Severe Constipation in Toddlers: Causes and Solutions for Parents

Bowel issues

Hello Doctor: My daughter is currently over 3 years old and has been experiencing severe constipation lately, unable to have bowel movements on her own.
When I palpate her abdomen, I can feel hard masses (likely stool).
Recently, she took a stool softener prescribed by a clinic doctor, but it only resulted in watery stools without any solid bowel movements.
At the end of June, we took her to the emergency department at Shin Kong Hospital, where an X-ray was performed.
The emergency physician indicated that it was stool, but he was hesitant to perform an enema and advised me to continue giving her the stool softener prescribed by the clinic doctor.
However, she has been taking it for almost a week now and still cannot have a bowel movement.
We have also been encouraging her to drink water, as she is very picky with her food.
Recently, I purchased medicinal probiotics and enzyme powder for her, but there hasn't been much improvement.
I have researched some information online, and I found that some cases of constipation may be due to intestinal abnormalities, which could lead to difficulties in bowel movements.
I would like to ask if you have any recommendations.
Thank you.

Dìfāng māmā, 30~39 year old female. Ask Date: 2020/07/10

Dr. Zhang Yingwen reply Pediatrics

1.
Simple probiotics and enzyme powders do not contain dietary fiber, thus their effectiveness in aiding bowel movements is limited.
However, they can help alleviate abdominal pain caused by constipation.

2.
To ensure smooth bowel movements in children, there are three essential factors: (1) adequate intake of cellulose (dietary fiber), (2) sufficient hydration, and (3) regular toilet habits without withholding bowel movements: training for daily toilet use may not guarantee a bowel movement every day, but having a bowel movement every two days indicates that there is no constipation issue.
3.
If the above methods are attempted and constipation persists, it may indicate a neurological issue in the intestines, such as congenital megacolon.
Therefore, if these methods do not lead to smooth bowel movements, it is advisable to consult a pediatric gastroenterologist nearby.
Wishing you and your family peace and safety!

Reply Date: 2020/07/10

More Info

Severe constipation in toddlers can be a distressing issue for both the child and the parents. It is essential to understand the potential causes and explore effective solutions to alleviate this condition.
Causes of Severe Constipation in Toddlers:
1. Dietary Factors: One of the most common causes of constipation in toddlers is a diet low in fiber. Many children are picky eaters and may avoid fruits, vegetables, and whole grains, leading to hard stools. Additionally, excessive consumption of dairy products can also contribute to constipation.

2. Dehydration: Insufficient fluid intake can lead to hard stools that are difficult to pass. Toddlers often do not drink enough water, especially if they are consuming a lot of sugary drinks or milk.

3. Lack of Physical Activity: Toddlers who are less active may experience slower bowel movements. Encouraging play and physical activity can help stimulate digestion.

4. Psychological Factors: Stress or anxiety about using the toilet can lead to withholding behavior, where a child may avoid bowel movements due to fear or discomfort.

5. Medical Conditions: In some cases, underlying medical issues such as hypothyroidism, intestinal obstruction, or other gastrointestinal disorders may contribute to constipation.
Solutions for Parents:
1. Dietary Changes:
- Increase Fiber Intake: Introduce more fiber-rich foods into your child's diet. Foods such as fruits (like apples, pears, and berries), vegetables (like broccoli and carrots), and whole grains (like oatmeal and whole grain bread) can help soften stools.

- Limit Dairy: If your child consumes a lot of dairy, consider reducing it and replacing it with alternatives that are lower in lactose.

2. Hydration:
- Ensure your child drinks plenty of water throughout the day. You can also offer diluted fruit juices, which can help with hydration and provide some natural sugars that may stimulate bowel movements.

3. Encourage Physical Activity:
- Engage your child in active play. Activities like running, jumping, and playing outside can help stimulate bowel function.

4. Establish a Routine:
- Encourage your child to sit on the toilet at regular times, especially after meals. This can help establish a routine and reduce anxiety associated with bowel movements.

5. Use of Laxatives:
- If dietary changes and hydration do not help, consult your pediatrician about the use of over-the-counter laxatives or stool softeners. It is crucial to follow the doctor's guidance on the appropriate type and dosage for your child.

6. Behavioral Strategies:
- If your child is anxious about using the toilet, consider using positive reinforcement. Praise them for sitting on the toilet, even if they do not have a bowel movement. Avoid punishment or negative reactions, as this can increase anxiety.

7. Consult a Specialist:
- If your child's constipation persists despite these interventions, it may be necessary to consult a pediatric gastroenterologist. They can conduct further evaluations to rule out any underlying medical conditions.

In conclusion, addressing severe constipation in toddlers requires a multifaceted approach that includes dietary modifications, hydration, physical activity, and possibly medical intervention. It is essential to be patient and supportive, as this can be a challenging time for both the child and the parents. Regular follow-ups with your healthcare provider can help monitor your child's progress and adjust treatment as necessary.

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