Normal defecation in children of all age groups is considered a health indicator. For this reason, this situation starts to gain importance from the first months of life. Yeditepe University Kozyatağı Hospital Pediatric Gastroenterology Specialist emphasizes that approximately 30 percent of children and 1-2 percent of children who apply to pediatric outpatient clinics complain of constipation. This problem brings difficulties for both children and parents. 

Because it can vary from person to person, it is most simply expressed as difficulty or delay in defecation. Defined by the frequency of defecation, it is considered to be “less than three defecations per week”. However, the definition in infants and children differs from that in adults. For at least two weeks, most stools have been defined as hard stools similar to pebbles, with two or fewer hard stools per week defined as constipation. Stating that this problem is extremely important for the general health of children, Yeditepe University Kozyatağı Hospital Pediatric Gastroenterology Specialist remarked that constipation may also be caused by different diseases.

Constipation Can Lead to Serious Problems!

Pointing out that constipation should not be perceived as a simple problem and should be evaluated, the expert states: “It should not be forgotten that serious problems such as loss of appetite-development retardation in the child, abdominal pain, deterioration in the quality of life of the child and the family, unhappiness, restlessness, and psychological disorders as a result (especially if there is stool incontinence (encopresis), social exclusion, (depression and anxiety), cracked/torn anus (anal fissure), bleeding in the stool, hemorrhoids, the last part of the large intestine (rectal prolapse), recurrent urinary tract infections, urinary incontinence may occur.”

2% of School-Age Children Have This Problem

Approximately 3 percent of preschool children and 1-2 percent of school-age children complain of constipation. In addition, 3-5 percent of general pediatric outpatient clinics and up to 25 percent of pediatric gastroenterology outpatient clinics are constipated patients. Babies usually defecate 4-6 times a day for the first week of their lives. This frequency decreases gradually with age and can decrease to 1-7 stools per day at the age of 2 and 1-2 stools per day at the age of 4. There is no change in the number of defecations after the age of four.

What is the Cause of Constipation in Children?

90-95% of constipation in children is caused by functional constipation, while the rest is due to organic causes. Functional constipation is defined as constipation in which there is no underlying pathological condition and is usually seen in children under 5 years of age. In this case, since children often feel pain in defecation, they delay defecation and hold the stool in order not to feel this pain. Reminding that there may be various reasons that lead to painful defecation, our expert states: “Toilet training can delay defecation due to dietary changes, stressful events, intervening infections, lack or inappropriateness of the toilet, play, and the child's association with friends at school.” 

Under organic causes, there can be many problems. These include anatomical disorders, hypothyroidism, hyperparathyroidism, metabolic and gastrointestinal diseases such as diabetes, cystic fibrosis, celiac disease, spinal cord abnormalities, spinal cord trauma, neuropathic conditions such as cerebral palsy, intestinal nerve and muscle disorders, abnormal abdominal muscle structure, connective tissue diseases, and some medications. Furthermore, dietary habits such as cow's milk protein intolerance, insufficient fiber intake, insufficient fluid intake, heavy metal intake and vitamin D intoxication can also cause organic constipation.

Risky Period: Eating Solid Foods

Stating that the first period that is risky for constipation is the period when the baby started to eat solid foods other than breast milk. “There is insufficient fiber in the child's diet during this period and this is often the main cause of constipation. Adequate intake of fiber and fluids may help prevent constipation or treat mild intermittent constipation. It is very important to inform the mothers during this period.”

Constipation Must Be Treated

Although it is not an underlying pathological condition, constipation is a problem that needs to be treated as it can continue for many years and can impair the quality of life and social life of the child and family.

“Only 50 percent of patients who received intensive treatment for constipation and have not used laxatives for 1 year have been successfully treated. In another study, it was shown that 25 percent of patients with constipation before the age of 5 continued to have serious constipation complaints after puberty.

Treatment Has 4 Main Steps

Childhood constipation treatment consists of 4 main steps: education, excretion, prevention of stool accumulation, and follow-up.  At this point, our expert emphasizes that the family and the child should be informed first. ''The family should be given detailed information about the disease and the family, and the child should be relaxed. Then the petrified stool in the rectum should be emptied. Regular bowel habits should be ensured to prevent fecal accumulation. During this period, which is defined as maintenance therapy, behavioral changes such as diet, medication–mineral oil/lactulose, sorbitol-, going to the toilet after meals, and rewarding will benefit. One of the most important options that can be recommended to children or parents with constipation is to change the diet and content. Studies have shown that adolescents with constipation receive less fluid and dietary fiber.”

Diet is Very Important in Constipation

In the nutrition of children with constipation, it is recommended to increase the intake of absorbed and non-absorbable fibers with fluid intake for the continuation of soft stool. Our expert explains the points to be considered in the nutrition of children:

“Fibers are found especially in fruits and vegetables. These increase the liquid content and frequency of the stool. Again, fruit juices are useful in laxative form with their osmotic effects. The diet should contain pulp, and the amount of pulp in the diet should be gradually increased. Dietary fiber softens stool and reduces transit time by increasing water retention and microbial mass in the large intestine. It is recommended to consume all fruit and vegetables in season (if there is no known allergy or reaction). Fruit and vegetable juices or purees are not recommended. Popcorn is also a good fiber food. The amount of fiber the child should take daily is “age (years) + 5 grams”. The amount of milk and dairy products may need to be reduced in some children.”

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