Constipation Treatment for Toddlers & Children | Kids Clinic Singapore


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(Last updated: 13 Jun)

Child Constipation

How do I Know if My Child has Constipation?

Everyone has a different normal bowel pattern. For example, some children have bowel movements only once every 2-4 days. It is common for breast-fed or formula-fed babies to have large, soft bowel movements without pain up to 5 days apart. Others have bowel movements 2-4 times daily.

However, a child is constipated whenever his/her pattern slows down noticeably, with hard stools that are difficult to pass out. Sometimes constipation can cause recurrent tummy pain. Once constipation begins, it tends to continue, unless proper treatment and lifestyle modifications are started early.
Constipation in children is often related to dietary, lifestyle or bowel habits

What Causes Constipation in Children?

Very rarely, some diseases can cause constipation. In these cases, the problem usually begins in the early weeks of life. Some examples include nerve problems in the large intestines (known as Hirschsprung disease), hypothyroidism (low thyroid hormone levels), spinal abnormalities (such as spina bifida) or anal malformations (e.g. imperforate anus or anal stenosis).
In most toddlers and children, there is no disease and constipation is often related to dietary/lifestyle/toileting factors. Some of the factors that may contribute to the onset of constipation are:
  1. Lack of fibre-rich foods (cereals, vegetables, fruits), inadequate fluid intake and an excess of sweet junk food in the diet
  2. Poor bowel habits, problems with toilet training and at times, unwillingness to spend time on the toilet
  3. Small tears (fissures) at the anus due to frequent straining, causing pain at the time of bowel movements, thus making the child withhold. Withholding of stools will cause the stools to become harder while in the intestines, which makes it even more difficult for them to be passed out, thus creating a vicious cycle which worsens the constipation
  4. Some medications such as iron supplements
  5. Illness (vomiting, fever) in which a lot of fluids have been lost

How is Constipation in Children and Toddlers Treated?

  1. The first step is to clear your child’s bowels of all the hard stools (known as disimpaction phase). Without this step, treatment of constipation will usually not be successful. This can be achieved through rectal medications (such as fleet enema or glycerin) or through oral medications (such as PEG). Your child’s paediatrician will be able to advise you on this
  2. It is also very important to treat anal fissures/tears and relieve pain during bowel movements, so that your child will not withhold due to pain, and end up worsening the problem. Your child’s paediatrician will be able to prescribe certain cream/ointments to the anal region
  3. After the first step of successful disimpaction over one to two weeks, the next step would be the maintenance phase, in which stool softeners, dietary, lifestyle and toileting habits come into play to prevent the stools from becoming hard again. Your child’s paediatrician may prescribe a stool softener for a longer period of time, and will advise you on the appropriate dietary/lifestyle/toileting habit changes required
  4. Be patient. Improvement may be slow and it can take several weeks of active treatment before your child returns to his or her normal bowel pattern
  5. Do not punish your child if he or she does not have a bowel movement or if he/she soils his/her underclothes

How do I Prevent Constipation in My Child or Toddler?

  1. Make sure that your child’s diet contains adequate fluids and high-fibre foods that act as natural laxatives (fruit juices, fruits, particularly prunes, vegetables and salads, cereals)
  2. For babies over 2 months old, give diluted fruit juices, such as prune juice twice a day
  3. For babies over 4 months old, add strained foods with high fibre content, such as cereals, apricots, prunes, peaches, bananas, papayas, pears, plums, beans, peas, or spinach twice daily
  4. Decrease consumption of constipating foods, such as ice cream, cheese and cooked carrots
  5. When your toddler is old enough (about 2 to 3 years old) help him/her establish regular bowel/toileting habits. Have your child spend a few minutes on the toilet or the “potty” once or twice daily immediately after meals. The position should be comfortable with knees up. For a small child using the toilet, a footrest will be necessary so the legs don’t hang down and the knees are up in a crouched position. Such a position eases bowel movement

Consult Your Child’s Paediatrician Early if:

  1. Your child’s general health seems to be affected by the constipation
  2. Your child has significant stomach pain
  3. There is blood in the stools
  4. Your child cannot pass a bowel movement after 4 days despite increasing fluids and fibre (vegetables, cereal, fruits) in diet
  5. Your child loses some control of his/her bowel actions and begins to soil underclothes
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