Children of any age, including toddlers, can develop constipation. Constipation at this age usually means the passage of hard stool.
Symptoms. Small, hard stools every 3 or 4 days; hard, dry stools (even if they are passed daily) that are difficult or painful to eliminate; abdominal pain relieved by a bowel movement; small amounts of diarrhoea or soiling (when stool becomes impacted). Infrequent movements alone are not a sign of constipation; some children just go less often than others.
Season. Any time of year, but may be more likely when there is a change in diet and schedule (as during a holiday).
Cause. Many possible, including a diet low in fiber and fluids. Temporary constipation may develop during or after an illness; certain medications can be responsible. In addition, constipation often develops in toddlers going through the toilet-learning process, especially when there is parental pressure to perform. Constipation may also develop in a toddler who is uncomfortable using the toilet away from home (at day care, preschool, a friend’s house, or a store) or who withholds a bowel movement out of pique, because of being otherwise engaged, or for any other reason. The longer movement held, the harder and drier it becomes, and the more difficult and painful it is to pass. Fear of passing these hard, stools often prompts a child to continue withholding, and a cycle of withholding and constipation is set in motion. Movement that are withheld too long, in addition to becoming hard, can become very large. When passed, they can stretch the rectum; repeated over stretching can make it more difficult for a child to recognize the urge. This, too, helps to perpetuate the cycle. When constipation becomes chronic and home treatment measures fail the doctor may look for a medical cause, such as an underactive thyroid gland or a spinal-cord anomaly, though these were very rare.
Transmission. Constipation is not contagious, but the poor eating and exercise habits, which often lead to or perpetuate it, can be passed from parent to child.
Duration. Anywhere from 1 day to a lifetime.
Treatment. When an underlying medical problem is a factor, medical treatment generally focuses on identifying and dealing with it, as well as softening and removing (usually with the help of enema) any impacted stool that has become lodged in the rectum and can’t be passed. But home treatment usually plays the most important long-term role in preventing recurrence. Treatment should include plenty of:
- Fiber. Be sure your toddler is getting whole-grain breads, cereals and pastas (‘whole wheat’, not just wheat; rolled oats rather than instant; and so on); fresh fruits (ripe apples and pears are particularly effective), and dried fruit (especially raisins, apricots, prunes, and figs); vegetables (cooked until tender but not mushy); and legumes (cooked dried beans and peas). Do be sure you always offer age-appropriate foods: dried fruit, whether cooked or fresh, should be diced for younger toddlers, and beans and peas should be mashed or split. For older toddlers, raw vegetables and salad are a good dietary addition. Give wheat (or miller’s) bran, which packs a major laxative wallop, only when the doctor has advised its use. It can be added to cereals, pancakes, muffins, breads, other baked goods, pasta sauce and almost anything with a gooey texture. Always serve the brain with plenty of liquid, don’t exceed the recommended quantity, and use it only for as long as it’s necessary.
- Fluids. Many toddlers who’ve been recently weaned off the bottle or breast drink much less than they did before weaning; in some cases, it’s less than they need. Be sure that’s not the case with yours. If he or she isn’t managing to drink at least 1.1 liters/2 pints of fluids a day at meals and snacks, try offering sips of milk, juice, or water frequently in between. Fruit juices are particularly beneficial; limit cow’s milk to about 3 cups a day, since the calcium salts in it can harden stools.
- Exercise. Although you don’t have to sign your toddler up at the local health club to make sure he or she is getting enough constipation – combating exercise, you should see that the whole day isn’t spent in the car seat or buggy, with little opportunity for physical activity. Treat your toddler to some outdoor play every day, weather permitting. On inclement days, try an impromptu calisthenics class on the living room floor (jumping jacks, toe touches, upside-down bicycling).
- Lubrication. Baubing a bit of petroleum jelly at the anal opening may help the movement slip out more easily. Do not use enemas or suppositories for constipation without a doctor’s advice. Except in rare instances, these treatments make problems worse, not better.
- Medication. Occasionally, the doctor may recommend a brief course of medication; don’t give laxatives stool softeners, mineral oil, herbal teas or any other medicines for constipation without the doctor’s recommendation.
Prevention. Most of the lifestyle changes necessary for treating constipation a will also help keep it at bay. Fiber, fluids and exercise should be part of every child’s health routine, but they are especially important for those with a history (or family history) of constipation.
When to call the doctor. When your toddler has not had a bowel movement for 4 or 5 days; when constipation is accompanied by abdominal pain or vomiting; and/or painful; when constipation is chronic and the home measures described above have been infective; when there is blood in or around the stool. The doctor will probably want to rule out the slim chances of an underlying organic problem, as well as determine the best approach to treating the constipation.