Health & Fitness

Doc Talk: Functional constipation common in kids

A normal bowel movement is thought to be a sign of health in children of all ages, especially during the first few months of life when parents pay close attention to the frequency and characteristics of their children's stools — along with everything else.

Any deviation from what is thought to be normal may trigger a call or a visit to the pediatrician. In fact, about 3 percent of general pediatric outpatient visits and 25 percent of pediatric gastroenterology consultations are related to a perceived problem with passing stool.

Constipation is defined as a delay or difficulty having a bowel movement for two or more weeks. On average, an infant less than 1 year old has two to three stools per day. A child between 1 and 3 years has one to two stools per day; after 3 years, it's about once a day.

Beyond the newborn stage, most common constipation is functional, without evidence of a pathological condition. Usually it is caused by painful bowel movements that cause the child to withhold the stool to avoid discomfort. Many events can contribute, including toilet training, changes in routine or diet, stressful events, intercurrent illness, unavailability of toilets or the child simply being too busy to go.

Chronic abdominal pain or anal/rectal pain is reported by about half of children with constipation. If left untreated, it may lead to soiling and accidents in children who are toilet trained. This can create anxiety, distraction or embarrassment that affects the child's school performance. Constipation also can lead to such problems as decreased appetite, urinary tract infections and daytime or nighttime urinary accidents.

What can parents do?

Once the problem is identified, increase dietary fiber in your child's diet and make certain they get enough water. The daily recommended amount of fiber is calculated by adding the child's age in years + 5, so a 4-year-old needs 9 grams of fiber every day. Adults need about 25 to 35 grams of fiber each day.

A diet high in fiber can help overcome and prevent constipation. Raw fruits and vegetables, whole grain cereals and bran are good sources of fiber.

You can find fiber supplements in any grocery store or pharmacy. Choose from many different formats, such as fiber bars, fiber gummies and other forms.

Some foods, such as prunes, pears and apple juice, act as natural laxatives.

Drinking enough water and clear liquids, especially in the hot summer weather, also is crucial in the management of constipation. On average, a child will need 6 to 8 cups of liquids every day, keeping in mind that the amount of water varies with the individual, depending on the amount of physical exercise, and on the environmental temperature and humidity.

Encourage your child to make toilet-sitting time a part of his/her routine. The best time is 10 to 15 minutes after a major meal.

If increasing fiber and fluids doesn't control your child's constipation, treatment with a stool softener, laxative or stimulant may be warranted. Your child's doctor will decide the best treatment option, depending on the severity of the symptoms and the child's age.

What if these treatments don't help?

If starting treatment doesn't control your child's symptoms or they still seem unusual, seeing a pediatric gastroenterologist may be necessary. As there may be another cause leading to constipation — anatomy problems, thyroid disorders, celiac disease and others — this specialist will need a detailed history, physical exam and possibly laboratory or imaging tests for diagnosis. Then management can be tailored specifically to your child.

Remember: Functional constipation is common in childhood. Other causes need to be excluded by history, physical exam and, if necessary, further testing.

Successful treatment can require a combination of:

* parent and patient education

* nutritional intervention

* behavioral intervention

* medical therapy

* long-term compliance with the treatment regimen.