Remedies for Constipation in Children

Constipation in children is an all-too-common ailment, accounting for nearly five percent of all pediatric visits each year and one out of every four pediatric gastroenterology visits. More than 90 percent of constipated children have “functional” constipation, meaning constipation without any underlying disease.

Although symptoms may vary for each patient, common signs to look for include:

  • Infrequent bowel movements (less than three per week)
  • Stool leakage
  • Withholding behavior
  • Difficult, painful or hard bowel movements
  • Abdominal pain
  • Urine accidents
  • Blood-coated stools

The most common cause of constipation in  children is withholding due to past experience with painful passage of stools, says Dr. Ashish Chogle, pediatric gastroenterologist at CHOC. Other leading factors relate to water and food intake.

constipation in children
Dr. Ashish Chogle, pediatric gastroenterologist at CHOC

Stool leakages in the underwear are often encountered in children with long standing constipation. Most children will not feel the stools passing accidently, as feeling in the rectum decreases as a result of the stretching that takes place from being constipated for a long time.

There are several things parents can try at home to alleviate the problem of constipation, he says. First, if your child is not usually a keen water drinker, increase their water intake to normal levels. CHOC recommends one full eight ounce glass of fluids per year in age every day. Increasing their fiber intake can also help relieve mild cases of constipation in children. Good sources of fiber include whole grains, whole wheat items, beans, green leafy vegetables and fruit. The minimum amount of fiber for children is equal to your child’s age plus five grams. For example, a child who is 5 years old should eat 10 grams of fiber each day (5 years + 5 = 10 grams). If the child isn’t better after trying these methods at home, consult your pediatrician. Your pediatrician may recommend a treatment plan or refer you to a pediatric gastroenterologist.

Treatment plans may include a stool softener regimen such as laxative therapy, or lifestyle changes, depending on the severity and underlying causes of the constipation. If your child has significant stool back up in the colon, the doctor might recommend a bowel clean out with Miralax.

Parents may worry that their child will become dependent on a stool softener if given for an extended duration, and thus may stop the laxatives sooner than advised by their physician.

“By stopping a laxative therapy plan too soon, the child can bounce back to being constipated,” says Dr. Chogle. “The treatment needs to last long enough that the colon fully recovers from the stretching that has occurred due to constipation. Parents don’t need to worry about their children becoming dependent, as long as they follow their physician’s treatment plan and have an understanding that it can take months for the colon to recover and function properly.”

The length of the regimen will vary depending how long the child has been constipated. There are some patients with an inherently slow colon (those with slow transit constipation). These patients will likely require laxatives long term, says Dr. Chogle.

Older children or teens with chronic constipation issues may actually be suffering from pelvic floor dysfunction, especially if they spend a long time straining on the toilet or pass only small amounts of stools each time. This could be due to an incoordination in pelvic floor muscles, also known as anal dyssynergia. Muscles tighten instead of opening up while attempting to pass a bowel movement- similar to trying to squeeze out toothpaste from a tube with the cap half open. Your child’s doctor may order a test called an anorectal manometry to determine anal pressures and pelvic floor coordination if they do not respond to other treatment options. Physical therapy, specifically anal biofeedback therapy, may be recommended for some patients.

Learn more about constipation from the gastroenterology experts at CHOC.

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    U.S. News Names CHOC One of the Nation’s Best Children’s Hospitals

    From treating the most complicated cases of epilepsy and repairing complex urological conditions, to curing cancer and saving premature lives, CHOC Children’s physicians and staff are committed to delivering the highest levels of safe, quality care. That commitment has earned CHOC its most recent accolade:  inclusion on the coveted U.S. News & World Report’s Best Children’s Hospitals rankings.   CHOC ranked in eight specialties: cancer, neonatology, neurology/neurosurgery, pulmonology, orthopedics, gastroenterology and GI surgery, diabetes and endocrinology, and urology, which earned a “top 25” spot.

    U.S. news

    According to U.S. News, the Best Children’s Hospitals rankings are intended to help parents determine where to get the best medical care for their children. The rankings highlight the top 50 U.S. pediatric facilities in 10 specialties, from cancer to urology. Of the 183 participating medical centers, only 78 hospitals ranked in at least one specialty. For its list, U.S. News relies on extensive clinical and operational data, including survival rates, clinic and procedure volume, infection control measures and outcomes, which can be viewed at http://health.usnews.com/best-hospitals/pediatric-rankings. An annual survey of pediatric specialists accounts for 15 percent of participants’ final scores.

    “The Best Children’s Hospitals highlight the pediatric centers that offer exceptional care for the kids who need the most help,” says U.S. News Health Rankings Editor Avery Comarow. “Day in and day out, they offer state-of-the-art medical care.”

    Dr. James Cappon, chief quality and patient safety officer at CHOC, points to the survey as an invaluable tool for him and his colleagues to evaluate programs and services, determining best practices, and making plans for the immediate and long-term future.

    “CHOC is certainly honored to be recognized once again by U.S. News. But our dedication to serving the best interests of the children and families in our community is what truly drives us to pursue excellence in everything we do. Our scores, especially in the areas of patient-and-family-centered care, commitment to best practices, infection prevention, breadth and scope of specialists and services, and health information technology, for example, reflect our culture of providing the very best care to our patients,” explains Dr. Cappon. To hear more about CHOC’s commitment to patient safety and quality care—and what parents need to know— listen to this podcast.

    CHOC’s culture of excellence has it earned it numerous accolades, including being named, multiple times, a Leapfrog Top Hospital. Additional recent honors include the gold-level CAPE Award from the California Council of Excellence; Magnet designation for nursing; gold-level Beacon Award for Excellence, a distinction earned twice by CHOC’s pediatric intensive care unit team; “Most Wired Hospital”; and The Advisory Board Company’s 2016 Workplace Transformation Award and Workplace of the Year Award. Inspiring the best in her team, CHOC’s President and CEO Kimberly Chavalas Cripe was recently named a winner of the EY Entrepreneur of the Year Award in the “Community Contributions” category.

