Constipation is a very common problem in children of all ages. The exception is fully breastfed babies who are rarely constipated. On the other hand, it is common for formula-fed infants to become constipated.
Symptoms of constipation
The symptoms of constipation vary, not all children have all the symptoms. Anyone with constipation is at some point difficult to poop or think the poop is hard. Many children experience stomach ache, sometimes after a meal, sometimes otherwise. Some children have pain wile going to the toilet, perhaps because the hard stools caused a crack in the rectum. Some feel unwell, and if constipation is severe, children may be vomiting. Reduced appetite is also common in constipated children.
Constipation causing diarrhea
Paw traces in the underwear, or stool leaks (encoprresis in medical language) are usually due to constipation. Sometimes there is such a hard stool lump in the rectum that the poop runs past, scratching the clothes. It can also make it difficult to detect that the child is constipated, because everything that comes out is too loose.
Anal fissure - a sore in the rectum
The hard constipation stool can cause a crack in the rectum opening when pushed. There is often quite a lot of fresh blood in the toilet and it hurts a lot. It is not dangerous, although the blood looks dramatic. However, the child needs constipation treatment. Pain relieving ointment in the rectum opening before toilet visits can also help. Seek your GP or paediatrician for treatment, but there is no need to to to the ER.
When an anal fissure heals, a small mucosal flap can be formed in the rectum opening. It does not trouble the child at all and does not need a check-up. Just let it be there.
The vicious circle of constipation
When the stools become hard and it becomes difficult to poop, it often happens that children will refuse going to the toilet. Then the stool remains in the bowel and the large bowel mucosa can absorb more fluid from the pouch, which becomes even harder. When the child tries to poop it makes it even worse and the child stays longer. An evil circle is running.
In a child who is not constipated, the rectum is empty. When it is filled with feces, signals are sent to the brain that it is time to poop. In a constipated child, there is feces in the rectum for most of the time. The rectum sends signals to the brain, and when it is not possible to poop, it is easy to interpret those signals as pain. Or the gut gets tired of sending signals that never lead anywhere and the child stops feeling the need to to to the toilet.
Treatment for constipation
In the long term, the treatment of constipation involves breaking the vicious circle and allowing the signal system between the gut and the brain to be restored. These processes take time, usually several months. It is therefore important to continue treating constipation all the time, and not stop after a week or two even if your child is pooping every day.
With a slight constipation, dietary changes may suffice. Of course, this requires that you have a child who accepts dietary changes. Children who only eat a few things and who are very much in trouble with the food may need to give medicines from the beginning.
Dietary advice for constipation
Prunes or pear puree
Probably the most classic home remedy for constipation is prunes. It works pretty well against mild constipation. Of course, it is easier said than done to try to give a picky preschooler prunes, but for infants who eat canned food, you can try to prune and pear puree.
Whole grains and high fiber foods
Fiber-rich foods are usually recommended against constipation. For children, high-fiber, moist fruits like well-ripe pears, plums and apple are usually good. However, dry fibers, as in whole grain products, can have the opposite effect if the child does not drink more at the same time. Try out what works for your child and don't forget to give them water to drink.
A dairy free diet against constipation
Many parents try dairy-free diets to help their child with constipation. In some cases it works and you can then assume that the child has a kind of cow's milk protein allergy. In most cases it does not help, and then you should not let your child stay on a restricted diet for a long time.
Toilet routines for a constipated child
For children who have stopped having diapers, do introduce a toilet routine where the child sits 10 minutes on the potty or toilet twice daily. Preferably after meals when the bowel has easier to empty. Some toddlers just want to poop in their diaper for a pretty long time. Then let them do it, but if your child does, it might help to sit on a potty with diaper on as the crouching position and floor support to the feet can help with bowel movements.
Medication for constipation
If dietary changes and toilet routines do not help, medicines for constipation are needed. It is extremely common for children to need constipation medication sometime during their upbringing, and some need it for many years.
