Constipation in children

My child has constipation…what now?

In this leaflet we give you an introduction to children’s constipation, its causes, treatment and guidance for a healthy bowel.

What is constipation?

The bowel works by turning the the food we eat into a liquid. This travels to the small bowel where nutrients are absorbed into the body. The liquid then travels to the large bowel where the excess water is absorbed, leaving the poo. Poo then moves along to the rectum which stretches to tell the brain ‘I need a poo!’

Constipation happens when there is a problem with this process and a child has a hard and painful poo or has less than three poos a week. If left untreated, constipation can cause ‘impaction’ where the rectum is blocked with hard poo. Often the only waste that can come out is watery poo, which can’t be controlled. This is called soiling. When there is a build-up of hard poo this is called impaction.

Constipation’s cause is mostly unknown but with the right medicine for the right length of time your child will usually get better.

Treatment of constipation

The right medication tailored specifically for your child will be prescribed by your doctor or paediatrician. These include Movicol / Laxido Paediatric which is a ‘poo softener’. Other ones you may be prescribed are Senna, or Sodium Picosulphate. These stimulate the large bowel to push poo into the rectum.

The aim of treatment is to ensure your child can empty their bowel of any build up and return to passing a ‘normal’ poo without any soiling. If there is impaction, your child’s medication will build up to a high daily dose until the bowel empties fully. You’ll know this has happened when they start to pass large amounts of loose stool or liquid poo that is different to the small amounts of loose poo that is passed with impaction. This high dosage will be continued for two days then reduced as advised until your child poo is sausage-shaped, soft and smooth, or made up of soft blobs.

The table below shows how dis-impaction can usually be achieved for children of different ages. Your nurse or doctor might use the chart below to show you how much to give to your child.

Treatment schedule

A typical dosage for children, dependant on age is:

Movicol / Laxido Paediatric plain sachet sheet available here (614kB pdf)

Your child’s long term medication

Once your child is no longer impacted, they can then be treated more effectively. It is also less likely to be uncomfortable. Your nurse or doctor will tell you what they think are the best treatments for your child and they might give you a ‘dose range’. They will give you advice about how to decide how much to give from one day to another within this dose range.

Other treatments of constipation

In some circumstances, your child may have to have other treatments. Suppositories are medicines that are given to the child by inserting them directly into their bottom. These are usually given when oral medicine is not working and when the build-up of poo is close to the bottom.

It’s really important to make sure that your child isn’t impacted when they start this treatment so that it works properly. It’s also a good idea to make sure an expert, often a nurse, shows you how to give the suppositories so it doesn’t upset your child.

An Enema could also be used to empty the bowel out and again this will be discussed with your child to ensure they are happy with this. Removing the poo in an operating theatre is sometimes needed and is done under general anaesthetic, but this will be discussed with you and your child.

Withdrawing treatment when poo is ‘normal’

The withdrawal of medicine is done slowly, sometimes over many months or years, even when a ‘normal’ daily poo is happening. Sometimes, constipation can cause the bowel to be stretched and this will need time to slowly become the right shape and size to avoid future problems.

Often, constipation can happen again, for unknown reasons. If this happens, contact your GP or paediatric clinician for advice and treatment.

Keeping your child’s bowel healthy

To keep your child’s poo soft and easy to pass their diet must be rich in fluids and fibre. Try and aim for 6-8 glasses of non-fizzy liquids and food with a high water content including soups, custards, etc. Food to keep the bowel healthy are high in fibre and include wholegrain cereals, wholegrain pasta and rice, wholemeal bread, fruits, vegetables, beans, pulses and lentils.

Further Information

Please raise any questions with your nurse or clinician. The following links may also be helpful:

https://www.eric.org.uk/how-to-treat-constipation

https://www.eric.org.uk/how-to-treat-constipation

https://www.eric.org.uk/how-to-prevent-constipation-in-children