From the Guidelines
Persistent constipation in toddlers is most commonly caused by dietary factors, such as inadequate fiber intake and excessive consumption of dairy products, as well as behavioral issues like withholding stool during toilet training. The American Academy of Pediatrics suggests that pediatricians play a central role in guiding children's health and nutrition, and recommends focusing on nutrient-dense foods, including whole fruits and vegetables, rather than relying on fruit juice 1. According to the study, fruit juice lacks the fiber of whole fruit, and consuming it instead of whole fruit does not promote healthy eating behaviors 1.
Some key points to consider when addressing constipation in toddlers include:
- Inadequate fiber intake, with toddlers consuming too many processed foods and not enough fruits, vegetables, and whole grains
- Insufficient fluid intake, as proper hydration is essential for soft stools
- Behavioral issues, such as withholding stool due to fear or pain from previous hard bowel movements
- Changes in routine, such as starting daycare or travel, which can disrupt normal bowel habits
- Medical causes, though less common, including cow's milk protein allergy, hypothyroidism, or anatomical issues
Treatment typically involves dietary changes, such as increasing fiber and fluids, establishing regular toilet routines, and occasionally using medications like polyethylene glycol for short periods 1. It is essential to note that while some juices, like prune, pear, and apple juices, may be recommended for treating constipation due to their sorbitol content, whole fruits and vegetables are generally preferred due to their higher fiber content and nutritional value 1. Persistent cases of constipation warrant medical evaluation to rule out underlying conditions and develop an appropriate management plan.
From the Research
Common Reasons for Persistent Constipation in Toddlers
The most common reasons for persistent constipation in toddlers include:
- Infrequent defecation (≤ 2 per week) 2
- Faecal incontinence 2
- Retentive posturing 2
- Painful or hard bowel movements 2
- Large diameter of stool 2
- Inadequate fluids and fiber intake 3
- Excess dietary dairy or carbohydrates 3
- Stool withholding 4, 5, 3
- Low-fiber diet 5
- Physical inactivity 5
- Altered intestinal microbiome 5
- Centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress 5
Risk Factors
Additional risk factors for constipation in toddlers include:
- Weaning 2
- Toilet training 2, 6
- Transitions to kindergarten/school 2
- A bout of febrile illness 2
- Overseas holidays 2
- Developmental delays 2
- Behavioural problems 2
- Frequent soiling of underwear 2
Pathophysiological Mechanisms
The main pathophysiological mechanisms of constipation in toddlers include: