Does your child suffer from constipation?

Nothing brings out a bigger burst of giggles from kids than the word “poo,” but in Jack Hourigan’s Toronto household, it’s no laughing matter. Hourigan’s four-year-old daughter, Tess, suffers from constipation, a condition that affects up to 30 percent of young children, according to Toronto paediatrician Daniel Flanders.

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Constipation is a delay or difficulty in having a bowel movement that causes discomfort. Tess’s constipation leaves her feeling uncomfortable for days at a time and can give way to intense pain. “She lays across my legs as I rub her tummy and push her knees up and down toward her belly,” says Hourigan. “She gets so fearful of the pain she tenses up and makes it worse. There have been times when she gets stuck mid-poop and she screams for me to get it out.”

How do kids become constipated? Sometimes it’s from persistently holding in their bowel movements over a long period of time, resulting in stools accumulating and causing the rectum to stretch, making it less effective as a pump, says Flanders. Inactivity can also play a role. The other culprit? Not getting enough fibre and liquids, which work together to keep stools soft and easy to pass. Flanders recommends children stay well hydrated and consume enough fibre every day: 20 grams for toddlers; 25 grams for four- to eight-year-olds; and 30 grams for nine- to 13-year-olds. Great sources of fibre are fruit, vegetables, legumes and whole grains. You can also sneak high-fibre cereals into pancakes, or muffin and cookie recipes. For kids who can’t or won’t consume enough fibre, supplement products may be used to treat or prevent constipation.

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Be careful about focusing on frequency as an indicator of constipation; healthy patterns can vary. “I know kids who have bowel movements every 10 days and they’re not the least bit constipated, and I have many patients who have bowel movements multiple times per day and they have severe constipation,” says Flanders. “If a child goes two weeks without a bowel movement, I would begin to wonder if constipation is a problem, but I wouldn’t use that alone to make a diagnosis.” The more important symptoms are abdominal pain, cramps, a loss of appetite and large, hard, dry, sometimes bloody stools that are difficult and painful to pass, he says. Contact your paediatrician if you notice these signs.

While fibre, in combination with adequate hydration and regular physical activity, is typically enough to keep most children’s bowels healthy, in cases of severe constipation, laxatives may be used, although always with the direction of a physician.

A version of this article appeared in the March 2014 issue with the headline “Constipation,” p. 20.