Symptoms, causes and treatment of constipation in children

Author, editor and medical expert - Klimovich Elina Valerievna.

Number of views: 486 530

Last updated: 02/16/2022

Average reading time: 17 minutes

Constipation (from the Latin constipatio - accumulation, accumulation) can occur in a child at any age1, 3. It is associated with a slowdown in the movement of feces through the intestines3, 4. This is one of the most common “children’s” problems4, but many parents do not recognize it or They believe that a child at 3 or 4 years old will “go away on its own”, without medical help. Some parents do not consult a doctor on time3, 5 because they cannot understand whether the baby goes to the toilet often enough, whether the density and volume of feces is normal1, 3, 5.

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Symptoms

A child after 2 years of age can tell or show 3, 4 parents that he cannot go to the toilet or is in pain. But recognizing constipation in an infant aged 1.5 - 2 years is not so easy3, 4, 5.

In the case of infants, doctors recommend focusing not on the frequency of stool, which varies greatly among infants3,4, but on the density of feces and the baby’s behavior during bowel movements1,4.

If he does not cry during bowel movements, the feces pass softly, have a characteristic appearance and color1, 4, and the tummy does not become dense, as if inflated, then it is considered that the baby does not have constipation, even if he soils his diaper 2 times a week1, 4.

You can talk about probable constipation in a baby if the stool becomes denser, thicker, darker than usual 1, 4. Children under one year of age often have a swollen tummy, when pressing on it they cry or whine, and at the moment of stool expulsion they can tense up and scream 14.

After a year and older, the following are considered signs of insufficient bowel movements:

• The child began to go to the toilet “mostly” less often than before1, 3, 4.
• During defecation, it is clear that he is in pain, he has to strain 1, 3, 4.
• Passing less stool than usual1, 3, 4.
• How does it look dry, hard, dense1, 3, 4.

If the child has already had stool retention before, and he remembers5 that it hurts, then he begins to bring his legs and knees together, walk on his heels, tuck his buttocks, hold his breath for a short time - wait it out and suppress the urge. During defecation, it is clear that the process is difficult, and to facilitate it one has to take different positions3, make significant efforts, push2, actively work with the anterior abdominal wall1, 4.

If a child has one or more signs of constipation 2-3 times within 2 months1, 6, then you need to monitor the nature and frequency of stool, and if suspicions are confirmed, then consult a doctor to find a way to help your child with constipation, select a diet and treatment1, 3.

The table below provides information 4 about approximately how many times children of different ages can have bowel movements, as well as the characteristics of stool.

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Diagnosis of pathology

If your baby often suffers from constipation, you should seek help from a pediatrician, who will often refer you to a proctologist and pediatric gastroenterologist. A visual examination is divided into an anamnesis, during which a specialist draws up the dynamics of the disease, records the frequency of bowel movements and the consistency of stool, as well as an examination, during which the doctor determines bloating.

Palpation reveals feces and examines the level of sphincter strength. The specialist must also rule out developmental abnormalities. The medical specialist sends the baby for tests in the laboratory: biochemistry and general blood test, stool examination, ultrasound of the pancreas and stomach.

It is also necessary to undergo endoscopy and x-ray of the abdominal cavity, and examine parts of the colon.

Causes of constipation in children

The reasons for the absence of bowel movements in children are divided 1, 3, 6 into two groups:

1. Organic3 - arising against the background of any disease, pathology of the intestinal structure.
2. Functional3, 5. Arise due to improper functioning of the gastrointestinal tract, due to reasons not related to problems of the digestive system.

The intestinal walls periodically make wave-like movements. This is called peristalsis2,3 and is necessary to move digested food down and out. If peristalsis slows down, becomes slow and sluggish, that is, the tone of the intestinal wall decreases, then they speak of atonic constipation3, 6. And if the tone becomes so strong that spasm occurs and peristalsis stops, then this condition is called spastic3, 6.

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What to do if a child under one year old has constipation?

Lifestyle
Helping breastfed children involves regulating the diet of the nursing mother, especially if she herself has problems with bowel movements.

From the list of products that a mother consumes during breastfeeding, those that contribute to gas formation should be excluded3:

• legumes;
• cabbage;
• tomatoes;
• mushrooms;
• black bread.

Also recommended3:

• exclude semolina and rice porridge, bananas;
• reduce the amount of milk consumed;
• reduce the amount of baked goods and refined foods in the diet;
• reduce consumption of foods such as blueberries, black tea, cocoa.

