Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Infants and children with constipation are treated differently than adults, because patterns of bowel movements change from the time they are born until they reach the age of 3 or 4 years. The majority of children with constipation do not have a medical disease or disorder causing the constipation. Rarely, a disorder causes infants and children to have significant problems moving their bowels.
Many things can contribute to constipation.
The most common cause in a child older than 18 months is their willful avoidance of the toilet (for various reasons). For example, toddlers are often so involved in their play that they lack time or patience for toilet breaks.
At school they may be concerned with lack of privacy or the cleanliness of the bathroom.
They may have had a prior painful or frightening experience that makes them want to avoid the bathroom. Over time, their brain learns to ignore repeated urges by the colon to visit the bathroom. As stool remains in the colon, the colon will absorb water out of the stool, making it hard and dry. This hard stool is even more difficult or painful to pass, which causes the child to continue "holding it."
Changes in diet, or a different diet affect bowel habits. In adults, high-fiber diets have been shown to improve bowel function. In children, however, high-fiber diets have not been proven to improve constipation. Infants and children who eat well-balanced meals typically are not constipated.
Breastfed infants will generally have more stools per day. Their stools vary more in frequency when compared to bottle-fed infants. For example, breastfed infants produce anywhere from 5-40 bowel movements per week; whereas formula-fed infants have 5-28 bowel movements per week. Switching the type of milk (or formula) can also cause constipation.
Teenagers and toddlers who eat a lot of sugar and desserts are prone to difficult passing of their stools.
Any intense changes in a child-such as illnesses
causing fever, becoming
bedridden, eating less, or
dehydration may decrease the frequency of stools or may harden stools.
A number of medical disorders can cause chronic constipation.
Hypothyroidism (reduced activity of the thyroid gland) is a condition that causes decreased activity of the intestinal muscles along with many other symptoms. All newborns should be tested for hypothyroidism as part of the newborn screening blood test (heel prick or Guthrie test). This condition is usually diagnosed when a baby is very young but can occur at any age.
True constipation in infants and children that has been present since birth may be from
Hirschsprung's disease. In this rare congenital condition, a segment of the colon lacks ganglion cells (a type of nerve cell). The affected colon cannot receive directions from the brain to work properly. Most infants with Hirschsprung's disease display symptoms within the first few weeks of life. They may be underweight or small for their age. They may vomit and pass small stools, which are described as ribbon-like. Hirschsprung's disease is generally more common in boys and in babies with Down syndrome. If Hirschsprung's disease is suspected, you need to take your child to a specialist (gastroenterologist or pediatric surgeon) for further tests.
Diabetes is common medical problem associated with constipation.
Alterations in blood mineral and
(especially calciumor potassium) can change the bowel habits.
Although other symptoms of lead poisoning
should be more obvious, children with chronic lead exposure may have constipation.
Children with disorders of the nervous system (such as cerebral palsy, mental retardation, or
spinal cord problems) display a high rate of constipation because they spend prolonged time in one position, experience abnormal colon movement, or lack coordination in moving their bowels.
Some medications can make children more likely to be constipated. Common contributors include over-the-counter cold medications and antacids. Antidepressants, anticonvulsants,
chemotherapy medications, or narcotic pain medications (such as codeine) can also constipation.
Other possible causes of constipation are depression, coercive toilet training,
attention deficit disorders, and sexual abuse.