Lisa Grentz, MS, RDN, CD/LDN, FAND
Kristin Furfari, MD
There is nothing that stops eating in its tracks faster than constipation. Constipation affects about 30% of all children and accounts for approximately 5% of all visits to pediatricians. Still, constipation is common in people of all ages, which means that you and your child are not alone in dealing with this!
Constipation is clinically defined as fewer than three bowel movements per week with symptoms that include dry or hard stool and/or stool that is difficult or painful to pass. Fecal incontinence (the inability to control bowel movements, which can result in involuntary stooling) in toilet-trained children can also be an indication of constipation. So, if your child is struggling to have consistent bowel movements, demonstrates symptoms of constipation, or if you notice blood in their stool – it’s important to talk with your healthcare provider.
There are many factors that can contribute to the development of constipation. Health conditions, such as neurological, endocrine, or digestive disorders; lifestyle factors like consuming a diet high in processed food, inadequate hydration, and lack of physical activity; certain medication with constipation as a side effect; low muscle tone; and even familial predisposition are just some factors. Diet modifications such as eating a fiber-rich, well-balanced diet, increasing fluid intake, and regular movement/exercise can be helpful, but sometimes are not sufficient to manage constipation alone, in which case, medical intervention may be
warranted. In that case, the goal of medical therapy is to help ensure that your child can pass at least one soft stool per day. There are many different pharmacologic treatments for constipation, and they can be broadly lumped into categories known as “pushers” and “squishers.”
Pushers are products that stimulate motility to help stool pass through the large intestine. Bisacodyl and sennosides (both stimulant laxatives) are examples of pushers. Squishers, by comparison, are products that are designed to soften stool to make it easier to pass. Examples of squishers include polyethylene glycol, magnesium citrate, magnesium hydroxide, lactulose, and docusate sodium. Realistically, constipation may be alleviated with the use of a squisher product or a pusher product, but sometimes, both types of products need to be used on combination for best results. In children, medical treatment also involves behavioral modifications to address any behavioral contributors such as stool withholding. As always, parents should always consult with their child’s physician before considering what modifications to encourage, and before starting any medical treatment for constipation.