Breastfeeding mothers are advised to drink more fluids and eat whole grains, vegetables and fruits.

In babies, when introducing baby food from 6.5-7 months, you can use fruit purees and juices from:

• apples;
• pears;
• apricots;
• peaches;
• prunes

They contain plant fiber in the required quantities. This helps stimulate the active functioning of the baby's intestines. Children over 8 months can be given fermented milk products: kefir, yogurt.

In addition to changing your diet, there are other preventive measures that can be used to treat constipation.

Types of constipation

Peristaltic disturbances can occur 1, 3, 6 due to a variety of factors.

Organic or primary constipation

In childhood, they are associated with congenital diseases and disorders of the intestinal structure1, 3. These include Hirschsprung's disease, dolichosigma, megacolon, fusion of the rectum, stenosis of the large intestine and rectum, impaired development of the anal sphincter1, 3, 4. Stool retention with them - a symptom, a sign that the intestines are not working correctly, their normal physiology is disrupted.

Primary stool retention also occurs due to an acquired violation of the structure and shape of the intestine, a decrease in its lumen1, 2. This may be due to polyps, tumors, hemorrhoids, adhesions3, 6.

Stool retention in these cases goes away after cure (if possible) or selection of a method for correcting the disease.

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Functional constipation5

This is the most common type of defecation disorder in children5; it occurs from exposure to a provoking cause that disrupts intestinal tone.

• Intestinal immaturity in young children1. Peristalsis is just getting better, the intestines do not immediately respond to the arrival of food. Feces are retained and thickened.
• Nutritional disorders (nutritional) 1, 3, 5. If the daily menu does not contain enough water, a lot of flour, cereals, and sweets, then the intestines receive little dietary fiber needed to stimulate peristalsis. As a result, the progress of the bolus of feces slows down. In infants, nutritional disorders arise as a consequence4, 5 of improper feeding, the introduction of supplementary feeding, and complementary feeding.
• Hereditary tendency. Research has shown5 that if a baby's mom or dad suffered from constipation, then their child is likely to have this problem too.
• Various acute and chronic diseases not related to the digestive system 4, 5.
• Hormonal diseases1, 5 - congenital hypothyroidism, pheochromocytoma.
• Iron deficiency (anemia), rickets, helminthic infestations5.
• Retention of stool due to atopy, for example, with food allergies1, 5.
• Dehydration. As a rule, it is associated with a painful state of the body - fever, heat stroke. Due to lack of water, feces become dry, move through the intestines with difficulty, and are retained in the rectum1, 2, 5.
• Inactivity. When moving or walking, the abdominal muscles actively work and, as it were, massage the intestines and stimulate peristalsis1, 2, 5.
• Abuse of enemas, gas tubes5. The enema interferes with the natural mechanism of defecation, the nerve endings of the intestine “get unaccustomed” to respond to irritation, urges disappear, and the baby loses the skill of recognizing them1, 5.
• Taking 5 certain medications that reduce intestinal motility.

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Psychological constipation in children

This is a functional disorder 5, but due to its formation and prevalence it deserves to be classified as a separate group. For many parents, the absence of stool in a child for psychological reasons comes as a big surprise 2, 3, 5.

Psychological constipation is called if there are no organic causes, there are no other painful conditions that could cause stool retention2, 3, 5. The source of problems with stool are psychological factors, the peculiarities of the nervous system in children.

The nervous system has an autonomic department that regulates the functioning of all internal organs. If a person experiences some difficult situation or stress, then the reaction of the autonomic system can cause intestinal dysfunction5. An example of such a situation is a pet’s illness, moving to a new place of residence, or the loss of a favorite toy. The child forgets to go to the toilet for several days, the stool becomes thicker, defecation becomes painful and difficult, and the baby begins to consciously avoid it2, 3, 5.

Examples of other situations that cause psychogenic constipation:

• The baby consciously suppresses the desire to go to the toilet for a variety of reasons2, 5, “forgets” to go to the toilet, he is not in the mood for it because of games or reluctance to go home. A few days of such conscious retention of stool - and now the stool has become compacted, and going to the potty is painful. The child is not yet able to establish a connection between cause and effect; he begins to avoid what caused the pain, that is, defecation.
• Rejection of the potty2, 5 due to unpleasant sensations when planting or rude, persistent attempts to teach “doing things” without fail to go to the potty with punishment for a mistake.

