Constipation is a common problem parents and doctors encounter with children. The child is constipated if his or her bowel movements are irregular, hard to pass and occasionally painful, and if this condition persists longer than two weeks. According to the European and American Societies for Paediatric Gastroenterology, constipation is a delay or difficulty in the defecation persisting for two weeks or more. Delaying treatment leads to considerable difficulties in eliminating the problem.

According to some estimates, 4 to 36% of children worldwide suffer from constipation. Children aged two to four are most likely to experience constipation, although it is no less common among primary and secondary school children.

A normal frequency of bowel movements depends on the child’s age. For ages two to four, bowel movements average once or twice per day, whereas after age four the average is once per day – although every other day is normal as well.

As with adults, childhood constipation can have a number of causes that are either functional or organic. Organic constipation is caused by specific disorders or medical conditions. Functional constipation, on the other hand, is a disorder characterised by hard or lumpy stool, straining and feeling of incomplete bowel emptying, and fewer bowel movements in the absence of obvious organic or structural conditions.

Common causes of functional constipation are:

  • poor diet (excessive consumption of fast food, an unvaried diet, and inadequate fibre intake);
  • excessive consumption of milk;
  • changes in habits;
  • picky eating;
  • difficulties in potty training (pressure from family and peers);
  • psychological stress;
  • aversion to the toilet (common among pre-school and school age children due to over-stimulation or painful bowel movements);
  • inactive lifestyle;
  • inadequate water intake;
  • painful bowel movements.

Organic causes of constipation include specific conditions such as hypothyroidism, cystic fibrosis, coeliac disease, and several other disorders. It can also be caused by an allergy to cow’s milk, or taking medications such as antidepressants, antacids with calcium or aluminium, and more.

Lastly, constipation can also be caused by genetic factors. Research shows that in 30–50% of cases one member of the family suffers from constipation.

Although functional constipation is common among children, parents should pay attention to warning signs, such as blood in the stool, swollen belly, inadequate weight gain, vomiting, and fever. If these symptoms are present, it is imperative to seek medical attention to determine whether constipation is functional or organic, and to start appropriate treatment as soon as possible.

When it lasts for a longer period of time, functional constipation can escalate to chronic constipation which is even more difficult to eliminate. Constipation often will not go away on its own; therefore it needs to be actively addressed.