Pediatric constipation often develops when children "hold back" from going to the bathroom to avoid painful or unpleasant defecation.¹ Such functional constipation, that is, constipation without objective evidence of a pathological condition, typically occurs in response to events like¹:

• Toilet training
• Changes in routine or diet
• Unavailability of toilets
• Being too "busy"

Bowel movements become painful when children avoid going to the bathroom because stool remains in the colon and can get larger, firmer and more difficult to pass. Constipation can eventually result in fecal impaction, as evidenced by a hard mass in the lower abdomen and dilated rectum filled with a large amount of stool.

The following proactive treatment measures are recommended by NASPGHAN for pediatric constipation¹:

Dietary intervention—particularly, increase intake of fluids and absorbable and nonabsorbable carbohydrates as a method to soften stools. A balanced diet should include whole grains, fruits and vegetables.

• Behavioral modification and regular toilet habits, especially unhurried time on the toilet after meals.
• Stool frequency diaries to be kept by children and their caregivers, which can be combined with a reward system (e.g. a child's calendar with stickers to record each stool that is passed in the toilet).

According to the Constipation Guideline Committee, children who receive medication achieve remission of constipation significantly sooner then children who do not.¹ The use of laxatives is viewed as the most advantageous for children until maintenance of regular toilet habits.

REFERENCES
1. North American Society of Pediatric Gastroenterology, Hepatology and Nutrition. Clinical Practice Guideline: Evaluation and treatment of constipation in infants and children. J Ped Gastroent Nutr. 2006; #43(3):e1-e13; 405-407.

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