Another psychological reason that causes difficulty in defecation is prolonged exposure to difficult, mentally difficult circumstances2, 3, 5. Conflicts in the family, difficulties in relationships in a team or with teachers in kindergarten or at school, embarrassment to go to the toilet in front of strangers, uncomfortable bathroom outside the home, memory of past failures (didn’t have time; didn’t understand that the process is not finished yet; doesn’t know how to carry out intimate toileting after bowel movement, etc.) - all this and much more can cause psychological fear of defecation2, 4, 5 .

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Transient constipation

Stool retention is not always associated with serious problems. Sometimes this is a transient or one-time retention of feces. Happens infrequently, less than once every 2 or 3 months1, 4, 6, and is usually associated with nutritional reasons or an acute illness: the child has not drunk much for several days, sweats a lot in the heat or temperature, has eaten a lot of fixative food - blueberries or bird cherries. After resuming fluid intake and correcting the diet, motility and stool are restored on their own1, 4, 5.

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Why might a child be constipated?

In infants, nutrition is an important factor in normal bowel function. Typically, formula-fed babies have half as many trips to the toilet as breastfed babies. It should be remembered that a small person has not yet developed mechanisms for regulating digestion. Therefore, any change in diet can lead to intestinal dysfunction, including constipation. It is advisable that the baby be fed breast milk for at least 6 months; complementary foods (juices, purees, cereals, fermented milk products, cottage cheese) should not be introduced until 5-6 months; frequent changes of food, especially the main diet, are extremely undesirable (for example, if the baby receives some kind of artificial mixture, you should not try to replace it with another unless there is a clear need for it)2.

Constipation is often accompanied by intestinal dysbiosis. Disturbances in the composition of normal (functional) intestinal flora occur for various reasons. Any problems during pregnancy, such as the threat of miscarriage, toxicosis, infectious diseases, taking antibiotics or hormonal drugs, hidden and sluggish chronic diseases in a pregnant woman, can cause dysbiosis in the baby. Other reasons are also possible: caesarean section, premature birth, infection of the child and poor nutrition (early transition to formula milk, late introduction of complementary foods, lack of nutritional stability)3.

Nutrition as a regulator of intestinal motor function retains its role in older children (4 years and beyond). Long-term consumption of crushed and heat-treated food products (mashed potatoes, jelly, liquid porridges and others), the absence of foods containing coarse fiber or fiber in the diet can cause constipation4.

Eating high-calorie foods even in small quantities (caviar, chocolate, flour products) can also contribute to constipation. Strong tea, cocoa, cottage cheese, rice, pomegranates, pears, quince, astringent products and the above-mentioned chocolate, baked goods have a fixing effect5,6.

The cause of constipation in children can be muscle hypotonia (muscle weakness) and physical inactivity (sedentary lifestyle). In infants, muscle weakness can develop due to poor nutrition (low birth weight) or rickets3. Muscle hypotension (“sluggish” muscle work) in older age is a consequence of physical inactivity7.

Psycho-emotional stress can also provoke functional constipation in a child over 1 year old. Any psychological trauma can lead to the development of chronic constipation in a child. It can be caused by the death of a beloved animal, excessively harsh punishment, severe fear, conflicts with peers and adults. Adolescent schoolchildren aged 10 years and older often experience bowel retention due to the fact that they suppress the urge to defecate, are afraid of being distracted from the lesson, or are embarrassed to go to the toilet “in a big way” at school6.

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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Treatment

What to do if you are constipated? Constipation in babies may indicate the presence of various ailments that require immediate treatment. Recommendations regarding therapy should be made by a pediatrician who will select individual measures.

What to do for constipation at home?

When selecting a treatment option, the doctor should ask:

• severity of the disease;
• the reason for its appearance;
• the presence of pain;
• the age of the baby;
• psychological characteristics of the patient;
• associated ailments.

The treatment will be long-term, so you should not expect quick results.

Home help methods

In the case when a child is not able to empty himself, it is necessary to know the rules of first aid. The most effective first aid methods include cleansing enemas, glycerin suppositories, and laxatives (can only be given if prescribed by a doctor).

To help your baby with constipation, you can use an enema or glycerin suppositories.

For an enema, you should use boiled water at room temperature. Two teaspoons are added to the liquid. glycerin and solution are mixed. Under no circumstances should children be given an enema using saline solution, which will cause pain and a burning sensation. Children tolerate this procedure with whims.

