Constipation in Children (ท้องผูกในเด็ก)

Child health and constipation awareness

Constipation is a common condition in children, and the problem is becoming increasingly prevalent. The definition of constipation may differ between the perspectives of caregivers and physicians.

Defining Constipation in Children

Constipation in children is defined as having bowel movements less than or equal to 2 times per week. It involves hard stools accompanied by pain, straining, or even blood. This diagnosis can apply even if the child passes stool every day or several times a day, as long as the consistency is hard and painful.

However, for infants aged 1–2 months who are exclusively breastfed, it is normal for them to stool several times a day or once every few days. As long as the baby is healthy, feeding well, and gaining weight normally, they may go 5–10 days without a bowel movement without it being considered a medical issue.

Diagnosis in newborns does not rely on frequency alone; it requires a detailed history and a physical examination by a doctor.

Causes of Constipation

Chronic constipation is usually caused by multiple factors that vary by age. It can stem from intestinal abnormalities, psychological factors, improper toilet training, or underlying medical conditions.

Infants/Toddlers: Doctors must first rule out specific diseases or conditions like Cow's Milk Protein Allergy.
Older Children: Most cases are Functional Constipation, often caused by withholding behavior.

The Vicious Cycle of Withholding: Children often hold their stool because they fear pain from a previous hard stool, or they are too busy playing or uncomfortable using school toilets. As stool sits in the colon, it becomes larger and harder. This decreases the sensitivity of the rectal wall to the urge to go. Eventually, when they do try to pass it, it causes pain or small tears (anal fissures), leading to more fear and more withholding.

Bristol Stool Chart for children Graphic showing different types of stool consistency.

Treatment

Treating chronic constipation requires parents to first accept that the condition exists and understand its nature. Success relies on cooperation between parents, teachers, and doctors, focusing on:

Diet: Encouraging high-fiber foods and ensuring adequate water intake.
Toilet Training: Establishing a regular, stress-free routine for bathroom time.
Medication: Using appropriate stool softeners as prescribed by a pediatrician.

A Warning for Caregivers: Avoid the frequent use of suppositories or glycerin sticks without medical advice. Children can become "trained" to only go when stimulated, or they may develop a phobia of rectal insertion, which leads back to withholding behavior.

The treatment for chronic constipation can take 2–3 months, or in some cases, over a year. Your pediatrician will guide you on the best stimulation methods and select the most appropriate medications.