Constipation in children: how to find out the causes and help your baby

Constipation disrupts the functioning of the gastrointestinal tract. The main manifestation of constipation is rare bowel movements and difficulty in emptying the intestinal tract. If bowel movements occur once every three days, but there is no bloating or discomfort, and the stool has a normal consistency, this is not considered constipation.

If your child suffers from constipation, you should consult a specialist. Initially, you should seek help from a gastroenterologist. The First Children's Medical Center employs the best pediatric gastroenterologists in Saratov: here you can get qualified medical care!

What is constipation?

Functional constipation is one of the most common problems in pediatrics. They most often occur at the age of 2-4 years, when the child is potty trained. However, both at an earlier and at an older age, bowel dysfunction worries approximately 15-25% of children.

In order to understand whether it is constipation or not, special diagnostic criteria have been developed. To make a diagnosis, there must be at least 2 symptoms observed within 1 month:

• 2 or fewer bowel movements per week;
• episodes of excessive accumulation of feces in the intestines;
• episodes of painful or difficult bowel movements;
• episodes of large diameter stool;
• the presence of large fecal masses in the intestine of a child trained in toilet skills.

Additionally, the following symptoms may be observed:

• at least 1 episode per week of fecal incontinence in a toilet-trained child;
• episodes of large-diameter stool, which can cause blockage in the toilet drain.

Diagnostic criteria for diseases and conditions associated with constipation of functional origin, in accordance with the Rome IV criteria (2016)

That is, you need to understand that constipation is not only retention of stool, but also difficult, painful passage of feces with incomplete bowel movements (when the child holds back bowel movements) (even if he goes to the toilet every day).

Other causes of constipation in a 6 month old baby

Constipation may be caused by taking antibiotics.

In addition to errors in the baby’s diet, there may be the following causes of constipation:

• When breastfeeding, a nursing mother consumes coffee, strong tea, a lot of carbohydrate foods and little fiber.
• The child or nursing mother took antibiotics or medications containing iron.
• The child has damage to the central nervous system, received in utero or during childbirth, and the mechanisms regulating the act of defecation are damaged or not developed.
• Living conditions and surroundings have changed dramatically, and the child suffers from stress due to separation from his mother.
• If, according to the mother, stool is very rare, but the baby is actively awake, does not worry, and maintains his appetite, there is no need to worry about constipation. It is quite possible that rare stools are an individual characteristic of the child or the effect of heredity.

Causes of constipation

There are many reasons why a child may experience constipation. The most common is unbalanced nutrition. The predominance of quickly digestible carbohydrates, low amount of fiber in the diet, insufficient fluid intake during the day - all this leads to disruption of intestinal function and weakening of perilstatics.

In addition, in recent years there has been a lot of talk about the influence of stressful events on the formation of constipation in a child. Among the trigger factors are: untimely and painful potty training, bullying from peers and other family members, hospitalization, separation from loved ones, frequent punishments and others.

When a child experiences frequent constipation, we can often observe a kind of vicious circle: having once experienced pain during bowel movements, the child begins to subconsciously restrain and suppress the urge to defecate, which leads to the accumulation of feces in the rectum. And having accumulated in large quantities, dense feces cannot come out painlessly! That is why treatment of constipation should be carried out comprehensively.

Why does constipation occur?

There are two types of constipation - organic and functional. The causes of organic constipation are:

• Hirschsprung's disease;
• abnormalities in the development of the gastrointestinal tract;
• pathologies of the endocrine system;
• metabolic disorders.

In a newborn baby, such a symptom may indicate a narrowing, lengthening or expansion of the intestinal tract.

Causes of functional constipation include:

• psychological problems, such as being in an unfamiliar environment;
• lactose deficiency;
• lack of fluid in the body;
• errors in diet;
• negative reaction of the body to taking antibacterial drugs, drugs for the treatment of anemia, anticonvulsants;
• stagnation of bile in the gallbladder and its ducts;
• intestinal infection by worms.