When using an enema, you must adhere to safety rules that will help not harm the child:

• We disinfect the syringe.
• Lubricate the tip of the syringe with baby cream.
• Fill the syringe with boiled water at room temperature.
• Using an enema, we administer about 200–220 ml of liquid to the baby.

Important! It is contraindicated to exceed the recommended dose of administered fluid, so as not to cause pain in a small child.

When is urgent help needed?

A child who is only one year old requires urgent help from a medical specialist in cases where, due to constipation:

• the stool looks too dense interspersed with mucus and bloody streaks;
• the child experiences severe pain in the abdominal area;
• blood is discharged from the anus;
• temperature rises;
• the baby is vomiting;
• against the background of constipation, liquid stool leaks out.

Relieving a small patient of such pathologies can only be done by a doctor.

What to do if a 2-3 year old child has constipation? Causes, treatment and diet

The article was prepared by a specialist for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor.

Description of the disease

Constipation in a child is a dysfunction of the gastrointestinal tract, which is manifested by long periods without stool with or without the urge to defecate. Sometimes a sign of constipation is the subjective feeling of incomplete bowel movement.

Physiological norms of defecation in children of different ages:

• Infant (from 1 month to 1 year) – up to ten times a day;
• Nursery (from 1 year to 3 years) – daily;
• Preschool (from 3 to 7 years) – from three to six times a week.

These data are conditional; different medical sources indicate norms that vary within very wide limits. However, it has certainly been proven that in a healthy child, the frequency of bowel movements correlates with the quality (digestibility) of the food consumed and the presence of coarse fiber in it - a stimulator of intestinal motility, as well as with the volume of liquid drunk per day.

Constipation (constipation) between the ages of 0 and 16 years has a number of features associated with physiological and psychological changes in the growing body.

Physiological features of constipation in children

When diagnosing and treating constipation, factors corresponding to different periods of childhood are taken into account, including:

• Frequency of stool, its character (significantly different at different ages);
• Availability of physical and instrumental diagnostic techniques (some research methods are ineffective or inapplicable);
• An arsenal of medications, as well as therapeutic and surgical treatment methods (age-related contraindications are taken into account).

Psychological features of constipation in children

The problem of constipation in adults is not considered as a significant psychological inconvenience, with the exception of a person being forced to spend a long time in unusual living conditions. In childhood, the psyche is unstable, subject to the influence of adults and the team, and the regulation of bowel movements in a child is imperfect.

Constipation has a significant impact on the quality of life of children in the form of:

• Emotional lability (instability) – increased fears, timidity;
• Mental stress - imaginary or real fear of humiliation;
• Deterioration of the child’s socialization – isolation or self-isolation in a group.

There are four critical periods in terms of the possible development of constipation in children:

• Transition from breastfeeding to solid foods (ages four to six months to one year);
• Weaning from diapers, transition to defecation in a potty (age about one and a half to two years);
• Strengthening the reflex to regulate the act of defecation (age about three years);
• The period of socialization of the child (kindergarten, school, health camp).

Adults must be attentive to such a delicate problem, because the consequences of constipation in children can manifest themselves in the form of:

• Inability to defecate independently (without an enema or laxatives);
• Fecal incontinence due to atony of the anal sphincters;
• Continuous discharge of liquid feces due to constipation - encopresis (combined damage to the anal sphincters).

Encopresis is an extreme form of the pathological consequences of constipation. Develops in approximately 3% of children by the age of three, more often in boys than girls. Encopresis and other consequences of chronic constipation are potential causes of child disability.

Diagnosis of constipation in children

Normal stool appearance for different periods of childhood:

• From the first day of life to six months – mushy;
• From six months to two years – mushy or semi-formed;
• From two years onwards - formed feces (type 3-4 on the Bristol scale).

Diagnostic criteria indicating constipation in children:

• Reduced frequency of bowel movements;
• Difficulty in defecation;
• Complaints of a feeling of incomplete bowel movement;
• Increased density and lumpy stool.

Constipation is detected in the anamnesis of up to 50% of examined children entering treatment with problems of the gastrointestinal tract (GIT). Almost always (up to 94%), childhood constipation is a consequence of functional disorders of the gastrointestinal tract. Intestinal dysrhythmias of organic origin are much less common: according to various sources, in approximately 6% of all examined patients admitted for inpatient treatment of gastrointestinal diseases.

