Constipation

    Constipation in children is a common problem and can have many causes. Here are the most important reasons and triggers.

    At what point do we speak of constipation in children (Rome IV criteria)?

    Under 4 years (non-toilet trained)

    At least 2 of the following criteria must be present for at least 1 month without an organic cause:

    • ≤ 2 bowel movements per week
    • History of excessive retention of stool
    • Pain during bowel movement
    • Large amounts of stool
    • Stool smearing (stool in the diaper or underwear)
    • Large stool masses that can block the toilet

    Over 4 years (toilet trained)

    At least 2 of the following criteria must be present for at least 1 month without an organic cause:

    • ≤ 2 bowel movements per week
    • Episodes of defecation (at least once a week)
    • History of excessive retention of stool
    • Pain during bowel movement
    • Large amounts of stool
    • Large stool masses that can block the toilet

    Important to know

    • The diagnosis is based on observation and anamnesis, not necessarily on imaging procedures.
    • Early treatment is important to avoid chronic complaints and psychological stress.
    • The criteria also help to differentiate functional constipation from other diseases such as Hirschsprung’s disease or coeliac disease.

    Common causes of constipation in children

    • 🍽️ Nutrition
      • Too little fiber (e.g. little fruit, vegetables, whole grain products)
      • Insufficient fluid intake
      • Change of diet (e.g. introduction of complementary foods)
    • 🚫 Restraining the chair
      • Children sometimes avoid going to the toilet (e.g. out of fear, shame or because they are playing)
      • This can lead to a habit of suppressing bowel movements
    • 🛌 Lack of exercise
      • Little physical activity can slow down bowel function
    • 💊 Medication
      • Some medicines (e.g. iron supplements, antidepressants, opiates) can inhibit bowel movements
    • 🧠 Psychological factors
      • Stress, anxiety, changes in everyday life (e.g. starting school, moving house)
      • Emotional stress can affect digestion
    • 🦠 Physical causes
      • Rarely: Diseases such as irritable bowel syndrome, neurological disorders or metabolic disorders (e.g. hypothyroidism)

    What helps?

    • High-fiber diet (e.g. whole grains, fruit, vegetables)
    • Drink a lot (especially water)
    • Regular exercise
    • Encourage toileting habits (e.g. fixed toileting after meals, age-appropriate sitting position, quiet environment) with toilet training and reward system with PLOP
    • If necessary: medically recommended, child-friendly laxatives

    Stool shapes

    Type

    Stool consistency

    Description

    1

    Single solid globules, like nuts (difficult to excrete)

    2

    Sausage-like, lumpy

    3

    Sausage-like with a cracked surface

    4

    Sausage-like with a smooth surface

    5

    Single soft, smooth-edged lumps (easy to remove)

    6

    Single soft lumps with irregular edges

    7

    Liquid, without solid components