Constipation

Definition: Constipation is a decrease in the frequency of bowel movements; characterized by the passing of hardened stools which may be large and associated with straining and pain.

 

Constipation in children

Normal stool frequency in children: ranges from an average of 4 per day in the first week of life to 2 per day at 1 year of age. Passing between 3 stools per day and 3 per week is usually attained by 4 years of age.

 

Contributing factors include: Pain, fever, inadequate fluid intake, reduced dietary fibre intake, toilet training issues, the effects of drugs, psychosocial issues, and a family history of constipation.

 

Signs of constipation

Two or more of the following clinical features indicate that a child is constipated:

 

            1. Fewer than three complete stools per week (unless exclusively breastfed, when stools may be infrequent).
            2. Hard stools (see the Bristol stool chart: www.nice.org.uk/guidance/cg99/resources/bristol-stool-chart-pdf-245459773).
            3. Large stool.
            4. ‘Rabbit droppings’ stool.
            5. Overflow soiling in children older than 1 year of age (commonly very loose, smelly stools, which are passed without sensation or awareness).

Childhood constipation and soiling from NHS Elect on Vimeo.

 

Constipation in babies

Breastfed babies are rarely constipated as breast milk is almost 100% completely digested and utilized by baby’s growing body. Breast milk leaves little “leftovers” to cause constipation. Many breastfed babies do have infrequent bowel movements however this does not mean that they are constipated

 

Formula fed babies may have constipation more often than breastfed babies. Unlike breast milk, formula is not as easily digested nor is it as completely absorbed and used by a baby’s body.

 

Infant constipation isn’t common. However, your baby might have infant constipation if he or she has: Hard or pellet-like bowel movements. Bowel movements that appears difficult to pass, causing your baby to arch his or her back or cry. Or infrequent or less frequent bowel movement. If your newborn seems constipated, contact your HV or G.P for advice. Keep in mind that the normal amount of bowel movements an infant passes varies depending on his or her age and what he or she is eating. Infants also have weak abdominal muscles and often strain during bowel movements. Infant constipation is unlikely if your baby passes a soft bowel movement after a few minutes of straining. Infant constipation often begins when a baby starts eating solid foods.

 

Faecal impaction may be possible if there is:

  •  A history of severe symptoms of constipation.
  • Overflow soiling.
  • A faecal mass palpable on abdominal examination. 

 

 You can help relieve constipation in infants with:

  • A warm bath
  • Bicycle legs: place your baby on her back and lightly hold her legs in a half-bent position. Gently begin to move your baby’s legs as if she is riding a bicycle.
  • Tummy massage: Gently massage and rub baby’s tummy in a clockwise direction. Place your hands at baby’s navel and massage in a circular motion, moving your hand(s) out and away from the center of baby’s belly.

 

Useful links

The organisations below can provide more information and support for parents and carers of children and young people with constipation:

 

ERIC (Education and Resources for Improving Childhood Continence):  www.eric.org.uk
You can also go to NHS Choices for more information: www.nhs.uk/Conditions/pregnancy-and-baby/pages/constipation-and-soiling.aspx

British Association of Dieticians (fluid intake): www.bda.uk.com/foodfacts/fluid.pdf