Diagnosis of chronic constipation in children includes a comprehensive examination, including:

• Taking an anamnesis (usually interviewing an accompanying person who describes his own subjective feelings, and not the child);
• Clinical examination (identification and/or exclusion of phenotypic signs of undifferentiated connective tissue dysplasia (UCTD) - one of the main causes of constipation in children);
• Laboratory methods (markers of intestinal microflora, reliability of immune status);
• Irrigography;
• Ultrasound of the abdominal cavity and lower gastrointestinal tract.

Irrigography is the main and most informative method for diagnosing functional constipation. This is an X-ray examination of the distal intestine filled with a contrast agent. Currently, various variants of this technique are used, including a minimally invasive combination of ultrasound and x-ray, which is suitable for safe use in children from an early age.

With the help of irrigography, the following is revealed:

• Incomplete emptying of the rectum (normally it is empty after defecation);
• Lengthening and/or increased tone of the sigmoid colon;
• Expansion of the rectal ampulla;
• Colonic reflux.

Differential diagnosis of constipation in order to determine the severity of the pathology and the compensatory capabilities of the child’s body is carried out using the following methods:

• Fibrogastroduodenoscopy (FGDS) to identify various functional disorders in the upper gastrointestinal tract (for example, upper intestinal reflux);
• Daily pH-metry of the cardiac esophagus to detect daily changes in acidity levels in the upper gastrointestinal tract;
• Ultrasound of the gallbladder to determine its contractility;
• Ballonographic method for studying the motor (propulsive) activity of the intestinal wall;
• Electromyography, manometry, sphincterometry - methods for diagnosing the functional state of the anal sphincters;
• Gas-liquid chromatography (studies of short-chain volatile fatty acids (SCFA) - markers of intestinal microbiocenosis disorders during constipation);
• Cytochemical analysis of peripheral blood lymphocytes (gives an idea of ​​the depth of the pathological process associated with constipation in a child);
• Mental state tests (usually during adolescence). Indicators of physical and emotional status associated with constipation are determined, as well as the level of social adaptation (using the PedsQL questionnaire in the Russian version).

Causes of constipation in children

Based on duration, childhood constipation is divided into:

• Episodic (one-time or acute);
• Chronic (permanent with possible periods of remission).

Constipation in children can be organic or functional:

• Organic constipation. Caused by structural abnormalities of the intestine (Hirschsprung's disease, Payer's syndrome, Crohn's disease). This group includes an extensive list of diseases of interest to a narrow group of gastroenterologists, coloproctologists and surgeons;
• Functional constipation. In childhood, functional disorders are the main cause of constipation. Almost all studies confirm the leading role of undifferentiated connective tissue dysplasia (UCTD) in the development of chronic constipation in children.

Undifferentiated connective tissue dysplasia (UCTD) is a group of interrelated syndromes that represent a connective tissue pathology. NSTD manifests itself with a variety of symptoms in all organs that have such tissue.

Pathological changes in NSTD during constipation are found in the connective tissue of the following body systems:

• Musculoskeletal;
• Cardiovascular;
• Respiratory;
• excretory;
• Digestive;
• Nervous.

Visceral (related to internal organs) manifestations of NSTD are:

• Gastroesophageal reflux disease (GERD) is a gastrointestinal disease caused by the reverse ejection of food from the stomach into the esophagus;
• Duodenogastroesophageal reflux (DGER) is a gastrointestinal disease caused by the pathological effect of acid on the mucous membrane of the small intestine due to the reverse ejection of intestinal contents from the duodenum into the stomach.

Phenotypic (detected by examination) signs of NSTD, which have diagnostic value for constipation, are represented by stigmas - diseases most often combined with undifferentiated connective tissue dysplasia.

1. Craniofacial stigmas (signs) of chronic constipation in children:

• myopia (nearsightedness);
• congenital curvature of the nasal septum;
• abnormal bite and tooth growth;
• abnormalities in the structure of the auricle.

2. Stigmas of the musculoskeletal system, combined with manifestations of chronic constipation in children:

• kyphosis, scoliosis (various curvatures of the spine);
• abnormalities in the shape and length of the fingers.

3. Skin stigmas combined with constipation in children:

• stretch marks (stretch marks or atrophic scars), the mechanism and reasons for their development are completely unknown;
• multiple age spots;
• hypertrichosis (excessive hair growth);
• hemangiomas (benign tumors of the first days of life).

