Diarrhoea and constipation in children

It's difficult to be specific about what constitutes a normal toilet habit. Many people think that once, or possibly twice, a day is normal, but there's a wide range. Breastfed babies may not pass faeces for several days but still be healthy. With children, it's important to take note of a change in habit.

Symptoms of diarrhoea and constipation

With diarrhoea, the child may open their bowels several times a day, passing watery or runny faeces. There can be a lot of wind and the diarrhoea may be explosive or particularly foul smelling. Depending on the cause, the child may also experience abdominal pain, nausea and fever.

With constipation, the child may open their bowels less than three times a week. The stools may be small and pellet-like ('rabbit droppings') or large enough to block the toilet. They may be hard and painful to pass, and can cause a tear in the delicate lining of the anal canal, which may lead to streaks of blood on the faeces.

Because the bowels become overloaded with faeces, the sensation of needing to open them may be lost and the child can unintentionally soil themselves as the bowels overflow (liquid faeces may bypass around harder pellets blocking the gut). This can cause both diarrhoea and constipation at the same time.

There may be abdominal pain that comes and goes with the passage of stool, or the child may have a poor appetite that improves with passage of large stool.

Causes of diarrhoea and constipation

There are many causes of diarrhoea and constipation. Constipation affects up to 30 per cent of children and it becomes chronic in more than one in three cases.

The causes of constipation include dehydration (for example, following a feverish illness), a poor diet especially low in fibre, a small tear or fissure in the anal canal (commonly, fear of pain inhibits the child from opening their bowels), psychological stress (for instance, unfamiliar surroundings or emotional trauma) and, rarely, a medical condition.

Diarrhoea may be caused by infection (such as gastroenteritis) or malabsorption problems, when food isn't taken in through the gut properly (such as food intolerance, coeliac disease and cystic fibrosis).

Treatment of diarrhoea and constipation

With diarrhoea, try to continue feeding your child as normal - don't starve them. Soups and high-carbohydrate foods are good choices. Offer drinks to avoid dehydration. Rehydration solutions can be used, but follow the instructions carefully.

With mild constipation, increasing the intake of fluid and fibre (for example, stewed apples and root vegetables) may be enough. If this isn't effective, or if the constipation is more severe, talk to your doctor.

New guidelines from the National Institute for Clinical Excellence (NICE) recommend that constipation in childhood is treatment with a combination of both lifestyle and dietary measures, as well as medicines called laxatives.

Lifestyle treatments include:

• Scheduled toileting to set up a regular bowel habit
• Eating a balanced diet with adequate fluid and fibre

There are many different laxatives to chose from, but NICE recommends starting with a type known as polyethylene glycol 3350 or PEG laxatives, which soften the stool by increasing its water content. If this doesn’t work, then other laxatives can be tried. Some children may need to take laxatives for several years.

Always get medical advice for small babies. If you notice blood on the stool, with either diarrhoea or constipation, you should talk to your doctor. If problems persist, or your child seems unwell, see your doctor. Occasionally, persistent diarrhoea or constipation are a sign of more serious illness that needs to be investigated by a hospital specialist.