Most kids have an occasional bout of firm, hard and possibly painful stools or a change in their normal bowel movement pattern. Your healthcare provider will generally reassure you, but you may still worry and wonder what causes these changes in bowel habits and stool consistency.
The digestive system or gastrointestinal (GI) tract begins at the mouth and ends at the anus. An important part of the tract is the intestine — a long, continuous tube from the stomach to the anus. Most absorption of nutrients and water happens in the intestine.
The organs associated with the tract are the liver, pancreas and gallbladder. Each plays an important role in digestion. Nerves, hormones, bacteria and blood in the tract are necessary for digesting the food and liquid consumed. Digestion breaks down food into nutrients (small molecules), which allows the body to absorb the carbohydrates, fats, proteins, vitamins and minerals necessary to produce energy, to grow and to promote healing.
The small intestine absorbs most of the nutrients via the blood. Digestion produces waste products such as undigested food and other by-products. They move into the large intestine where intestinal muscle movements keep the flow of waste moving along the tract. The large intestine absorbs water and any remaining nutrients and changes the waste from liquid into stool. The rectum stores and then pushes the stool out of the body during a bowel movement.
What causes constipation? As food moves through the intestine or colon, water is absorbed and the by-products of digestion become formed and dry. As the food reaches the rectum, most of the water in the forming stool has been absorbed, making the stool solid. If there is a change in the intestine’s motility, such as slowing down, more water is being absorbed, thus making the stool drier and harder.
The main causes of constipation in kids are a decrease in fluid intake and a low-fiber diet. Children who do not get enough exercise or who are toilet training may develop constipation. Other causes may be emotional, fear of pain when stopping, a busy schedule, medications or a physical problem. Your provider will determine if there may be an underlying medical cause and order the appropriate tests.
Signs of constipation in kids include:
* Changes in normal storing patterns, such as going less than twice a week.
* Trouble or pain during a bowel movement.
* Stools large in diameter.
* Red blood on the toilet paper or smeared on the stools.
* A history of excessive stool retention — not wanting to have a bowel movement.
* Abdominal pain.
* At least one episode a week of stool soiling underwater.
* Decreased appetite.
* Presence of a large fecal mass in the rectum.
If your child shows signs of constipation, your provider can help determine the best plan of care. The following may contribute to constipation:
* Inadequate fluid intake.
* Junk foods and fast foods usually high in fat content.
* Caffeinated drinks.
* Overconsumption of milk.
* Lack of exercise.
* A low-fiber diet and a high-carbohydrate diet.
* Return to school.
* No established daily routine for a bowel movement.
If a dietary issue causes constipation, increase your child’s intake of daily fluids, which should include water, milk and a little juice. The food in a child’s diet has a direct impact on stool consistency. Kids should have a variety of fruits and vegetables. The best fruits to alleviate constipation are prunes (including prune juice), figs, apples with the peel (also applesauce), apricots, plums, mangoes, nectarines, oranges, kiwis, strawberries, raspberries, blackberries and raisins.
Vegetables are another great source of fiber. High-fiber vegetables include: baked beans and other legumes, broccoli, Brussels sprouts, beets, cabbage, carrots, corn, green beans, spinach, avocados and potatoes with skin.
Children should have 100-percent whole-wheat breads and pasta, as well as whole-grain cereals and waffles.
Limiting fast food, food with a high fat content, caffeine (especially in soda), and having no more than 24 oz. of milk per day can help prevent constipation.
If your child is currently being toilet-trained and is resisting stopping on the toilet, you may abandon the training for a while. Pushing kids too hard creates emotional issues and constipation from holding in their stool.
All children need daily exercise, which helps the body transport stool through the intestine. Some medications may cause constipation. Your provider can discuss with you necessary steps for prevention.
Establishing a daily time for having a bowel movement helps kids develop good toiling habits. Most children do not like to go to the bathroom at school or in public places. They may suppress the urge to go. Feelings of stress or having power struggles with parents will contribute to constipation. Rarely, kids may have physical problems that cause constipation. Your provider will determine if further testing is needed.
Establishing a bowel movement routine is important. Generally, about 30 t0 60 minutes after a meal is a good time to use the bathroom. Kids should stay on the toilet for at least 15 minutes, even if they don’t go. Do not become irritated with your child if there is no bowel movement. It may take a couple of weeks for the routine to take hold.
Do not give enemas, suppositories or stool softeners without consulting your provider first.
Establishing a high-fiber diet, adequate fluids, daily exercise and a bathroom routine will help children maintain healthy bowel habits, thus preventing constipation. Kids are happier and more relaxed when a good regime is maintained.
Jo Ann B. Serota, DNP, RN, CPNP, FAANP, IBCLC, is co-owner of Ambler Pediatrics, Ambler, PA. She is president of the NAPNAP Foundation, past president of NAPNAP, corresponding editor of primary case studies for the Journal of Pediatric Health Care and a Ready, Set, Grow advisory panel member.