4. Gastrointestinal stigmas combined with chronic constipation in children:

• cardia insufficiency (incomplete closure of the valve between the esophagus and stomach);
• diaphragm hernia;
• deformations or kinks of the gallbladder;
• hernia of the anterior abdominal wall.

In some cases, chronic functional constipation of childhood does not correlate with NSTD.

The causes of chronic functional constipation in childhood can also be:

• Congenital or acquired anomalies of the large intestine - dolichocolon, dolichosigma and others;
• Psychosomatic factors (conscious suppression of the urge to defecate);
• Defects in the neuromuscular or endocrine regulation of the functioning of the large intestine (Hirschsprung's disease, intestinal vegetative dystonia, hypothyroidism, hyperparathyroidism, dystrophy of the intramural ganglia due to staphylococcal infections);
• Physical inactivity (sedentary lifestyle, prolonged bed rest for illnesses);
• Food allergies (most often constipation alternates with diarrhea);
• Nutritional factors (poor diet, dry food, small amount of food, lack of fiber, lack of fluid);
• Reflex factors (inflammatory diseases of other organs associated with the large intestine or with the external and internal anal sphincters);
• Intoxication or metabolic disorders that cause damage to the sensitivity of the receptor apparatus of the intestinal walls;
• Dehydration (especially with symptoms of acidosis, hypokalemia and hypercalcemia);
• Iatrogenic factors (dysfunctions caused by long-term unjustified use of antibiotics and other drugs without taking into account the consequences).

In clinical practice, there is a combination of several reasons that cause constipation. Diagnosing constipation in children is difficult due to the complex mechanism of disease development.

The pathogenesis of chronic functional constipation in children develops according to one of three scenarios:

• Suppression of propulsive (pushing) motor activity - disturbances in peristalsis in some cases are programmed genetically, as there is a family predisposition to this kind of constipation;
• The occurrence of dystrophic processes in the intestinal walls and impaired sensitivity of the receptor apparatus - in some children suffering from chronic constipation, a careful examination reveals a decrease in the functions of the intestinal receptor apparatus. In clinical practice, there are also cases of constipation associated with damage to the nerves in the spinal and lumbosacral spine;
• Functional dystonia or obstacles to the movement of feces - constipation can be associated with spasms of the anal sphincters, preventing the evacuation of feces from the anus, as well as with the lack of defecation skills in children or the pain of the act itself (rectal fissures, inflammation).

Constipation in an infant (one month old)

The first month of a child’s life is the most anxious period for the mother of a newborn, especially if it is her first child.

Signs of a baby’s health in the first month of life are:

• The presence of reflexes characteristic of this period;
• Good appetite, normal weight gain and height;
• Regularity of natural functions.

Normally, feces pass after each feeding, there is no pain reaction during defecation, the consistency of the discharge is mushy, the color is yellow-green, and the smell is sour milk. A healthy child certainly has problems with bowel movements during the first month of life, but this is not always a medical pathology.

It is necessary to be prepared for problems with bowel movements (constipation) in a baby in the following cases:

• Changes in the gastrointestinal tract detected in a newborn during diagnostic examinations;
• Forced use of medications (antibiotics) by a breastfeeding mother;
• Transferring a child from breastfeeding to artificial feeding;
• A sharp change from one food recipe to another.

In some medical sources, the causes of constipation are also called untimely latching of the newborn to the breast, prematurity of the child and developmental delays due to poor intrauterine nutrition of the fetus.

Signs of constipation in newborns

Constipation in a newborn is indicated in the following cases:

• Absence of bowel movements for more than 1-2 days (it is necessary to exclude possible underfeeding of the child as a reason for the absence of bowel movements not related to gastrointestinal pathology);
• Restlessness and crying (prolonged absence of bowel movements against the background of calm behavior is a sign of complete absorption of breast milk or baby food);
• Frequent regurgitation (returning food through the mouth without straining) immediately after feeding is a likely sign of a lack of movement of feces in the intestines.

Constipation in a newborn, requiring immediate medical attention, is rare. Meanwhile, it is necessary to know its signs, since constipation is one of the symptoms of an “acute abdomen.”

Acute abdominal syndrome in a newborn manifests itself as follows:

• Sharp abdominal pain is the leading symptom, then the signs are listed in descending order of diagnostic significance;
• Shock is a progressive destruction of the vital functions of the body (shock at the first stage is accompanied by excitement, and then gives way to a sharp depression of consciousness);
• Constipation (much less often - diarrhea);
• Vomiting (rarely observed in newborns);
• Passage of intestinal gases (flatulence);
• Melena is black, pasty stool (a sign of gastric or small intestinal bleeding).

