Constipation in infants and young children - Symptoms, Causes and Treatments

Definition

Constipation in infants and young children is the rreduction of material emissions fecal dehydrated (which have lost some of their water), leading to a slowing down of intestinal transit (progression of digested food in the intestines).

Generalities

Constipation causes a decrease in the number of stools, which are abnormal and difficult to pass.

We speak of constipation when this number is:

Less than 1 per day, in infants from the first months of life
Less than 2 per week in older children.

Symptoms

Pathophysiology

At the infants, the stools are molded or semi-liquid, golden yellow to greenish. At this age, the symptoms of constipation are hard stools (which look like marbles), and the infant's efforts to eliminate them.
At the young children, constipation results in spaced and hard stools.

Medical exam

Physical examination

The doctor, thanks to the precise questioning of the family, will inquire:

A family history of constipation.
From the time of the broadcast of the meconium (first stool in the newborn), which should not exceed 25 hours after birth.
The duration of the emission of this meconium, which must not exceed three days.
From the date of onset of constipation.
Frequency of stools.
From their appearance.
The child's eating habits (drink type and quantity).
From the family context (search for conflict in particular).
Possible growth problems in weight and height, by checking the curves on the health record.
Abdominal pain, vomiting, bloating.
Repeated urinary tract infection problems.

The doctor's examination will focus on the anus, checking whether there is:

bleeding.
Pain that may be due to cracks, or to Fistulas.
Malformations.

Le rectal examination, has a particularly important place in the examination of the child: he will look in particular for a fecal impaction (dry stools). It consists of exploring the anus and the palpable part of the rectum (last part of the colon). To perform a digital rectal examination in adults, the index finger is used; in infants or small children, the little finger is generally used, so as not to traumatize the anus. The finger is provided with protection such as a glove or a finger cot (a type of sheath protecting the finger), previously lubricated, generally with petroleum jelly. This digital rectal examination will allow, when the stools are felt far from the finger, to lean towards a diagnosis of Hirschsprung's disease, and when the stools are located near the anus, to diagnose "less serious" constipation.

Cause

Causes of constipation in infants and toddlers include:

First of all, we must eliminate a Hirschsprung's disease, which is a diffuse or localized intestinal paralysis, the treatment of which is surgical. If this is the case, the treatment consists of inserting a probe into the rectum, or performing small, careful enemas. This is intended to allow the evacuation of stools, but this technique is not effective in all cases. In forms where this medical treatment is ineffective, what is called a colotomy (and not a colostomy which is the creation of an artificial anus by connecting a portion of the colon to the skin). Colotomy consists of making a surgical opening in the wall of the colon, thus allowing it to be explored.
In all other cases, it is a purely medical illness that must be treated, in order to avoid entering a vicious circle which is that of constipation leading to lesions at the level of theanus (among others), causing stool retention (due to pain), which itself causes constipation.
The most common causes of constipation are due to:
A nutritional problem highlighted by the interview, which reveals an abnormality in the diet. In this case, dietary correction can help find a solution to the constipation of the older child:
- Reduce the number of foods containing fast sugars (sweets).
- Increase in the amount of water.
- Increase in the number of plant fibers, among others.
In this context of dietary disorders, also falls an unsuitable diet, including excessive consumption of cow's milk.
Irritable bowel syndrome, due to many causes, alternates between episodes of constipation and diarrhea.
In more serious cases, there may be malformations of the anus or rectum, requiring surgery, monitoring by the gastroenterologist, as well as rehabilitation of this organ.
Rare causes of constipation are:
- stenoses (reduction in the caliber) of the intestine, the treatment of which is surgical.
- Malformations, or after-effects of a previous surgical operation.
- Neurological causes.
- La cystic fibrosis.
- L'hypothyroidism (insufficient secretion of thyroid hormones).
- La celiac disease.
- Le diabetes insipidus : inability of the kidneys to concentrate urine, leading to polyuria, that is, the emission of too much liquid in the urine. It is accompanied by intense thirst. This type of diabetes can have several causes.
- Complications of long-standing constipation, leading to occlusion (inability of fecal matter to move through the digestive tract) causing malnutrition and serious infectious problems.

Treatment

Treatments for constipation in infants and young children are:

Hygiene rules :
- Reduce the amount of sweets (including chocolate).
- Provide sufficient water (Hepar from time to time, but not continuously).
- Sometimes avoid rice and carrots.
- Eat green vegetables containing short fibers, such as green beans, spinach, zucchini, and preferably blended.
- Give the child prunes, cereal, or bran bread.
- Use vegetable oils, to add to food, and more particularly to vegetables.
- Reduce consumption of dairy products, or dairy equivalents (children generally have a very high appetite for them)
Lifestyle planning :
- Take the time to have a bowel movement in the morning.
- Avoid retention in school.
- Seek the advice of a psychological team if you experience "abnormal" behavior.
Medication, which should not be abused, will be prescribed if the previously mentioned diet is ineffective. The following molecules are usually used:
- Laxamalt.
- lactulose .
- Lactilol.
- Trirnebutine.
- Neostigmine.
- Dihydroergotamine.
- Cisapride.

Evolution

When constipation persists, it is necessary to resort to additional tests:

Either radiological with or without preparation like the barium enema.
Be there manometry (search and pressure difference, allowing to highlight a malfunction of the colon).
In the most serious cases, proceed to a rectal biopsy (taking a sample of the rectal wall).