How to Recognize Constipation

Recognizing constipation in children involves looking beyond just the frequency of bowel movements. While having fewer than three bowel movements a week is a key sign, other symptoms are equally important for identifying the issue. According to the Rome IV criteria, a diagnosis of functional constipation requires at least two of the following symptoms to be present for at least one month:

• Two or fewer defecations in the toilet per week (for toilet-trained children).
• At least one episode of fecal incontinence per week (encopresis).
• Voluntary stool withholding behavior.
• History of painful or hard bowel movements.
• Presence of a large fecal mass in the rectum.
• History of large-diameter stools that may obstruct the toilet.

One of the most remarkable signs is a change in your child's normal bowel movement pattern. If a child who usually has a daily bowel movement starts going every two or three days, this could be an early sign of constipation.

Other Common Signs and Symptoms

Parents can look for the following:

• Stool that is hard, dry, and difficult to pass: The stool may appear as small hard pellets or as a large lumpy sausage.
• Pain during bowel movements: Your child may cry, strain, or express that it hurts to poop.
• Stool withholding behavior: You might notice your child crossing their legs, clenching their buttocks, or rocking back and forth to avoid having a bowel movement. This is often a response to previous painful experiences.
• Abdominal pain or bloating: A buildup of stool in the colon can cause discomfort, cramping, and a swollen belly.
• Decreased appetite: When a child feels full from the retained stool, they may eat less than usual.
• Blood on the stool: A small amount of bright red blood on the surface of the stool can be caused by a small tear (anal fissure) from passing a hard stool.

It is important to seek treatment if you notice these symptoms, especially if they persist or are causing your child significant distress. Early intervention can prevent the problem from becoming chronic.