What to do if a child 2-3 years old has constipation? Causes, treatment and diet

Constipation in a child is a dysfunction of the gastrointestinal tract, which is manifested by long periods without stool with or without the urge to defecate. Sometimes a sign of constipation is a subjective feeling of incomplete bowel movement.

Physiological norms of defecation in children of different ages:

• Thoracic (from 1 month to 1 year) – up to ten times a day;

• Nursery (from 1 year to 3 years) – daily;

• Preschool (from 3 to 7 years old) – from three to six times a week.

These data are conditional, in different medical sources the norms are indicated, which vary over a very wide range. However, it has certainly been proven that in a healthy child, the frequency of bowel movements correlates with the quality (digestibility) of the food consumed and the presence of coarse fiber in it – a stimulator of intestinal motility, as well as with the amount of liquid drunk per day.

constipations (constipation) at the age of 0 to 16 years have a number of features associated with physiological and psychological changes in the growing organism.

Physiological and psychological features of constipation in children

Physiological features of constipation in children

When diagnosing and treating constipation, factors are taken into account that correspond to different periods of childhood, including:

• The frequency of the stool, its nature (significantly differ at different ages);

• Availability of physical and instrumental diagnostic techniques (some research methods are ineffective or inapplicable);

• An arsenal of drugs, as well as therapeutic and surgical methods of treatment (taking into account age-related contraindications).

Psychological features of constipation in children

The problem of constipation in adults is not considered as a significant psychological inconvenience, with the exception of a forced long-term presence of a person in unusual living conditions. In childhood, the psyche is unstable, subject to the influence of adults and the team, and the regulation of bowel movement in a child is imperfect.

Constipation has a significant impact on the quality of life of children in the form of:

• Emotional lability (instability) – increased fears, timidity;

• Mental stress – imaginary or real fear of humiliation;

• Deterioration of the child’s socialization – isolation or self-isolation in the team.

There are four critical periods in terms of the possible development of constipation in children:

• Switching from breastfeeding to solid foods (ages four to six months to one year);

• Weaning from diapers, transition to defecation in a potty (age about one and a half to two years);

• Fixing the reflex of regulation of the act of defecation (age about three years);

• The period of socialization of the child (kindergarten, school, health camp).

Adults are obliged to be attentive to such a delicate problem, because the consequences of constipation in children can manifest themselves in the form of:

• Impossibility of independent (without enemas or laxatives) defecation;

• Fecal incontinence due to atony of the anal sphincters;

• Continuous discharge of liquid feces against the background of constipation – encopresis (combined damage to the anal sphincters).

Encopresis is an extreme form of the pathological consequences of constipation. It develops in about 3% of children at the age of three, more often in boys than in girls. Encopresis and other consequences of chronic constipation are potential causes of child disability.

Diagnosis of constipation in children

Normal design of feces for different periods of childhood:

• From the first day of life to six months – mushy;

• From six months to two years – mushy or semi-formed;

• From two years onwards – formed feces (type 3-4 according to the Bristol scale).

Diagnostic criteria for constipation in children:

• Decreased frequency of bowel movements;

• Difficulty defecation;

• Complaints about the feeling of incomplete emptying of the intestine;

• Increased density and lumpiness of feces.

Constipation is detected in the history of up to 50% of the examined children admitted for treatment with problems of the gastrointestinal tract (GIT). Practically always (up to 94%) children’s constipation is a consequence of functional disorders of the gastrointestinal tract. Intestinal dysrhythmias of organic origin are much less common: according to various sources, in about 6% of all examined patients admitted for inpatient treatment of gastrointestinal diseases.

Diagnosis of chronic constipation in children includes a comprehensive examination, including:

• Collection of anamnesis (usually a survey of the accompanying person describing their own subjective feelings, and not the child);

• Clinical examination (detection and / or exclusion of phenotypic signs of undifferentiated connective tissue dysplasia (NTTD) – one of the main causes of constipation in children);

• Laboratory methods (markers of intestinal microflora, reliability of immune status);

• Irrigography;

• Ultrasound of the abdominal cavity and lower gastrointestinal tract.

Irrigography is the main and most informative method for diagnosing functional constipation. This is an X-ray examination of the distal intestine filled with a contrast agent. Various variations of this technique are currently in use, including a minimally invasive combination of ultrasound and X-ray, which is suitable for safe use in children from an early age.

Causes of constipation in children

According to the duration, children’s constipation is divided into:

• Episodic (single or acute);

• Chronic (permanent with possible periods of remission).

Constipation in children are of an organic and functional nature:

• Organic constipation. Caused by structural anomalies of the intestine (Hirschsprung’s disease, Payer’s syndrome, Crohn’s disease). This group includes an extensive list of diseases of interest to a narrow group of gastroenterologists, coloproctologists and surgeons;

• Functional constipation. In childhood, functional disorders are the main cause of constipation. Almost all studies confirm the leading role of undifferentiated connective tissue dysplasia (NTTD) in the development of chronic constipation in children.

