant-led toilet training is one of the main steps in preventing constipation in older children. Begin toilet training when your child is ready, in accordance with their developmental timetable. Your toddler will exhibit his interest, often in the form of imitation (‘just like mommy’), and identity searching (‘all by myself’). Respect her size and give her her own place to go in the form of a potty chair or a plastic toilet seat. Teach her words for her actions and recognise her signals for when she’s about to go (Leary, 1990).


Teach older children how their bowels work, explain the importance of responding to intestinal urges and that holding on to stools makes them harder and more difficult to pass (Leary, 1990).


Children with chronic constipation often say that they don’t know when they need to go because the usual intestinal stretching signals of defecation are no longer working properly. This problem may be compounded by the embarrassment of soiled pants. Encourage your child to spend time on the toilet at the same time every day to instil a regular bowel habit. A good time may be after breakfast or lunch when the bowels are their most active. Ensure that your child does not feel rushed and if she experiencing pain, allow her to try again later (Collins, 2003; Leary, 1990, NDDIC, 2008; Norgine Ltd).



If no solution works, contact a child psychiatrist to explore emotional problems (Leary, 1990).