Diarrhea/Constipation

Children experience diarrhea and constipation, or gastroenteritis, the same way, if not more intensely, than adults. In children constipation is infrequent bowel movements or hard and dry stools. Diarrhea is loose, watery stools which occur more frequently than usual. Medically, constipation is defined as less than three bowel movements a week, and diarrhea is more than 200 grams of lost a day in bowel movements. Acute diarrhea is described by a few days and chronic diarrhea persists at least three weeks. Moreover, symptoms of constipation in children are:

  • Bowel movements less than three times a week
  • Hard, dry, difficult to pass bowel movements
  • Pain with bowel movement
  • Pain in the abdomen
  • Nausea
  • Trace amounts of liquid or clay-like stool within child’s undergarments
    • Can be a sign for backed up stool in the rectum
  • Blood on hard stool.

These children affected by constipation may avoid using the toilet or defecating. Some children may have spontaneous defecation at inappropriate times or an inability to control their bowel movements. Parents should seek medical attention when the child experiences:

  • Fever
  • Vomiting
  • Blood in stool
  • Abdominal swelling
  • Weight loss
  • Bloating
  • Painful tears around the anus – anal fissures
  • Intestinal protrusion out of the anus – rectal prolapse.

Diarrhea is commonly caused by:

  • Acutely
    • Usage of antacids with magnesium (side effect is diarrhea)
    • Antibiotic-associated diarrhea (clindamycin)
    • Medication for blood pressure
    • Clostridium difficile
    • Campylobacter jejuni
    • Cancer medications
    • Clostridium perfringes
    • Cryptosporidium – especially children with HIV/AIDS
    • CMV infection
    • coli
    • Entamoeba histolytica (lung abscess)
    • Food allergies – wheat is very common
    • Food poisoning – bad food or food not cooked properly
    • Intolerance of fructose or galactose or lactose
    • Giardiasis
    • Norovirus
    • Rotavirus
    • Salmonella
    • Shigella
    • Staphylococcus infections – aureus from old potato salad
    • Post stomach surgery
    • Traveler’s diarrhea – coli, ETEC
  • Chronic diarrheal causes:
    • Medication for BP
    • Caffeine (should be avoided in children)
    • Medication for cancer
    • Celiac disease – wheat allergies/intolerance
    • Cholecystectomy – removal of a gallbladder
    • Colon cancer – uncommon in children, but must be ruled out
    • Crohn’s disease – more common in later teens and early adulthood
    • Bariatric surgery – possibly for obese children
    • Hepatitis A, B or C
    • Hyperthyroidism – high metabolic rate
    • Irritable bowel syndrome – alternating constipation and diarrhea
    • Ischemic colitis
    • Pancreatic insufficiency – may be due to cystic fibrosis
    • Ulcerative colitis – a form of IBD
    • Whipple’s disease – after infection with Tropheryma whippelii.

For many causes of diarrhea in children, self-resolution is preferred versus medication. Nonetheless, there are some diseases which need intervention and those who reside in Denver should visit the Denver Holistic Center for more information.

On the other hand, common causes of constipation are:

  • Child may be withholding defecation
  • Children who rebel from potty training
  • Change in diet
  • Routine that is altered
  • Medications
    • Antidepressants
    • Drugs blocking the parasympathetic system and stimulating the sympathetic system
  • Allergy to cow’s milk
  • A family history
  • Medical conditions
    • Anatomic malformation
    • Metabolic disorder
    • Digestive problem.

Parents and guardians should be made aware of some risk factors that can lead to constipation. These include:

  • Children who are sedentary
  • Low fiber diet
  • Low fluid intake
  • Side effects of medications
  • Any medical conditions pertaining to the anus or rectum
  • Family history.

Constipation should be treated earliest as possible because complications include painful breaks in the skin, withholding stools and encopresis (inappropriate bowel movements). Treatments vary depending on the underlying cause of a child’s constipation. When a physician sees a child for a differential diagnosis, a full medical history will help decide what the perfect management will be.