One of the most frequent reasons parents seek emergency medical attention for a child is severe abdominal pain and vomiting. As a pediatrician, I usually interact with these families after an exhausting work-up, including imaging, blood work, and often a surgery consult, has already been done. Fortunately, for many children, the cause of their abdominal pain is not appendicitis, gallbladder issues, or pancreatitis but rather simple constipation.
Constipation usually presents as infrequent or painful bowel movements and is a common American problem. The prevalence of constipation in the US is estimated between 12% and 19%. In children, constipation can sometimes present with small diarrheal stools or stool incontinence when the hard poop dilates the colon to allow looser stool to pass through. Overall, the reported rate of constipation in children ranges from between 1% to 30%. Whatever the actual rates are, constipation is the principal complaint in 3-5% of all visits to pediatric outpatient clinics and as many as 35% of all visits to pediatric gastroenterologists.
So what causes constipation? In a few cases, constipation is due to a genetic abnormality. Hirschsprung disease, for example, is a cause of constipation from abnormal nerve growth in the colon. Cystic fibrosis, celiac disease, and other disorders can sometimes present with constipation. For the most part, constipation is the result of a low fiber diet, lack of exercise, and lack of adequate water intake. Children four years and under are prone to constipation in conjunction with potty training. A combination of factors increases their risk; they include: it not being convenient to stop play, they don’t like sitting on a potty, or they won’t poop at preschool. Be sure to teach your children that it is important to go to the bathroom when they feel the need.
Treating constipation in your child requires an approach that takes into account both age and lifestyle choices. It is important that your child be examined by a health care provider to make sure there is no underlying cause for the constipation. For those children with constipation from stool refusal (usually children being potty trained or just starting preschool), a high fiber diet in conjunction with scheduled “potty times” can be very beneficial. Occasionally a mild laxative such as MiraLax is prescribed to help break up hard stool.
Fiber is very important in the treatment of constipation. How do you add more fiber into your child’s diet? Many parents often think that increasing fruit and vegetable intake will provide enough fiber in their child’s diet. It is important to eat fruits and vegetables for many other reasons. It is also important to avoid processed foods and focus on consuming whole grains. However, legumes (beans, peas, and lentils) are actually the best source of fiber. One cup of lentils, for example, has 15.6 grams of fiber (40% of daily goal of 40 grams of fiber!) compared to 1.9 grams in a slice of whole wheat bread and 4 grams in an apple. I encourage my patients with constipation to incorporate beans into their daily diet.
Beans are inexpensive, easy to prepare and can be used in a wide variety of recipes. I usually soak 1 cup of dry beans in 4 cups of water overnight (soaking helps prevent the gas traditionally associated with bean intake!). The next morning, I drain the water off and then cover with about 1 inch of fresh water and simmer until softened (usually about 1 hour). Don’t add seasoning until the very end because adding salt too soon will prevent beans from cooking. Beans can be eaten plain, with rice or pasta, added to salads, thrown into waffle batter (my kids LOVE bean waffles), used as sandwich spread, thrown into soups, or used as taco filling, etc. You imagination is the limit with bean recipes! I even know someone who used beans to make a pretty delicious pecan pie!
Other easy things to help with constipation include exercise and drinking water. Walking is especially beneficial for getting the muscles around the intestines to massage food through. The body reabsorbs water in the colon. If you are dehydrated, more water will be soaked up from the poop in the colon—making the stool hard. Be sure to drink at least 6 – 8 glasses of water each day. Drinking sweetened beverages or 100% fruit juice is not a substitute for water: the added calories outweigh any potential hydration benefit.
Constipation is a painful, chronic problem for many children and adults. Thankfully, with a few simple lifestyle interventions can help you and your child avoid the pain that comes from not pooping.
To learn about diarrhea, another common childhood problem, continue to our next article: The Scoop on Poop Part 2. Higgins, Peter D R, and John F Johanson. “Epidemiology of Constipation in North America: A Systematic Review.” The American Journal of Gastroenterology 99, no. 4 (April 2004): 750–759.  “Pediatric Constipation,” February 11, 2013. http://emedicine.medscape.com/article/928185-overview.