Constipation can be an issue for many children. Constipation often leads to lack of appetite. It seems to be a vicious cycle, and is sometimes hard to tell if the problem began when the child became constipated and didn’t want to eat or if he didn’t want to eat then became constipated. Constipation leads to less food intake because the child is full. Think about it in terms of a drain. If the drain is moving well and the contents are flowing through the drain, it is able to accept more without a problem. If however the drain is backed up it is unable to continue working properly and will not accept new contents. In this way the drain is similar to the digestive system. As long as he is eating and having regular bowel movements, he will be more willing to accept food. If however he is backed up and isn’t having bowel movements regularly. Your child will be resistant to food and not able to adequately accept meals.

Although some children have bowel movements as far apart as every three days, hard stools and bowel movements further apart than this should be treated as constipation.

Causes

There are many reasons for constipation.

1. Willful avoidance of the toilet. For children who are in the process or just finished potty training, this is the number one reason they become constipated. Toddlers often do not have the patience or willingness to take the time to stop playing and go on the toilet. These children need to be forced to go on the toilet at regular intervals to decrease the chances of constipation.

2. Changes in diet. Especially in children with feeding problems, changes in diet can affect bowel habits. Often as a baby transitions from formula to solid food constipation may occur while the body adjusts.

3. Lack of fluid. Not drinking enough fluid during the day is a major culprit in constipation. Children often need much more fluid then they are getting, and if constipation is a problem a simple solution is to increase the amount of fluid he gets.

4. Low fiber diets. Although the importance of fiber in preventing constipation in children is not proven, a balanced diet with adequate amounts of all nutrients help prevent constipation.

5. Low muscle tone. For children with low muscle tone, constipation is an issue because of abnormal colonic movement.

Treatment

Once a child is constipated, a visit to the doctor may be necessary to determine the degree of constipation and course of treatment. The doctor may administer an enema or recommend oral medication to cause a bowel movement. After your child is cleaned out, the doctor may recommend a laxative or stool softener for between a few months to a few years.

Prevention:

To prevent constipation from reoccurring, it is very important to give your child adequate fluids and provide a balanced diet. Other prevention methods include:

1. Mix 2 ounces of prune juice with 2 ounces of water and give this mixture one time per day.

2. To encourage your child to drink more fluids, provide juice ice pops or give drinks throughout the day. This can be tricky with an underweight child since you don’t want to fill them up on low calorie liquids, so make sure the fluids count and provide high calorie fluids whenever possible.

3. Add benefiber to meals. Although adding fiber is not proven to help children, if your child has a poor diet it can be a good idea to add fiber to the diet. Start slow with 1 scoop of benefiber per day and do not go over 2 scoops without consulting with a doctor.

4. Add 2 ounces of prune or pear puree to hot cereal.

5. Have your child drink small amounts of fruit nectars (~4 ounces/day).

6. Cut back on dairy products. Dairy usually contributes a significant amount of calories and nutrients to a toddler’s diet; however it can also be a contributing cause of constipation in many children. Many children become dependant on excessive amounts of milk, yogurt and pudding, leaving little room for fruits, vegetables and whole grains. In addition, cow’s milk protein can be a contributing factor to constipation. Limiting dairy to 12 to 16 ounces per day can lead to an improvement in constipation. Soy milk can be a good alternative that is usually less constipating then cow’s milk.

Remember to vary your child's diet as much as possible and provide a variety of fruits and vegetables. If constipation becomes a recurring problem, mention it to your child's pediatrician. He can determine if medication is needed or if tests should be done to rule out other reasons for your child's constipation. It is also a good idea to make an appointment with a dietitian to make sure there is nothing in your child's diet that can be tweaked to help prevent constipation.