Undifferentiated connective tissue dysplasia (UCTD) is a group of interrelated syndromes that represent a connective tissue pathology. NSTD is manifested by a variety of symptoms in all organs that have such tissue.

The causes of chronic functional constipation in childhood can also be:

• Congenital or acquired anomalies of the large intestine – dolichocolon, dolichosigma and others;

• Psychosomatic factors (conscious suppression of the urge to defecate);

• Defects in the neuromuscular or endocrine regulation of the functioning of the large intestine (Hirschsprung’s disease, intestinal vegetative dystonia, hypothyroidism, hyperparathyroidism, dystrophy of the intramural ganglia due to staphylococcal infections);

• Physical inactivity (a sedentary lifestyle, prolonged bed rest for diseases);

• Food allergies (more often constipation is interspersed with diarrhea);

• Alimentary factors (violation of the diet, dry food, a small amount of food, lack of fiber, lack of fluid);

• Reflex factors (inflammatory diseases of other organs associated with the large intestine or with external and internal anal sphincters);

• Intoxication or metabolic disorders that cause damage to the sensitivity of the receptor apparatus of the intestinal walls;

• Dehydration (especially with the phenomena of acidosis, hypokalemia and hypercalcemia);

• Iatrogenic factors (dysfunctions caused by prolonged unjustified use of antibiotics and other drugs without taking into account the consequences).

In clinical practice, there is a combination of several causes that cause constipation at once. Diagnosis of constipation in children is a difficult task due to the complex mechanism of the development of the disease.

Signs of constipation in newborns

It is necessary to be prepared for problems with bowel movements (constipation) in infants in the following cases:

• Changes in the gastrointestinal tract found in a newborn during diagnostic examinations;

• Forced intake of drugs (antibiotics) by a mother who is breastfeeding;

• Transfer of a child from breastfeeding to artificial feeding;

• Sudden change from one diet to another.

About constipation in a newborn is said in the following cases:

• Lack of defecation for more than 1-2 days (it is necessary to exclude possible underfeeding of the child, as the reason for the lack of defecation, not associated with pathology of the gastrointestinal tract);

• Anxiety and crying (prolonged absence of bowel movements against the background of calm behavior is a sign of complete assimilation of breast milk or baby food);

• Frequent regurgitation (reverse expulsion of food through the mouth without tension) immediately after feeding is a likely sign of the lack of passage of feces in the intestines.

Constipation in a newborn that requires immediate medical attention is rare. Meanwhile, it is necessary to know its signs, since constipation is one of the symptoms of an “acute abdomen”.

Abdominal massage for constipation includes the following manipulations:

• Stroking clockwise;

• Bringing the legs to the stomach;

• Stroking the back in the position of the child on the stomach;

• Folding the arms on the chest.

Exercise time is individual. The regularity of massage is very important, provided there is no discontent on the part of the baby.

Constipation after feeding

The first critical period in terms of the possible development of constipation is the introduction of additional foods, or complementary foods, into the infant’s diet. Complementary foods can be started from 4 months (breastfeeding) or from 5-6 months (artificial feeding). The indicated terms are indicative and depend on the individual development of the child.

Recommendations for the prevention of constipation during the transition to complementary foods:

• As a first food, use vegetable puree (steamed from vegetables containing large amounts of fiber);

• Start complementary foods with minimal amounts of food;

• Feeding means drinking boiled water in the amount necessary for the formation of normal fecal masses;

• Do not use foods that are potentially allergic to complementary foods (allergies are one of the causes of constipation in children);

• Additional protein in the baby’s diet should be introduced very carefully to avoid constipation;

• Observe the regularity of feeding.

These recommendations are not exhaustive instructions for the prevention of constipation in infants. Be sure to get additional medical advice related to the individual characteristics of your child’s digestion.

Constipation in a 2 year old

The second critical period in terms of the possible development of constipation in a child is the refusal to use diapers and potty training. At this time, mothers first encounter psychological problems in a child. The transition to controlled defecation occurs against the background of significant physiological changes in the child’s body.

By two years:

• Dairy nutrition finally becomes secondary (the length of the intestine increases due to a change in the type of nutrition);

• Milk teeth grow (by the second year – up to 20 teeth), therefore, the child is able to grind food on his own;

• Feces takes on a form corresponding to type 3-4 on the Bristol scale (the digestion of a child approaches the physiological norms of an adult);

• There are rudiments of regulation of the act of defecation.

Recommendations for the prevention of constipation in children of two years, taking into account the peculiarities of the physiology of digestion at this age:

• During this period, there is a final change in the type of food, milk can cause indigestion;

• The length of the intestine in a child of two years exceeds its height by six times, and in an adult, the intestine is only four times longer. It means that:

  • the passage of food in the intestines of a child takes a longer time than in an adult;

  • protein and fatty foods linger in the intestines longer, and therefore they should not form the basis of the child’s diet;

  • plant foods must necessarily include plant fiber that is not digested in the intestine;

  • it is necessary to regularly give the child to drink ordinary boiled water;

  • crushed food should be gradually excluded from the composition of the main diet.