In newborn children, the nervous system is immature, it is just being formed. Therefore, children are unable to control the movements of their muscles during bowel movements. You can help them by carefully bending their legs and pressing them to their tummy. With the help of these movements, the pelvic muscles relax, and the bowels are released much faster.

Diagnosis of constipation in children

Today, in accordance with international recommendations, in order to verify constipation in a small child, the doctor only needs to correctly collect anamnesis, i.e. interview parents about the duration of complaints, features of defecation, compare with the clinical picture and take into account diagnostic criteria. All! There is no need to test coprogram and feces for dysbacteriosis! If necessary, the attending physician may prescribe additional instrumental diagnostic methods (ultrasound of the abdominal organs, X-ray contrast studies, etc.).

Symptoms of anxiety

If you suspect constipation in a young child, pay attention to the so-called “red flags”, i.e. symptoms, the presence of which indicates the need to consult a doctor!

• early onset of constipation (less than 1 month of life);
• passage of meconium after more than 48 hours in a full-term newborn;
• family history of Hirschsprung's disease;
• ribbon stool;
• blood in the stool in the absence of anal fissures;
• fever combined with stool retention;
• vomiting bile;
• severe bloating.

Rational feeding

Properly organized nutrition will help get rid of constipation.

Products that cause constipation, in the mother’s opinion, should be temporarily excluded from the complementary feeding schedule and returned to them later, when the baby’s intestines and stomach are more mature.

If constipation is caused by whole cow's milk, it is better to return to formula (for formula-fed children), or dilute it with water for making porridge.

Introducing vegetable puree or pureed soup with vegetable broth into the diet can normalize the situation.

An optimal drinking regime achieves the same goals. Instead of water, you can give your baby a decoction of dried fruits or regular raisins, steamed in a thermos with boiling water. This decoction is rich in potassium, an element that directly affects intestinal motility.

Properly organized nutrition can completely relieve a 6-month-old child from constipation, if rare and painful bowel movements are not associated with organic pathologies.

What to do if your child is constipated?

When a child goes to the toilet quite rarely (no more than 2-3 times a week, but without blood in the stool and severe pain), and the stool is dense (type 1-3 according to the Bristol scale), then, first of all, you need to pay attention on his diet and level of physical activity. Add more fresh vegetables and fruits, cereals, dairy products to your diet, and analyze the amount of water you drink. It is important to ensure sufficient motor activity - this additionally stimulates perilstatics.

If the family first encountered a problem when the child did not walk “largely” for more than three days or bowel movements are not effective (i.e. the baby is in the toilet for more than half an hour, cries in pain and says that “I can’t poop”), then As an emergency, you can use an enema or rectal suppositories. It is worth clarifying that the currently popular microenemas have an exclusively local effect, i.e. if a small amount of feces has accumulated in the ampulla of the rectum, and constipation is no more than three days. If the problem is more “global”, it is necessary to resort to cleansing. There is nothing scary about this.

Take a syringe with a volume of 300–400 ml. Depending on the age, the volume of fluid administered will be different - this must be clarified with the pediatrician observing the baby, but approximately the volume is calculated using the formula: 1 kg of body weight = 20 ml of fluid. The liquid should be warm - approximately body temperature, i.e. 37 °C or slightly lower. Lubricate the tip with Vaseline or baby cream. The child needs to be laid on his left side and his legs pressed to his tummy (pre-calm him if he is scared). The tip is inserted into the anus with a gentle twisting motion towards the navel about 4–5 cm. Pour in the liquid slowly, carefully, while squeezing the baby’s buttocks.

Most likely, the child will say that it is difficult for him to hold back his feces and that he is about to “shit himself.” This is how it should be, warn him about this in advance. Pull the tip out of the anus and continue squeezing the buttocks with your hand. Do not let him sit on the potty or toilet for about 5 minutes - during this time the stool softens. Talk to your child at this time, distract him, you can turn on a cartoon. I repeat that these are extreme measures. You should not often resort to such intestinal cleansing, since it is almost always scary for the child. After enemas, children often begin to be afraid of even antipyretic suppositories! If your baby has frequent constipation, be sure to consult a doctor!

