by Nicole Evans M.D.

Created on: April 10, 2009   Last Updated: October 15, 2010

Constipation is very common in young children.  The most common cause of constipation in children is called functional constipation. The term functional constipation refers to constipation that results from voluntary withholding of stool by your child.

Functional constipation often first coincides with the attempt to toilet train an infant. However, this is not usually a conflict regarding toilet training itself.  Rather, stool retention by the infant is often caused by pain on defecation and the resultant fear of defecation.  This creates a vicious cycle of chronic constipation.

Functional constipation may be related to feeding method in some children.  While breast-fed infants usually produce stool at least two times a day, formula-fed infants may produce stool only once every 2 or 3 days. While this decreased frequency of bowel movements is considered normal by most pediatricians, it may predispose to functional constipation in certain infants.

The decreased frequency of bowel movements in formula fed infants may result in functional constipation because stool increases distention of the infant's rectum. This rectal distention then decreases rectal sensation, such that an even greater amount of stool is required to initiate the urge to defecate.  Again, a vicious cycle is initiated of pain and difficulty during bowel movements.

While functional constipation is the most common cause of constipation in children, other causes of constipation must be considered.  Constipation may rarely be caused by abnormal anatomy or physiology in a child.  Many of these causes of  constipation may first become noticeable in the neonatal period which is the first month of life. Serious causes of constipation in infants include:

-anal stenosis

-anal stricture

-Hirschsprung disease

-neuronal dysgenesis

-anterior dislocation of the anus

-meconium ileus

In all children with constipation, the possibility that the constipation is caused by drugs and metabolic conditions should be ruled out.  Drugs and toxins that can cause constipation in children include lead, narcotics, antidepressants and more.  Metabolic conditions that commonly cause constipation in children include dehydration and hypothyroidism.

An allergy to milk or soy protein can also cause constipation.  In children who began to have constipation very early in life, it is helpful to assess whether they were formula fed at that time. Milk protein or soy protein

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