• For the first time, the child is able to chew food independently. Teach him how to chew properly.

• It is advisable to completely abandon diapers at this age.

Constipation in children 3 years

The third critical period in terms of the possible development of constipation in a child is the final formation of a defecation delay reflex and the beginning of the baby’s socialization (kindergarten). At this time, there are no significant physiological changes in digestion that potentially affect the nature of defecation. However, this period of life is characterized by the psychological and intellectual development of a person. There are no universal recommendations for the prevention of constipation at the age of three, just as there are no identical children.

Meanwhile, important preventive measures to prevent constipation in children of three years old include:

• Formation of the correct diet and diet (normal stool in a child should not be associated with phobias);

• Refusal of diapers, the use of which smooths out the child’s discomfort after defecation, therefore, inhibits the development of a reflex to regulate the act of defecation.

If, despite a healthy diet, adherence to the daily routine and a normal psychological climate in the family, the child continues to have constipation, perhaps their cause lies in medical problems. Then the only correct advice is to go to the clinic for a complete examination and to a psychologist to determine the emotional causes of the disease.

Starting from the age of three, children are diagnosed with diseases such as encopresis and fecal incontinence:

• Fecal incontinence is a consequence of the thoughtless use of diapers in children after three years. Sometimes the problem lies in other causes that only a doctor can deal with on the basis of careful research;

• Encopresis is a disease that is manifested by constant soiling of underwear and is mistaken for diarrhea. But this is always the result of constipation. In the ampoule of the rectum during instrumental examinations, fecal seals are diagnosed;

• Psychological problems are always individual, it is unreasonable to limit yourself to Internet tips on what and how to say to a three-year-old child who has difficulty with defecation.

What to do if the child has constipation?

firstwhat should be done is to learn how to correctly assess the situation. If the problem, in your opinion, threatens the life of the child, immediately contact a medical institution. On the other hand, constipation may be imaginary. Its main symptom is the absence of defecation against the background of the normal behavior of the child, without colic (abdominal pain).

In this case, attention should be paid to the following circumstances:

• Insufficient weight gain in a child – perhaps the reason for the lack of bowel movements is underfeeding, and restless behavior is associated with hunger;

• Weight gain is normal – it is possible that breastfeeding is almost completely absorbed by the child (the tummy is not enlarged, there is no pain, the baby is developing well).

Second – seek advice from a specialist who patronizes the child. An inexperienced mother cannot always independently and adequately assess the situation. A professional pediatrician will help you understand the possible causes of constipation.

The third – master the simplest therapeutic and preventive procedures (massage, enema, rectal or oral administration of laxatives that are effective for the child). Do not try to carry out manipulations according to distance instructions, ask a specialist to demonstrate their correct implementation.

Fourth – learn to identify signs of dangerous conditions that threaten the health of the child (acute abdomen syndrome, which characterizes various diseases of the gastrointestinal tract in a child, accompanied by constipation). Find out where you can get help in this situation.

Treatment of constipation in children

Treatment of constipation in a child includes several aspects:

• Symptomatic treatment. Elimination of the main symptoms of pathology with laxatives of various groups used in pediatric practice, as well as enemas and physiotherapeutic manipulations aimed at emptying the intestines;

• Etiotropic therapy. Eliminate the cause of constipation. This is the most difficult direction of treatment, it depends on many factors: the results of diagnosis, the state of the child’s body, the etiology of the disease (congenital, acquired). Based on these data, treatment tactics are chosen: therapeutic (treatment with medications and physiotherapy) or surgical (surgical elimination of defects that cause chronic or acute intestinal dysrhythmia);

• pathogenic therapy. Treatment is aimed at eliminating the pathogenetic symptoms that have developed during the course of the disease (intoxication, growth retardation, disorders of the cardiovascular system). The arsenal of medications and physiotherapeutic agents is huge, their choice is individual, and depends on the pathogenesis of the disease.

Diet for constipation in children

The appointment of diet food for children is possible from about two to three years. Until that time, just include ordinary boiled water cooled to room temperature in the diet.

When the child can take regular food, the diet will need to include dishes prepared from the following products:

• First meal. Soups on fish broth (hake, cod, saffron cod), soups on meat broth (beef, turkey), vegetable soups (zucchini, tomatoes, carrots, potatoes, beets, cabbage, pumpkin);

• The second dishes. Cabbage rolls, meatballs (limit or exclude rice), fish and meat cutlets (beef), omelettes;

• Side dishes. Buckwheat, barley and pearl barley cereals in fat-free meat broth, boiled pasta, vegetables (listed above);

• The drinks. Dried fruit compotes (dried apricots, raisins, prunes, figs), tea, vegetable and berry juices, fruit drinks;

• Desserts. Cottage cheese puddings, honey, marshmallow, marmalade;

• Bread from flour of the second grade with the addition of whole grains and bran, dietary bread.

For constipation in children, the use of the following foods should be limited: fatty meat and fish, smoked and spicy foods, raw whole milk, radishes, onions, garlic, rice, semolina, chocolate.