Evaluation and Treatment
of Constipation in Infants and Children
WENDY S. BIGGS, M.D., and WILLIAM H. DERY, M.D.
Michigan State University College of Human Medicine, East Lansing, Michigan
onstipation has been defined as
“a delay or difficulty in defeca-
tion, present for two or more
weeks, sufficient to cause signifi-
cant distress to the patient.”1 This condition
is responsible for an estimated 3 to 5 percent
of physician visits by children.2 Constipation
often causes more distress to parents and
other caregivers than to the affected child.
Many caregivers worry that a child’s constipa-
tion is the sign of a serious medical problem.
As children age, normal physiologic
changes occur in the intestines and colon
that decrease the daily number of stools from
a mean of 2.2 in infants younger than one
year to a mean of 1.4 in one- to three-year-
old children (Table 1).1,3 Thus, less frequent
stooling may not be constipation. If, how-
ever, constipation is defined as “failure to
evacuate the lower colon completely,” 4 even
children who stool daily in small amounts
may be considered to have constipation.
Encopresis, which is the involuntary leakage
of feces into the undergarments, may be an
indication of constipation.
This article reviews the differentiation
of organic and functional constipation in
infants and children. The treatment of func-
tional constipation also is reviewed.
Up to one third of children ages six to
12 years report constipation during any given
year.5 Constipation generally first appears
between the ages of two and four years.6
Encopresis is reported by 35 percent of
girls and 55 percent of boys who have con-
stipation.7 In toddlers (ages two to four
years), the distribution of constipation and
soiling is equal in boys and girls. However,
by school age (five years), encopresis is three
times more common in boys than in girls.4
At the age of 10 years, approximately 1.6 per-
cent of children still have some encopresis.4
Etiology and Pathophysiology