Acute abdomen syndrome is extremely rare. Typically, abdominal massage is sufficient to eliminate and prevent constipation in newborns. Be sure to consult with your doctor about the advisability of the procedure, taking into account the individual characteristics of the baby.

Abdominal massage for constipation includes the following manipulations:

• Stroking clockwise;
• Bringing the legs to the stomach;
• Stroking the back while the child is lying on his stomach;
• Folding the arms on the chest.

The timing of the exercises is individual. Regular massage is very important, provided there is no dissatisfaction on the part of the baby.

Constipation after feeding

The first critical period from the point of view of the possible development of constipation is the introduction of additional foods, or complementary foods, into the infant’s diet. Complementary feeding can begin at 4 months (breastfeeding) or at 5-6 months (artificial feeding). The indicated dates are approximate and depend on the individual development of the child.

Signs that a child is ready to transition to complementary feeding:

• The baby's weight and height have doubled since birth;
• Physical development is normal (holds head confidently and responds to visual, verbal and tactile stimulation by turning head);
• Breastfeeding or bottle feeding does not make the baby feel completely full.

To prevent constipation (diarrhea), complementary feeding is started gradually and divided into three periods with the introduction of new products (fruits and vegetables, cereals, meat and fish dishes). To avoid problems with bowel function, you should not switch your child to a new type of diet too quickly. The signs of constipation in a 4-6 month old baby are the same as in a newborn.

Recommendations for preventing constipation when switching to complementary foods:

• As a first complementary food, use vegetable puree (steamed from vegetables containing large quantities of fiber);
• Start complementary feeding with minimal amounts of food;
• Complementary feeding involves drinking boiled water in the amount necessary for the formation of normal feces;
• Do not use foods that potentially cause allergies for complementary feeding (allergy is one of the causes of constipation in children);
• Additional protein should be introduced very carefully into the baby’s diet to avoid constipation;
• Maintain regular feedings.

These recommendations are not exhaustive instructions for the prevention of constipation in infants. Be sure to obtain additional medical advice related to the individual characteristics of your child’s digestion.

Constipation in a 2 year old child

The second critical period from the point of view of the possible development of constipation in a child is the refusal to use diapers and potty training. At this time, mothers first encounter psychological problems in their child. The transition to controlled bowel movements occurs against the background of significant physiological changes in the child’s body.

By two years:

• Dairy nutrition finally becomes secondary (the length of the intestines increases due to a change in the type of nutrition);
• Milk teeth grow (up to 20 teeth by the second year), therefore, the child is able to grind food independently;
• Feces take on a form corresponding to type 3-4 on the Bristol scale (the child’s digestion approaches the physiological norms of an adult);
• The beginnings of regulation of the act of defecation appear.

Recommendations for the prevention of constipation in children two years old, taking into account the peculiarities of the physiology of digestion at this age:

• During this period, a final change in the type of nutrition occurs; milk can cause indigestion;
• The length of the intestine in a two-year-old child exceeds his height by six times, but in an adult the intestine is only four times longer. It means that:

  the passage of food in a child’s intestines takes longer than in an adult;

• protein and fatty foods stay in the intestines longer, and therefore they should not form the basis of the child’s diet;
• plant foods must necessarily include plant fiber that is not digested in the intestines;
• it is necessary to regularly let the child drink ordinary boiled water;
• It is necessary to gradually exclude crushed food from the main diet.

Constipation in children 3 years old

The third critical period from the point of view of the possible development of constipation in a child is the final formation of the defecation retention reflex and the beginning of the baby’s socialization (kindergarten). At this time, there are no significant physiological changes in digestion that could potentially affect bowel movements. However, this period of life is characterized by the psychological and intellectual development of a person. There are no universal recommendations for the prevention of constipation at the age of three, just as there are no identical children.

Meanwhile, important preventive measures to prevent constipation in children three years old include:

• Formation of a proper diet and nutritional regimen (normal stool in a child should not be associated with phobias);
• Refusal from diapers, the use of which smoothes out the child’s discomfort after defecation, therefore inhibits the development of the reflex to regulate the act of defecation.

If, despite a healthy diet, adherence to a daily routine and a normal psychological climate in the family, a child continues to experience constipation, perhaps their cause lies in medical problems. Then the only correct advice is to go to the clinic for a full examination and to a psychologist to determine the emotional causes of the disease.

