Toddlers and Constipation
Author: Dr. Anna Kaplan
Children of any age, including toddlers, can develop constipation. Constipation at this age usually means the passage of hard stool. Frequency of bowel movements is not as important, because it can vary a great deal among normal children.
Breast-fed infants rarely develop constipation. Most often they frequently pass soft stools. Formula-fed infants, on the other hand, can have hard stools at a very young age. All infants develop firmer stools as they get older. They also have bowel movements less frequently.
Diet has an effect on stool consistency. Fiber, vegetables, and fruit help keep stools soft. Cow's milk can cause constipation in some children.
Most constipation in toddlers is not due to any disease or serious problem. Constipation is treatable, and the earlier treatment is started, the more likely it will be successful. 40% of toddlers with constipation have had symptoms in infancy. So, if symptoms reoccur or continue they should not be ignored.
One of the difficulties in diagnosing and treating constipation in toddlers is that they are often not completely toilet-trained, and they cannot or will not tell their parents what is bothering them. Sometimes toilet training is disrupted by the child's constipation. Parents have to observe the behavior and try to figure out what the problem is.
Constipation tends to be a cyclical problem. If a young child who is just gaining control of his or her bowels has a painful, hard stool, he or she may not want to pass the next one. It will stay in the rectum and get dryer and harder. This is called "fecal retention." More stool can be added to what is already there, which becomes bigger and even harder. When it does pass, it is very likely to be painful again.
Toddlers who have large amounts of hard stool in the rectum may actually have leakage of looser stool around the hard part. This can seem to be diarrhea, when the underlying problem is the opposite. Often, there can be small cracks in the tissue around the rectum caused by passing a large, hard stool. These are painful and can also bleed a small amount. This naturally worries parents.
Here are some indications that your child is having trouble with constipation:
- Hard, painful stools
- Infrequent passage of stools - especially if a change occurs
- Leakage of loose stool after your child has gained control over his or her bowels
- Stool large enough to clog the toilet
- Small amounts of blood on toilet paper or underwear
- Pain in the rectal area
- Straining to pass stool - although the child may in fact be straining to hold it in
If you believe your child is constipated, but is otherwise well, there are a number of things you can do. Mild stool softeners can be used, including milk of magnesia or Maltsupex. Mineral oil can be useful, helping the stool to slide out. Fiber supplements like Metamucil help soften stool. These stool softeners are available without a prescription, and most of them will need to be mixed with something because your child will not like the taste. Over a number of days the stool will soften, and eventually your child will pass it.
Parents should not give children strong laxatives unless a doctor recommends it. Strong, stimulating laxatives can cause cramps, as the contraction of the bowels trying to push everything out meets the obstructing hard stool.
Diet is also important in treating and preventing constipation. Most doctors suggest increasing the amount of liquid your child drinks. Adding fiber to the diet definitely helps soften stool. This can be done by adding more fruits and vegetables. If your child does not like many fruits or vegetables, he or she may be willing to eat a breakfast-type bar that has fiber as well as dried fruits like raisins in it. You might want to try stopping milk, at least temporarily.
Stool softeners should be continued until a more regular pattern appears and your child is not afraid of having a bowel movement. Any cracks in the tissue will heal, and that will also reduce the chance of any pain. Toilet training can be restarted or initiated once having a bowel movement is not an issue.
If your toddler has persistent constipation and you have tried some of these remedies, or if your child appears to be sick in other ways, you need to take him or her to the doctor. The doctor will examine your child to make sure there is nothing more serious causing the constipation. He may prescribe something to break up a large mass of stool in your child's rectum, like a suppository or enema.
Constipation is a common problem. Sixteen percent of parents of toddlers report that their children are constipated. Three percent of visits to pediatric offices are for constipation. It may very well happen to your toddler. It is not something to be alarmed about, but something to be aware of. If it does not improve with the simple measures described, it is time to take your child to his or her doctor. It can become a chronic problem, and your child's doctor will try and help prevent that.
