Constipation in children can cause mild to more severe stomach pain, depending on the severity of the constipation. However, if children have severe stomach pain that causes them major discomfort, it may be caused by another condition such as appendicitis. If your child complains of severe stomach pain, you should check for other symptoms such as fever which can indicate whether your child has an infection. Generally, constipation causes stomach pain with no other symptoms and the pain goes away after a bowel movement.

About 95% of cases of constipation in children are associated with eating and bowel habits. Children tend to eat a lot of fast food with insufficient fruit, vegetables and water in their diet. As this causes hard and painful stools, they may try to put off going to the toilet. However, this only results in the stool becoming harder and larger, eventually leading to constipation. 

Untreated chronic constipation can lead to emotional, mental and physical health problems such as:

• Physical Development: Because constipation prevents children from eating full meals, it can result in the children becoming underweight and short in stature due to a lack of nutrition.
• Emotional and Mental Health: Children with chronic constipation can sometimes have runny stools, which they cannot control. This can cause them to soil their pants and make them feel embarrassed in front of their friends. Some children who have stomach pain cannot explain their symptoms and their parents do not understand them, causing the children to undergo emotional and behavioral changes, such as being more irritable or unhappy.

If your child suffers from chronic constipation or stomach pain, take them to see a doctor. The doctor will ask about your child’s eating habits and may also perform an x-ray or ultrasound. When constipation is diagnosed, the child may be given an enema to loosen the bowels, and the doctor may recommend dietary changes. 

In severe cases where changing the child’s diet cannot improve the symptoms, medication may be required. The medication softens the stools and reduces the pain of bowel movements so that the child does not feel reluctant to empty their bowels and once again exacerbate the problem. When the symptoms are improved, the medication can be reduced. However, the medication should only be administered in conjunction with habit changes, such as a healthy diet and a regular bowel movement routine.

As always, prevention is better than cure and it begins at home at very young age, before your child is 1 year old. Here are some tips:

• Encourage the consumption of fruit and vegetables: Give your child homemade vegetable soup and fruit juice, which reduce constipation and get your child into a regular toilet habit. Besides, children learn to eat what is familiar to them and so they will not resist eating fruits and vegetables when they grow up. 
• Try to get children into a regular toilet habit: This can begin during the child’s first 2 years. First, find out if your child has any constipation problems, such as hard stools, holding it in, or crying when going to the toilet. If you observe any of these problems, changes to your child’s diet are the first step. Avoid foods that can harden the stools, such as brown rice, bananas, chocolate and cheese. When your child is no longer constipated, you can get him or her into a regular toilet habit.

By Dr. Mingmuang Worawattanakul, Pediatric Gastroenterology (Digestive System), Children’s (Pediatrics) Center, Bumrungrad Hospital