2. • What is constipation in children?
• Constipation is when a child has very hard stools,
and has fewer bowel movements than he or she
normally does.
• It is a very common GI (gastrointestinal) problem.
• Constipation is often defined as having fewer than 3
bowel movements a week.
• Passing stool that is hard and sometimes large.
• Having bowel movements that are difficult or
painful to push out.
3. • Reasons why a child may become constipated:
• Diet
• Eating too many foods that are high in fat and low in fiber. These
include fast foods, junk foods, and soft drinks.
• Excessive consumption of milk and milk products ,resulting in
reduced fiber in the diet.
• Not drinking enough water and other fluids:
• Plenty of fluids in form of water and juices are important
to maintain hydration and help in gut motility and softening of the
stools.
• Change in diet :
• Having a change in diet. This includes when babies change from
breast milk to formula, or when they start eating solid foods.
• Lack of exercise:
• Children who watch a lot of TV and play video games don’t get
enough exercise. Exercise helps move digested food through the
intestines.
4. • Erratic eating and sleeping pattern:
• Not following a regular eating and sleeping pattern,
has an influence on the gastrointestinal reflexes.
• Emotional issues
• Not wanting to use public bathrooms. Children may
then hold in their bowel movements, causing
constipation.
• Going through toilet training. This can be a difficult
time for many toddlers.
• Having power struggles with parents. Toddlers may
hold in their bowel movements on purpose.
• Feeling stressed because of school, friends, or
family
5. • Busy children
• Some children don’t pay attention to signals
that their body gives them to have a bowel
movement.
• This can happen when children are too busy
playing. They forget to go to the bathroom.
• Constipation can also be a problem when
starting a new school year. Children can’t go
to the bathroom whenever they feel the
need. They have to change their bowel
routine.
6. • Underlying physical problem
• In rare cases, constipation can be caused by a
larger physical problem. These physical issues can
include:
• Problems of the intestinal tract, rectum, or anus,
such as celiac disease, cystic fibrosis , meconium
ileus
• Nervous system problems, such as cerebral palsy
• Endocrine problems, such as hypothyroidism
• Certain medicines, such as iron supplements, some
antidepressants, and narcotics such as codeine
7.
8. • Management of constipation:
• Problems of constipation among
children are chronic , and require long
term management.
• Approximately 30% of children continue
this problem into puberty .
• It can have a debilitating affect on the
overall growth and also have an adverse
affect on his morale.
• It is therefore important to focus on the
management in terms of diet and
lifestyle changes .
9. • Treatment of constipation involves 4
phases as recommended by
NASPGHAN(North American Society for
pediatric gastroenterology , Hepatology
and Nutrition)
• Education
• Dissipation
• Prevention of re accumulation of feces
• follow up
10. • The primary goal in dietary management
is aimed to:
Education of the parent
Provide relief to the child
Modifying diet as per the age and
requirement
Behavioral therapy and lifestyle
modifications
11. • Education of The Parents:
• Parents need to be educated ,reassured and
counseled regarding normal stooling pattern among
children.
• How the pattern varies at birth , early infancy to
older children who are weaned off and when they
are given ‘family pot’ diet .
• Parents should be adviced not to blame the child
for his / her bowel habits.
• They should try to inculcate good toilet training
habits and eating and sleeping patterns.
• Parents should be educated about the importance
of balanced diet , and liberal intake of fluids (water
and juices ) to improve the bowel movement,
12. • Providing Relief To the child:
• Disimpaction :
• Disimpaction is the use of fingers to aid in the
removal of stool from the rectum. This may be done
by a person who is experiencing constipation or by
a medical professional .
• Rectal disimpaction with phosphate soda enemas ,
saline enemas or mineral oil enemas.
• In recent studies use of PEG(polyurethane glycol)at
a dose of 1- 1.5 kg/day has been found to be very
effective and acceptable
13. • Modifying diet as per the age and requirement
• Making changes in child's diet will help constipation.
• Help the child to eat more fiber
Add more fruits and vegetables to their diet.
Add more whole-grain cereals and breads.
Check the nutrition labels on food packages for foods
that have more fiber.
• Include more fluids, especially water in the child’s diet.
• Limit fast foods and junk foods that are often high in
fats. Offer more well-balanced meals and snacks
instead.
• Limit drinks with caffeine, such as soda and tea
• Limit whole milk if the child’s healthcare provider asks
to do so.
14.
15. • Behavioral therapy and lifestyle modifications:
• When babies start to eat solid food, constipation
can result. This is because they don’t have enough
fiber in their new diet. Add fiber to baby’s diet by
giving pureed vegetables and fruits. Or try whole-
wheat or multigrain cereals.
• Constipation can also happen during toilet training.
Children who do not like using a regular toilet may
hold in their stool.
• Toilet training should be encouraged by allowing
the child to get on the toilet for 5-10 min daily ,
after a meal , this stimulates the gastrocolic reflex
making the process of defecating easier.
16. • Include right amount of fiber and fluids in the diet.
• Other than these make sure the child has
Regular access to a bathroom.
Enough time to use the toilet.
Regular sleeping and eating habits.
Regular physical exercise.
Limit the time the child spends on T.V and Video
games/ Mobiles.
• If the child has chronic constipation, work with his or
her healthcare provider. Together a care plan that is
right for the child can be created .
• Children who fail to respond to the above therapies ,
they should be recommended to go for psychological
counseling.