    In the News: CHOC’s Feeding Program

    Dr. Mitchell Katz, a CHOC pediatric gastroenterologist, recently appeared on the radio program “Good Food” on KCRW to offer insight into the challenges parents face when their child can’t or won’t eat.

    Dr. Katz is the director of CHOC’s Multidisciplinary Feeding Program and pediatric GI lab services.

    CHOC’s multidisciplinary feeding program is one of only a handful of specialty feeding programs in the United States to offer comprehensive outpatient consultation and inpatient programs.

    Children under evaluation and treatment for feeding disorders at CHOC have typically failed outpatient feeding therapy and have either a feeding tube or at risk for a feeding tube. Patients  can have a range of medical problems, or difficult behaviors that make meal times a struggle. The program receives referrals from throughout the country.

    Listen to Dr. Katz’s insight below:

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    Gastroesophageal Reflux Disease and Treatment Options

    Gastroesophageal reflux (GER) occurs when a small amount of acidic stomach fluid or food in the stomach goes back up into the esophagus (swallowing tube). This is a normal process with symptoms including regurgitation or pain that can be experienced several times a day, especially after eating, and usually lasting less than three minutes. Some individuals with GER will have no symptoms. GER occurs in more than two-thirds of healthy infants, and half of these infants experience regurgitation or “spitting up” that spontaneously resolves without medication by approximately 1 year of age. A pediatrician or gastroenterologist should evaluate children whose symptoms worsen or do not resolve by the time they are 12-18 months of age.

    When to see a doctor
    When the reflux causes intolerable discomfort or complications, patients should be evaluated by a doctor for gastroesophageal reflux disease (GERD). GERD in infants is treated with a lifestyle modification approach. Children and adolescents can also be treated with medicine. In rare cases, surgery may be needed.

    Lifestyle modifications
    If you think your child may have GER or GERD, discuss it with your pediatrician. He or she may recommend lifestyle modifications:

    • For infants
      • Change in milk formulation
      • Hold your infant in an upright position after feedings
      • Avoid placing your infant in a car seat after a meal
    • For children and adolescents
      • Avoid large meals
      • Do not lie down immediately after eating
      • If obese or overweight, lose weight
      • Avoid foods and drinks that can cause acid reflux, such as garlic, peppermint, caffeine, tomatoes, chocolate, citrus fruits, alcohol and spicy foods

    Doctors may prescribe medications that lower the amount of acid in the stomach to alleviate symptoms of GERD:

    • Tums (calcium carbonate)
    • Milk of Magnesia (magnesium hydroxide)
    • Pepcid (famotidine)
    • Zantac (ranitidine)
    • Prilosec (omeprazole)
    • Prevacid (lansoprazole)
    • Nexium (esomeprazole)
    • Aciphex (raberprazole)

    Remember to always consult your child’s pediatrician, gastroenterologist or pharmacist before starting any medication.

    Warning signs or symptoms that immediately require further medical evaluation:

    • Weight loss
    • Seizure
    • Abdominal distention
    • Green or red vomit
    • Persistent forceful vomit

    It can be helpful to keep a diary of GERD symptoms. Record your child’s symptoms and bring the diary to doctors’ appointments. This information can help the doctor determine what is causing GERD symptoms and provide better care for your child.

    A Palatable Solution For Feeding Disorders

    If every meal with your child is a struggle, leaving you concerned that the problem could be more than a dislike for vegetables, it’s time to find out why. CHOC is nationally recognized for evaluating and treating young children with serious feeding problems, including those who have previously failed outpatient feeding therapy.

    Learning how to eat and enjoy food is as much a developmental skill for your child as walking. If that process is interrupted by prematurity or a serious illness, an infant may miss the important first steps.

    As medicine advances, more infants and young children are going home dependent on feeding tubes. new20150204_choc_00559Yet the transition to eating food by mouth is a complex learning process that involves far more than a spoon. It may also be complicated by such underlying medical conditions as acid reflux, food allergies or gastritis.

    The Multidisciplinary Feeding Program at CHOC  — the only one of its kind on the West Coast — offers a positive, holistic approach to feeding disorders. The program, which receives referrals from throughout the country, has grown and recently moved its treatment space to the third floor of the CHOC North Tower. The expanded space includes two feeding therapy treatment rooms, plus a central area equipped with state-of-the-art audio visual equipment, where families and staff may remotely watch therapy sessions in real time. The system also includes an audio feed, allowing therapists to provide advice and coaching when parents are alone in the room with their child.

    In June 2015, a third team of physicians, nurses, nurse practitioners, occupational therapists, speech pathologists, social workers, developmental psychologists and dietitians will be added.

    CHOC team members have presented at regional and national professional conferences, and have begun publishing their results in peer-reviewed journals.

    “We only provide positive reinforcement,” said CHOC pediatric gastroenterologist Dr. Mitchell Katz, who directs the program. “First, we work on resolving the medical part of the puzzle, and then we focus on the behavioral aspects and work through the child’s fear and anxiety.”

    In addition to outpatient services, a 19-day inpatient program is available for children with the most severe feeding disorders. A parent is admitted, too, and receives parenting and behavioral skills designed to improve the quality of life for the entire family.

    “Children do not automatically grow out of severe feeding disorders,” Dr. Katz said. “But with direction and guidance, they can get better.”

    For more information or to schedule an evaluation, please email feedingprogram@choc.org or call (714) 509-4884.

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