Starting from the age of three, children are diagnosed with diseases such as encopresis and fecal incontinence:

• Fecal incontinence is a consequence of thoughtless use of diapers in children after three years of age. Sometimes the problem lies in other reasons that only a doctor can figure out based on a thorough examination;
• Encopresis is a disease that is manifested by constant soiling of underwear and is mistaken for diarrhea. But this is always a consequence of constipation. During instrumental examinations, fecal compactions are diagnosed in the rectal ampulla;
• Psychological problems are always individual; it is unreasonable to limit yourself to online advice on what and how to tell a three-year-old child who has difficulty defecating.

What to do if your child is constipated?

The first thing you should do is learn to correctly assess the situation. If the problem, in your opinion, threatens the child’s life, contact a medical facility immediately. On the other hand, constipation may be imaginary. Its main symptom is the absence of bowel movements against the background of the child’s normal behavior, without colic (abdominal pain).

In this case, you should pay attention to the following circumstances:

• Insufficient weight gain in a child - perhaps the reason for the lack of bowel movements is underfeeding, and restless behavior is associated with hunger;
• Weight gain is normal - it is possible that breastfeeding is almost completely absorbed by the child (the tummy is not enlarged, there is no pain, the baby is developing well).

The second is to seek advice from a specialist who is caring for the child. An inexperienced mother cannot always independently and adequately assess the situation. A professional pediatrician will help you understand the possible causes of constipation.

Third, master the simplest therapeutic and preventive procedures (massage, using an enema, rectally or orally administering laxatives that are effective for a child). Do not try to carry out manipulations according to correspondence instructions; ask a specialist to demonstrate their correct implementation.

Fourth, learn to identify signs of dangerous conditions that threaten the child’s health (acute abdominal syndrome, which characterizes various gastrointestinal diseases in a child, accompanied by constipation). Find out where you can go for help in this situation.

There are also many special products that can help normalize a child’s stool, see the article - what helps with constipation?

Treatment of constipation in children

Treatment of constipation in a child includes several aspects:

• Symptomatic treatment. Elimination of the main symptoms of pathology with laxatives of different groups used in pediatric practice, as well as enemas and physiotherapeutic manipulations aimed at bowel movement;
• Etiotropic therapy. Eliminating the cause of constipation. This is the most complex area of ​​treatment; it depends on many factors: diagnostic results, the state of the child’s body, the etiology of the disease (congenital, acquired). Based on these data, treatment tactics are chosen: therapeutic (treatment with medications and physiotherapy) or surgical (surgical elimination of defects causing chronic or acute intestinal dysrhythmia);
• Pathogenetic therapy. Treatment is aimed at eliminating the pathogenetic symptoms that develop during the course of the disease (intoxication, growth retardation, disturbances in the functioning of the cardiovascular system). The arsenal of medications and physiotherapeutic agents is huge; their choice is individual and depends on the pathogenesis of the disease.

Diet for constipation in children

Prescription of dietary nutrition for children is possible from about two to three years of age. Until this time, simply include regular boiled water cooled to room temperature in your diet.

When the child is able to eat regular food, the diet will need to include dishes made from the following products:

• First meal. Soups with fish broth (hake, cod, navaga), soups with meat broth (beef, turkey), vegetable soups (zucchini, tomatoes, carrots, potatoes, beets, cabbage, pumpkin);
• Second courses. Stuffed cabbage rolls, meatballs (limit or exclude rice), fish and meat cutlets (beef), omelettes;
• Side dishes. Porridge from buckwheat, barley and pearl barley in low-fat meat broth, boiled pasta, vegetables (listed above);
• Beverages. Compotes from dried fruits (dried apricots, raisins, prunes, figs), tea, vegetable and berry juices, fruit drinks;
• Dessert. Curd puddings, honey, marshmallows, marmalade;
• Bread made from second-grade flour with the addition of whole grains and bran, dietary bread.

See the article - what you can and cannot eat if you have constipation

For constipation in children, you should limit the consumption of the following foods: fatty meat and fish, smoked and spicy foods, raw whole milk, radishes, onions, garlic, rice, semolina, chocolate.

Author of the article:

Sokolova Praskovya Fedorovna |
Pediatrician Education: Diploma in general medicine received from Volgograd State Medical University. Immediately received a specialist certificate in 2014. Our authors