Fort Worth, Texas,
27
March
2017

9 Signs You Should Be Worried About Your Child's Constipation

Doc Smitty explains the warning signs that your child needs help

Constipation in children is common. It affects 30 percent of kids at some point in their life, is usually short lived and not severe. Most people call this functional constipation (despite how functional or dysfunctional you feel in the midst of it).

Following our posts on the safety of Miralax and answering some frequently asked questions about Miralax use for constipation, we heard one resounding question:

"When should I be worried and when should more workup be done?"

Benign (or not concerning) causes:

  • Constipation starts with a dietary change or at the time of toilet training
  • Children show a stool withholding behavior
  • Things resolve easily with stool softeners

But what are the warning signs? When should you be worried? Here are nine symptoms or signs that more workup should be considered for your child’s constipation:

  1. Constipation has been present since birth or early infancy
  2. Any other symptoms with constipation-fever, vomiting or diarrhea
  3. Bleeding in the stool or from the rectum
  4. Swelling or distension of the belly
  5. Long, narrow stools (sometimes called “ribbon stools”)
  6. Urinary accidents or recurrent urinary tract infections
  7. Poor growth or weight loss
  8. Other, non-belly symptoms, especially neurologic symptoms like weakness or abnormal sensation in the legs
  9. Abnormal findings in the lower back (birthmarks or hair along the spine)

The workup for constipation can vary depending on the child’s symptoms and exam findings. Some things that might be considered:

Imaging -Most commonly the child will undergo a barium enema which is an X-ray that is enhanced by an enema that shows up on the X-ray. If there are concerns about the child’s neurologic symptoms, an MRI of the spine can be conducted to rule out something called a tethered cord.

Blood work - Depending on the child’s symptoms, blood testing for the following could be indicated: celiac or thyroid disease, calclium and blood lead levels.

In severe constipation or constipation that does not resolve, a referral to a gastrointestinal doctor can be helpful for further workup and treatment recommendations.

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About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in 2017.

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Justin Smith, M.D.
Medical Advisor for Digital Health
(972) 316-7400
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