Constipation is common in childhood, especially in primary and secondary school children. It is one of the typical gastrointestinal problems children experience. The incidence of constipation is increasing, due mainly to diet and lifestyle factors, and is set to become a major public health issue that parents and physicians face.

It is a problem that must be addressed without delay. Parents should approach childhood constipation in an active manner in order to determine its causes and start appropriate treatment as soon as possible. After it is determined whether constipation is functional or organic, the physician will prescribe the appropriate treatment.

The first step in treating functional constipation is adopting lifestyle and diet changes. The diet should be varied and we should avoid combining foods that can cause hard stools, such as rice, bananas, snacks, dry foods, and carrots. Consuming too much dairy products may also lead to constipation. We should reduce our milk intake to half a litre a day or less. Drinking enough fluids and staying physically active is essential. While a lack of physical activity is not an issue in pre-school children, it becomes a problem in children of school age and teenagers who are increasingly sedentary.

Inadequate fibre intake is another well-known risk factor for constipation. Consuming enough fibre is an essential part of a healthy diet.  Although an adequate fibre intake can reduce the chances of constipation, an additional increase has no therapeutic value. Above all, the fibre intake should be adjusted to the child’s needs. Some experts suggest that a child’s age plus five equals the required daily intake of fibre in grams. Generally accepted guidelines on daily fibre intake are 19 g for ages 1 to 3, 25 g for ages 4 to 8, and 25 to 30 g for older children. Ideally, this would include both soluble and insoluble fibre. Soluble fibre, such as pectin in apples, is found mainly in fruit and vegetables, and is soluble in water. Insoluble fibre, such as cellulose and lignin, is found in wheat and legumes. Insoluble fibre passes more or less intact though the digestive tract and absorbs large amounts of water which boosts bowel movements.

When increasing the intake of dietary fibre, be sure it is done gradually. A rapid increase can lead to a temporary worsening of symptoms and bloating, and thus seem to have no therapeutic value. You should add fruit, vegetables, wholegrain cereals, and legumes to the diet slowly.

Treating childhood constipation with medications commonly involves osmotic laxatives. Parents need not be worried about any negative effects since osmotic laxatives are not absorbed by the body. Osmotic laxatives work by drawing water into the large intestine, which increases the stool volume by three to five times and triggers peristalsis, or bowel movement. Since osmotic laxatives soften the stool, high doses can lead to loose stool or diarrhea, which is the only side effect of note. In this case, dosage should be adjusted to prevent recurrent diarrhea and stop the loss of fluids and electrolytes.

In most cases, constipation can be eliminated by diet and lifestyle changes alone. On the other hand, osmotic laxatives have a very good therapeutic effect. It is important to identify the problem and treat it without delay in an active and holistic manner in order to break the vicious circle of constipation.