What is constipation?

Constipation is a condition in which a child has infrequent bowel movement — fewer than three in a week — or bowel movements that are difficult or painful to pass.

Constipation is a common concern among parents of small children. In fact, almost 5 percent of pediatrician visits are related to constipation and at least 25 percent of visits to pediatric gastroenterology specialists are due to problems with constipation.

Constipation that is prolonged and does not resolve with the usual therapeutic measures is called “intractable constipation.” It’s usually been present for many years and requires more comprehensive testing and therapy.

What are the symptoms of constipation?

While children may experience symptoms differently, constipation symptoms may include:

  • not having a bowel movement for several days or passing hard, dry stools
  • abdominal bloating, cramps, or pain
  • decreased appetite
  • clenching teeth, crossing legs, squeezing buttocks together, or turning red in the face as your child tries to hold in a bowel movement to avoid discomfort
  • fecal incontinence, including small liquid or soft stool smears that soil your child's underwear

What causes constipation?

In general, there is no specific abnormality associated with constipation. It can be triggered by changes occurring in your child’s life and may not be related to an underlying medical condition. There are probably some genetic factors since this problem often seems to run in families. Contributing causes may include:

  • poor diet, full of high-fat, low-fiber foods and/or not enough liquids
  • changes in diet, such as a switch from breast milk to formula or beginning to eat solid foods
  • lack of exercise
  • emotional issues related to using public bathrooms, toilet training, or stress
  • changes in bowel routines
  • avoidance; hard, dry stools can be painful to push out, and the child might avoid using the bathroom to avoid the discomfort. Eventually, the intestine will not be able to sense the presence of stool.

Medical conditions and problems that can cause constipation in children include the following:

  • Hirschsprung's disease: a condition that occurs when some of your baby’s intestinal nerve cells don’t develop properly, causing them to interfere with the movement of food and stools in the intestines
  • congenital abnormalities of the intestinal tract, rectum, or anus, like imperforate anus
  • problems of the nervous system, such as cerebral palsy
  • endocrine problems, such as hypothyroidism
  • certain medications, such as iron preparations, some antidepressants, ADHD medications, and narcotics
  • underlying problems with the way the colon moves
  • neurologic problems associated with low muscle tone, or spinal cord injury or defect.

How do we care for constipation?

The Boston Children’s Hospital world-renowned pediatric gastroenterology team can get to the root of your child’s discomfort and provide access to highly specialized care for constipation. Our Motility and Functional Gastrointestinal Disorders Center tailors treatment plans to meet the varied needs of every child’s unique condition.