April 13, 2018
Constipation. It’s something most children have dealt with at least a few times. No doubt, constipation can be annoying and uncomfortable at any age. This is one of the most common concerns I encounter as a pediatric nurse practitioner.
Most of the time I hear “It’s been X days since my child pooped. She must be constipated.” Parents are often surprised to hear that timing alone does not equal constipation. Similar to adults, each child’s ‘normal’ is different. Some kids go twice a day. Others only go once every 2-3 days.
First, I like to reassure parents that if your child has a soft, non-tender belly, and they pass a formed stool without excessive straining or pain, they probably are not constipated. Even if your child only poops once every 3 days — that’s just their body’s pattern. After I explain this, I like to describe how to recognize true constipation.
According to the AAP, a child is considered constipated when their stools are dry, hard, difficult to pass, and often painful. Notice that nowhere does this mention the length of time between bowel movements. Although timing will be discussed when evaluating constipation, it is not the only factor to consider.
In fact, did you know that people can pass daily stools and still be constipated? Yes, that right! In some cases children even have tiny bits of diarrhea but are actually constipated! (More to come on that later.) The point is, the way constipation presents varies dramatically from one child to another.
Knowing what causes constipation is a great first step in preventing it. Common causes of constipation include:
Diet: The most common cause of constipation is diet. Dairy products are extremely constipating for most children. Lack of fiber and fluids can be another factor. Making sure to maintain a balanced diet is important when trying to prevent constipation. Check out this great list of kid-friendly foods that are high in fiber!
Behavior: Many parents may not want to consider this factor, but there are many childhood behaviors that commonly lead to constipation. Children withhold passing a stool for many reasons, including pain, embarrassment, being too busy, or independence. Often times, talking to older children or observing the trends of younger little ones will help to identify these factors.
Being Sick: It is difficult for the gut to function properly when your little one is dealing with an illness, especially when you consider the decreased appetite and mild dehydration that often comes with being sick. Rest assured though, basic constipation with sickness rarely indicates a serious medical problem.
Lack of Physical Activity: As with most adults, kids need daily physical activity to maintain regular bowel habits. At least one hour of moderate physical activity per day is correlated with a lower incidence of constipation.
Stress: Changes at home, school, or with friends or family can lead to constipation. This type of stress can impact overall health and bowel function.
Environmental Changes: Hot weather and dry climates increase the amount of fluid intake our bodies require. If not recognized, especially during travel, it can result in constipation. A change in a child’s normal routine, such as vacation or summer break can also lead to constipation.
Here are some common constipation symptoms parents should watch out for:
Abdominal Pain: Many kids will experience a crampy type of pain when their body is trying to prompt them to have a bowel movement. Severe and persistent pain should always be evaluated by a pediatric healthcare provider. However, brief, intermittent belly cramps or pain when passing a stool can be just a simple side effect of constipation.
You can download our tummy tracker to help you to note the time and severity of symptoms to share with your child’s pediatric healthcare provider.
Hard Stools: Stools that are formed are not a bad thing. However, when they become dry appearing and too hard to easily pass, this can indicate constipation. Interestingly, the more constipated a child gets, the smaller the stools become. Taking a look at this chart can help you describe the type of stools your child is having.
Diarrhea: Believe it or not, tiny bits of diarrhea can be a sign of constipation! It is often described by parents as incontinence. In reality, the colon is allowing liquid stool to seep around a large stool that is too hard to pass. This is known as stool overflow.
Bathroom Avoidance: Many children with constipation begin to anticipate pain when passing a stool. As a result, they often try to avoid the bathroom or hide when they are exhibiting signs of needing to poop. Unfortunately this only leads to worsening constipation. The longer the stool stays in the colon, the drier and harder it gets to pass it.
Rectal Bleeding: Passing large hard stools can cause tiny tears called fissures in the anus. This can present as a tiny bit of bright red blood on the stool or toilet paper. This type of bleeding is typically harmless. However, enough blood to turn the actual stool red is always abnormal and deserves further evaluation.
Fussiness: For many young children, fussiness is one of the first symptoms parents notice. It is hard for a child to describe what they are feeling in their belly. The subsequent cramping from constipation can make many kids very grouchy.
Decreased appetite: Belly fullness from constipation can cause discomfort and therefore a decreased desire to eat. This often resolves after the child has a bowel movement. However, if your child begins to vomit due to constipation, or is losing weight, please get them seen by their healthcare provider right away. This may indicate something else is going on.
It is important to know when to see your child’s healthcare provider. I advise the parents I work with to make an appointment if their child has consistent pain with bowel movements, scant amounts of blood in their stool, if their belly feels hard (but not tender), or if they are worried about their child.
Constipation severe enough to cause problems is not common. However, your child should be seen in the ER if they have persistent vomiting, are vomiting green fluids, have a large amount of blood in their stool, severe belly pain, or severe bloating. When these symptoms occur, it is important to rule out other more severe causes.
Constipation is not always something that can be solved in one visit or with one dose of medication. It takes patience, but it is treatable. Most of the times this can be managed at home with treatment from your regular healthcare provider and does not require a referral to a GI specialist.
In part two of this post we will discuss simple treatments you can try at home for different types of constipation. In the meantime, check out this post about stomach aches and grab the printable tummy tracker.
Author: Megan Lapinskas, MSN, CPNP
Megan Lapinskas is a pediatric nurse practitioner, wife, and mother of twins. She has been a pediatric nurse for 11 years and a PNP for 7 years. She specializes in pediatric development, feeding tubes, and treating children with special needs. Her love for treating the special needs community continues to grow as she cares for her daughter with Cerebral Palsy, feeding tube dependence, seizures, and dysautonomia.