Constipation in children

Constipation in children is characterized by

•  infrequent bowel movements, 
• hard stools, and 
• often painful defecation,
• usually occurring less than 3 times per week. .

Constipation in children symptoms include 

• Fewer than 3 bowel movements per week 
• Large, hard stools
• "Rabbit dropping" stool appearance 
• Straining during bowel movements 
• Abdominal pain or discomfort 
• Overflow soiling (accidental stool leakage due to retained stool) 
• Loss of appetite 
• Difficulty with toilet training 

• Dietary factors: Low fiber intake, inadequate fluid intake 
• Toilet training issues: Holding onto stool due to fear of pain 
• Psychological factors: Stress, anxiety 
• Medical conditions: Hypothyroidism, certain medications 
• Changes in routine: Travel, illness 

• Medical history and physical examination
   
• Stool consistency assessment
   
• Dietary review
   

Lifestyle modifications:

• Increase fiber intake through fruits, vegetables, and whole grains 
• Adequate fluid intake
• Regular toilet habits 
• Positive reinforcement during toilet training
   

Pharmacological interventions:

• Osmitoic laxatives 
• Stimulant laxatives 
• suppositores / enemas 
• Fibre
   

National institute of clinical excellence guidelines for Investigations for constipation in children 

If intractable idiopathic constipation child may require investigations including 

• Radiological ( X ray / scans / gut transit studies ) 
• Blood investigation ( Coeliac disease , thyroid function ) 
• Other investigations depending on child's clinical signs and symptoms