Recurrent constipation in a child is treated comprehensively. Treatment includes long-term use of laxatives followed by maintenance prophylactic doses, as well as behavioral therapy aimed at eliminating fear of bowel movements and establishing a bowel movement routine.

Treatment of childhood constipation

Constipation in children requires 6 mandatory treatment. Here are just a few reasons why.

Accumulated feces cause intoxication - poisoning with decay products3, 6, which begin to be absorbed back into the blood, the child becomes restless or lethargic, his appetite, mood, and physical activity decrease.

If there are intestinal dysfunctions, food is poorly digested3, 6. The body does not receive the necessary nutrients, vitamins, minerals, and this is one of the reasons for the decrease in protective forces and the development of anemia5, 6.

Long-term absence of stool causes constant discomfort, abdominal pain, and the physical and mental development of the child can be disrupted3, 6.

Due to the impossibility or difficulty of controlling urges and defecation, encopresis is likely to develop3, 4, 6 - spotting, fecal incontinence. With it, small particles of feces involuntarily come out at any time, staining clothes3, 6. Encopresis becomes a powerful stress, aggravating psychological problems.

If feces have not been excreted for a long time, it stretches the intestinal walls, which increases the risk of developing rectal fissures, hemorrhoids, bleeding, and inflammation of the large intestine3, 6.

The goal of treatment is to restore peristalsis, normalize the density and quantity of feces, and the frequency of bowel movements2, 4, 6

The treatment regimen and what exactly can be given to the child for constipation is prescribed by the doctor, based on age, nutritional characteristics, growth and development, the presence of other diseases, complaints, and the duration of the condition. Treatment consists of 1, 2, 6:

1. Correction of an existing disease.
2. Development of a therapeutic diet.
3. Organizations of a healthy lifestyle, including physical therapy.
4. Drug therapy.

The examination revealed that the child is constipated: what to do? If the cause is associated with any disease, then measures will be taken to treat it and at the same time a method will be selected to normalize the frequency of stool, taking into account the disease and other characteristics of the body.

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Therapeutic diet

One of the first therapeutic measures is diet4, 6. Proper nutrition makes stool softer, facilitates its passage, and stimulates peristalsis. If there is no pain during defecation, then the fear of having to go to the potty (toilet) will decrease or disappear.

Nutrition must correspond to the age and needs of the growing body. Breastfeeding should be continued, and for children on artificial or mixed feeding, the doctor will help you choose therapeutic and preventive formulas that contain additives that normalize stool1, 4, 6.

For complementary feeding, foods that stimulate peristalsis are recommended: pumpkin, squash, zucchini, Brussels sprouts and cauliflower, apricot puree, prunes1, 2, 6.

And if a child a year or older has constipation, what should he do with his diet?

You need to give a lot of clean water to drink - but not compotes or juices. Water helps soften accumulated feces and stimulates peristalsis1, 2, 6.

Bran, wholemeal bread, oatmeal and buckwheat support normal intestinal motility and accelerate the movement of feces1, 2, 6.

The diet must include fresh vegetables and fruits, foods high in fiber. However, sweet apples, bananas, blueberries, berry and fruit jelly are not given because of their astringent properties and ability to make feces dense1, 2, 6.

It is necessary to reduce to a minimum (or better yet eliminate) the consumption of sweets, flour products, and refined foods that slow down the intestines 1, 2, 6.

You should give up whole milk and cereals containing it, especially semolina and rice - they make stool thick and peristalsis sluggish1, 2, 6.

Cocoa, black and green tea, chocolate, coffee reduce intestinal activity and promote stool retention1, 2, 4, 6.

Peas and beans, white cabbage, grapes, pears, and fresh onions are not recommended. These vegetables provoke gas formation and abdominal pain1, 2, 4.

As a basis for rational nutrition, it is possible to prescribe one of the therapeutic diets - table No. 3 or No. 4 according to Pevzner1, 2, 4, 6.

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Daily regime

A daily routine, the habit of doing everything necessary every day, helps to normalize the functioning of the autonomic nervous system, instilling the need for regular bowel movements at approximately the same time.

