A synopsis of:
Evaluation and Treatment of Constipation in Children and Adolescents
SAMUEL NURKO, MD, and LORI A. ZIMMERMAN, MD, Boston Children's Hospital, Boston, Massachusetts Am Fam Physician. 2014 Jul 15;90(2):82-90.
An infant will have 3-4 stools per day for the first week of life. In infancy and and as a toddler, it will occur about twice a day, and will eventually progress to once every 1-2 days. Infants who are breastfed may not stool for several days. Parents will worry regardless.
Diagnosing constipation in a child is best done using the Rome III criteria found here. For childen younger than four years old, at least two of the following should be present; two or less bowel movements per week, history of excessive retention, history of painful or hard bowel movements, one or more episodes of incontinence per week, feces present in rectum, and history of large caliber stools. Patients above 4 year old may additionally have history of retentive posturing of excessive voluntary stool retention.
Childhood constipation is often functional, meaning that the patient will voluntarily hold in stool to avoid a painful bowel movement. Ironically, this will only cause to stool to become dryer and harder to pass. The rectum will eventually stretch out and lose the sensation of having a full vault, will will perpetuate incontinence. The full pathophysiology of fecal incontinence is poorly understood. It is common for patients who are constipated to have fluid leak from the anus, often being mistaken for diarrhea. Organic causes include hirschsprung disease, CF, anorectal malformation, and spinal cord abnormality.
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