Lactulose is a liquid medicine for constipation. It consists of long sugar molecules that are not absorbed into the blood but settle in the intestine. There, the lactulose molecules pull water out of the intestinal wall and the stools become looser. Lactulose tastes sweet and is therefore usually easy to give to most children.
Lactulose is available free of charge at pharmacies. A common dose to start with is 5 ml twice daily, reducing or increasing the dose according to results. The Bristol scale, a pie chart, is good to use to measure the outcome and know if you need to increase or decrease the dose, and preschoolers usually find it quite fun.
A common but harmless side effect of Lactulose is increased gases which can cause a stomach upset. If these side effects is tolerated, lactulose is harmless and can be used for many years without the gut becoming "dependent" or taking damage. Due to the gases, Lactulose is usually not a favorite drug for school children and teenagers. If your child needs constipation treatment for longer than three months, it is good to seek medical advice to rule out that constipation is due to some other illness.
Movicol, Omnilax, Forlax etc (macrogol)
There are many names of medicines for constipation that contain macrogol. They are sold as powders in sachets that dissolve in water or other beverages. Some have junior bags that contain half as much drug as an adult bag. Of course, it is just as good to buy adult bags and spend half as much.
Macrogol is a type of fiber that settles in the intestine and draws fluid so that the stools become soft. It works efficiently and usually does not produce gaseous side effects. The disadvantage is that it can be difficult to get the solution in some children.
The different varieties taste a little different. Movicol has a salty taste that many do not like, and that is not really hidden by juice or the like. Omnilax or Forlax does not have this salty taste and is usually better tolerated.
An adult bag or two baby bags are usually a good starting dose for school-aged children. In preschool age a child's bag or half adult bag. Control the treatment according to the Bristol scale just like with lactulose. These drugs are slow-acting and you do not have to be prepared to go to the toilet after drinking them. It is rather easier to poop the next day.
It is harmless and can be used for many years without the gut becoming "dependent" or taking damage. If your child needs constipation treatment for longer than three months, it is good to seek medical advice to rule out that constipation is due to some other illness.
If the child has severe constipation and acute stomach pain, it may be good to give an enema. An enema is injected into the rectum and hopefully leads to rapid bowel movement.
Klyx is an effective and fast-acting enema available in pharmacies. For fever-free children over 1 year with stomach pain and otherwise good general condition where you suspect constipation you can try to give a 120 ml Klyx at home. This often has good and fast effects, but it is common for the problems to recur in the near future. Therefore, lifestyle and dietary changes are often needed, and sometimes even daily drugs for a period of time.
Microlax is a small enema that works by irritating the intestinal mucosa so that the pouch comes out. Often effective, but it burns and hurts many children, so choose Klyx or Resulax instead.
Resulax is also a small enema, but unlike Microlax, it does not burn. It is a good alternative to Klyx, which many think is easier as it is smaller and smoother.
Common occasions when children become constipated
The most common is that of constipation no is due to some underlying disease but arises in connection with the conversion of any kind. During childhood one can see three periods when constipation is most common.
- At the transition from breast milk to infant formula, or from breast milk / infant forumla to solid food.
- When a baby ends using diapers
- When a child starts school. Many children do not want to poop in school, often because the toilets are uncleaned, that toilet paper is missing, that the doors cannot be locked, that other children knock on the door or interfere in some other way. Here's a lot to fix!
Other significant changes in a child's life may include travel, stressful periods and common infections. The latter affects the intestine in several ways. First, the infection itself can change the gut flora, as in the case of a stomach ailment. Second, children generally eat and drink worse when they are ill, which in combination with the loss of fluid, in the form of vomiting, diarrhea, fever or increased breathing work, is larger than normal, resulting in a drier and harder gut content.
When should I seek care with my child for constipation?
Severe, acute, or severe abdominal pain that does not improve after Klyx needs to be examined by a doctor on the same day.
Constipation that you can't cope with at home, or that requires treatment for more than three months needs to see a doctor at a scheduled medical time. Seek out a health center or pediatrician depending on where you live.