In the morning on an empty stomach, while still in bed, the child should be given 50 to 150 ml of clean drinking water at room temperature to drink, and after 15-20 minutes have breakfast - just enough time to get dressed, wash, and do exercises1, 2, 4.

After eating, you should try to induce a bowel movement, if the doctor allows, then with auxiliary means - an enema, a laxative. Parents can develop a system of rewards for successful visits to the toilet, but there is no need to scold for failure1, 3, 4, 6.

Children should move according to their abilities and age, play active games, and take walks. Cycling, skating and skiing, swimming, and playing with a ball are useful. A doctor or exercise therapy specialist will recommend suitable gymnastics or physical therapy exercises 1, 2, 4, 6.

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What to do if your baby is constipated?

Before 6 months of life, true constipation is rare. The main food for a child of this age is breast milk or adapted milk formula, which have a liquid consistency. In children of the first year of life, constipation most often occurs when complementary foods are introduced into the diet. This is not something to be afraid of, since changes in stool consistency due to the appearance of new foods in a child’s life are quite logical.

However, there are a number of conditions that can cause constipation and deserve special attention.

• Intestinal obstruction or intussusception: the child experiences paroxysmal restlessness, severe crying, and refusal to eat. The body temperature is normal, the abdomen is soft. After 5-6 hours, stool retention and bloody discharge from the rectum appear. This condition requires emergency care in a pediatric surgical hospital!
• Hirschsprung's disease: a disease in which the innervation of the colon is impaired. Constipation has been observed since birth.
• Congenital hypothyroidism: the movement of stool through the intestines slows down.
• Pathology of the central nervous system: often in diseases of the central system, which are associated with changes in muscle tone, a weakening of perilstatics is observed.
• Spina Bifida: a malformation of the spinal cord in which constipation is quite common.

So, if constipation in a child is still associated with changes in the usual diet, what should be done:

• Perform a tummy massage for the baby - use careful, soft finger movements to press on the anterior abdominal wall, paying attention to the baby’s reaction;
• you can take a warm bath - this will help relieve spasm from the intestinal muscles;
• postpone the introduction of a new product until the stool normalizes;
• in case of stool retention for more than three days - a cleansing enema/microenema or laxative suppositories (from three months);
• If constipation occurs regularly, contact your pediatrician!

Of course, such a delicate problem raises many questions, and when a small child has constipation, it also gives rise to a lot of fears. However, timely consultation with a doctor and proper treatment will help solve this non-children’s problem.

Improper introduction of complementary foods as the main cause of constipation

Babies need to introduce new foods gradually.

The most common cause of constipation in six-month-old children is too early or very abrupt introduction of complementary foods. Six months is the period for introducing a new diet to a normally developing baby.

It is recommended to introduce new foods gradually, starting with small portions. Everything that parents plan to introduce into the baby’s diet should be added gradually, without combining several new products.

Complementary feeding begins with cereal porridges and vegetable puree, to which a teaspoon of sunflower oil is added. Ideally, it will be pureed from zucchini or cauliflower - tender and nutritious vegetables. By offering their child vegetable puree, parents usually notice that the baby's bowel movements have become regular.

Constipation during artificial feeding

With artificial feeding, constipation occurs more often than with natural feeding. If your baby suffers greatly from constipation, you should consult a pediatrician. Perhaps the doctor will choose a different formula for your child, for example, a formula with added dietary fiber. Sometimes, along with the milk formula, fermented milk containing bifidobacteria and lactobacilli is prescribed.

A bottle-fed baby must be given small amounts of water and strictly follow the feeding schedule.

It is recommended to give probiotics to formula-fed babies, since these babies do not receive breast milk, which contains beneficial bacteria. "Bifidum BAG" helps to form the normal microflora that the baby needs. The use of "Bifidum BAG" is a good prevention of constipation, colic, and allergies. Its use is recommended for premature babies, babies born by cesarean section, babies receiving antibiotics, children with anemia, rickets, malnutrition.