From the Guidelines
Constipation in toddlers is most commonly caused by dietary factors, particularly insufficient fiber and fluid intake, as well as toilet training resistance and physical inactivity. The most common reasons for constipation in toddlers include:
- Insufficient dietary fiber intake, which can lead to hard stools that are difficult to pass 1
- Inadequate fluid intake, which can make stool harder and drier
- Toilet training resistance, where toddlers may deliberately hold their stool due to fear, anxiety, or negative experiences with painful bowel movements
- Changes in routine, such as starting daycare or traveling, which can disrupt bowel habits
- Physical inactivity, which can decrease bowel motility and contribute to constipation
- Certain medications, such as iron supplements and antihistamines, which can cause constipation as a side effect 1
- Underlying medical conditions, such as hypothyroidism or Hirschsprung's disease, which can increase the risk of constipation
According to the most recent and highest quality study, increasing dietary fiber intake and ensuring adequate fluid intake are first-line approaches to treating constipation in toddlers 1. Additionally, establishing regular toilet routines and encouraging physical activity can also help to prevent and treat constipation. If these measures are not effective, pediatricians may recommend over-the-counter stool softeners or occasional use of glycerin suppositories for immediate relief. It is essential to evaluate persistent constipation by a healthcare provider to rule out underlying medical conditions 1.
From the Research
Common Reasons for Constipation in Toddlers
The provided studies do not directly address the most common reasons for constipation in toddlers. However, they discuss the treatment options and management of constipation in children and adults.
Treatment Options for Constipation
- Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, are considered effective and safe for the treatment of pediatric functional constipation 2.
- Stimulant laxatives, like Senna and Bisacodyl, probiotics, fiber preparations, enemas, and suppositories can be used as adjunct therapies in specific clinical scenarios 2.
- Polyethylene glycol (PEG) with or without electrolytes is more efficacious than placebo for the treatment of functional constipation, with great safety and tolerability 3.
- PEG is considered more effective than lactulose in treating chronic constipation, with better outcomes in stool frequency, stool form, relief of abdominal pain, and the need for additional products 4.
Management of Constipation
- Nonpharmacologic modalities, such as increased exercise or fluid intake and bowel habit training, are generally recommended as first-line approaches, but data on their effectiveness is limited 5.
- Dietary fiber and medicinal bulk are popular therapeutic options for initial treatment of chronic constipation, with subsequent treatments including saline osmotic laxatives, lactulose, or stimulants like senna or bisacodyl 6.