What is considered constipation in children?
The frequency of stool depends on age and nutrition. A breastfed newborn may have stool after each feeding, and after the first months - once every few days, and this is normal if the stool is soft and the baby is calm. In children after a year, they focus on density and pain: hard, lumpy masses, straining, fear of the potty and traces of feces on the underwear indicate constipation, even if stool is daily. Another sign is a feeling of incomplete emptying and very voluminous stool.
- Bowel movements less than twice a week
- Dense, lumpy, large-volume stool
- Pain and straining during bowel movements
- The child restrains the urge, hides, crosses his legs
- Spotting and marks on underwear
- Abdominal pain that goes away after stool
Reasons and what triggers them
Functional constipation most often begins with one painful episode: anal fissure, dense feces after an illness, an unusual toilet in the garden. The child begins to put off going to the toilet, the rectum stretches, and the feces become even denser. Additionally, lack of fluids and vegetables, excess dairy products and sweets, and lack of exercise have an effect. Separately, the doctor takes into account medications and conditions that themselves slow down the intestines, and congenital causes that appear from the first weeks of life.
- Controlling the urge after painful bowel movements
- Lack of fluid and dietary fiber
- A sudden change in diet, switching to cow's milk
- Potty training and adaptation in kindergarten
- Hypothyroidism, celiac disease, iron deficiency
- Hirschsprung's disease and other congenital anomalies
- Some medications, including iron supplements and anticonvulsants
What are the dangers of prolonged constipation?
Prolonged stool retention does not go away without leaving a trace. Dense masses injure the anus, cracks and blood appear on the paper, and fear of pain increases inhibition. Gradually, the rectum stretches, sensitivity to urge decreases, and liquid feces begin to leak around the dense masses - parents sometimes mistake this for diarrhea. Chronic constipation also affects well-being: the child’s appetite decreases, his stomach hurts, his mood suffers, some children have problems with urination and repeated urinary tract infections.
- Anal fissures and pain during defecation
- Spotting and fecal incontinence
- Fecal impaction requiring treatment under medical supervision
- Decreased appetite and abdominal pain
- Urinary tract infections and enuresis
- Formation of fear of the potty and toilet
Survey
In typical cases, the diagnosis is made by questioning and examination: the doctor evaluates the abdomen, the condition of the anus, the height and weight of the child. A stool diary describing consistency helps more than tests. An examination is prescribed if there are alarming signs, early onset of constipation or treatment failure: then hypothyroidism, celiac disease, iron deficiency and intestinal abnormalities are excluded. Ultrasound helps to assess the volume of stool and associated changes.
- Examination by a pediatrician with assessment of the abdomen and perianal area
- Stool consistency diary
- Coprogram and fecal occult blood test
- Abdominal ultrasound
- TSH, tests for celiac disease, ferritin according to indications
- Consultation with a pediatric gastroenterologist or surgeon if an anomaly is suspected
Treatment and regimen
The treatment takes place in two stages: first, the intestines are freed from dense masses, then soft stools are maintained for months so that the child ceases to be afraid of bowel movements. The main drug for functional constipation is osmotic laxatives, which are not absorbed, are not addictive and are prescribed in a course. They cannot be canceled abruptly: the dose is reduced gradually under the supervision of a doctor. At the same time, they establish nutrition and toilet habits: sitting quietly on the potty after eating, support under their feet, no coercion or punishment.
- Enough liquid and vegetables, fruits, whole grains
- Limiting excess milk, baked goods and sweets
- Regular planting after breakfast and dinner for 5–10 minutes
- Support your feet so that your knees are higher than your pelvis
- Osmotic laxatives as prescribed by a doctor
- Outdoor games and walks every day
- Calm attitude towards failures, without putting pressure on the child