Toddler Constipation

Symptoms: 

As well as infrequent or irregular bowel movements, a child with constipation may also have any of the following symptoms:

  • Loss of appetite
  • Lack of energy
  • Being irritable, angry or unhappy
  • Foul-smelling wind and stools
  • Stomach pain and discomfort
  • Soiling their clothes
  • Generally feeling unwell
Tests to diagnose: 

Your child's doctor will:

Gather a complete medical history. Your child's doctor will ask you about your child's past illnesses. He or she will also likely ask you about your child's diet and physical activity patterns.

Conduct a physical exam. Your child's physical exam will likely include placing a gloved finger into your child's anus to check for abnormalities or the presence of impacted stool. Stool found in the rectum may be tested for blood.

More extensive testing is usually reserved for only the most severe cases of constipation. If necessary, these tests may include:

  • Abdominal X-ray. This standard X-ray test allows your child's doctor to see if there are any blockages in your child's abdomen.
  • Anorectal manometry or motility test. In this test, a thin tube called a catheter is placed in the rectum to measure the coordination of the muscles your child uses to pass stool.
  • Barium enema X-ray. In this test, the lining of the bowel is coated with a contrast dye (barium) so that the rectum, colon and sometimes part of the small intestine can be clearly seen on an X-ray.
  • Rectal biopsy. In this test, a small sample of tissue is taken from the lining of the rectum to see if nerve cells are normal.
  • Transit study or marker study. In this test, your child will swallow a capsule containing markers that show up on X-rays taken over several days. Your child's doctor will analyze the way the markers move through your child's digestive tract.
  • Blood tests. Occasionally, blood tests are performed, such as a thyroid panel.
Treatment: 

Treatment should continue for enough time to allow the bowel size and sensation to return to normal. Treatment should include:

Healthy bowel habits

It is important for constipated children to develop the habit of sitting on the toilet regularly.

This should be for three to five minutes after breakfast, lunch and dinner. They should sit on the toilet even if they do not feel the urge to go. They should stay on for three to five minutes, even if they have done some poo before then.

Providing a book and a footstool (so they feel secure) can be helpful. Using a kitchen timer can avoid arguments about how long they have been sitting.

Reinforce the good behaviours (sitting and pooing in the toilet) with encouragement and age-appropriate sticker or reward charts or other creative options.

Children should learn to respond to their body's urge to poo.

Remove frightening or painful associations

Many young children are worried that they may fall into the toilet.  A foot stool or rails can help.

You may want to find out if your child is worried about using the school or kinder toilets and see if anything can be done to help.

If your child is holding onto bowel motions after a painful experience, it can be helpful to use laxatives (oral medicines) to keep the poo soft for several weeks. This will allow easy passage of poo and give time for the anal fissures to heal.

A healthy diet

Giving your child adequate fibre in their diet might help prevent constipation in some children who have a natural tendency. To add more fibre to your child's diet, you can give your child:

At least two servings of fruit each day. Fruits with the peel left on, such as plums, prunes, raisins, apricots and peaches, have a lot of fibre.

At least three servings of vegetables each day.

Cereals that are less processed, such as bran cereals, shredded wheat, whole grain cereals or oatmeal. Avoid refined cereals, such as corn flakes and rice bubbles.

Wholemeal bread instead of white bread.

Reduce cow's milk intake to a maximum of 500ml per day (for children over the age of 18 months) and avoid sweet drinks before meals.  This will help to improve your child's appetite at meal times.

Infants

If you think your baby (less than 12 months of age) is constipated, you should consult your family doctor or Maternal & Child Health Nurse. Some babies might need their formula changed. For infants over six months of age, increased fruit and vegetables in their diet might help. You can give your baby strained, stewed prunes or apricots - up to three tablespoons, three times each week or prune juice diluted with water.

Laxatives

You may need to give your child a laxative if they are constipated. If you find this does not work, or you need to give it more than a few times in a year, then you should see your doctor.

Children who have been constipated for many months are likely to need laxative medications for several months, as well as encouraging healthy bowel habits.

Prune juice - this is a mild, natural laxative that works in some children. Prune juice may taste better if mixed with another juice, such as apple, apricot or cranberry juice. You can freeze prune juice to make icypoles.

Liquid paraffin mixtures - (eg Agarol™, Parachoc™) come as a flavoured liquid, and work by softening and lubricating the poo to make it easier to pass.

Macrogol3350 - (eg Movicol™) comes in a sachet to mix with water and works by softening the poo.

Lactulose - (eg Duphalac™) comes as a sweet-tasting liquid, and works by softening the poo and stimulating the bowel to empty. It may taste better mixed with juice or milk. It can cause smelly wind (farting).

Docusate / poloxalkol - (eg Coloxyl™) comes as a tablet or drops (which are most suitable for children under three years of age), and works by softening the poo.

Senna - (eg Senokot™) comes as a tablet or granules, and works by stimulating the bowel to empty. The granules can be mixed with food such as apple sauce or ice cream. Your child may have diarrhoea or stomach cramps if the dose is too high. Giving Senokot at night may reduce tummy cramping.

Bisacodyl - (eg Durolax™) comes as a tablet and works by stimulating the bowel to empty. It can cause tummy cramps.

Psyllium husk fibre (eg Metamucil™) this natural fibre supplement helps soften the poo and is a mild laxative. It comes in both unflavoured and orange flavour.

Suppositories & mini-enemas - (eg Glycerine, Duralax™ and Microlax™) these are small tablets or liquid that is placed into your child's bottom (rectum). They stimulate the rectum to empty. They do not soften the poo in the upper bowel. They are sometimes recommended for severe constipation but oral laxatives are more effective and less distressing for most children. Glycerine suppositories may be used for severe constipation in infants.

Never give an enema to your child unless your child's doctor has told you to.

Bowel irrigation - a very small number of children get so severely constipated that they need admission to hospital for a bowel washout. This is usually done using several litres of 'bowel prep' fluid. The fluid can be given as a drink or put down a tube into the stomach (nasogastric tube).