Should you worry when the going gets tough for kids?
Constipation is distressingly common in children and can be a source of concern for parents.
Not passing stool for a certain number of days does not by itself mean that the child is constipated. A stool which is hard to pass and is causing distress to the child would qualify as constipation.
Constipation can be acute – sudden and lasting a short time – or chronic, i.e. lasting a long time, even years. Most cases of constipation fall into the first category and aren’t dangerous. If you find yourself anxiously scrutinising each diaper, this week Consultant Paediatrician Dr. Ishani Rodrigo tells you what you need to know:
1. When should a child see a doctor?
Since constipation isn’t uncommon, it is best to give the child a few days and modify his diet before seeking medical attention. A child who’s constipated and also suffering from additional symptoms such as vomiting, fever, blood in the stool, a swollen abdomen or rapid weight loss may have a more severe underlying problem that requires more immediate attention. When diagnosing constipation, doctors are looking to see if the child has had two or fewer bowel movements per week or if parents can report a history of excessive stool retention, painful bowel movements or whether the child has a large faecal mass in the rectum.
Another instance where medical attention is needed is when a child has had constipation from birth – this may be due to a condition called Hirshsprung’s disease where the nerve fibres of the gut have stopped before they reach the anal sphincter.
2. How do you know when your child is constipated?
Sometimes, parents can tell simply from reading their child’s body language and posture. Kids may stand on tiptoes, rock back and forth, clench the muscles of their buttocks as if to physically hold the stool in. Children may also complain of abdominal pain and cramping or you may see signs of stool in the child’s underwear of notice urinary incontinence.
3. What causes constipation?
Among the most common causes of constipation is a diet poor in fibre. Fibre, which comes from plants, plays a crucial role in ensuring stool says soft and is easily passed through the colon. In addition to fibre, doctors recommend patients drink plenty of liquids and stay hydrated. Certain foods which contain cocoa and malt tend to make the stool hard.
4. Can medications cause constipation?
Yes, they can, especially pain medications that include narcotic. Antacids, some antidepressants and anticholinergics that are prescribed to relax the bladder muscles and prevent frequent or uncontrolled urination have also been associated with constipation.
5. Do children trigger constipation by holding back their own stool?
Yes, potty training could be proving stressful or children may not find a public toilet appealing. They may be too absorbed in play or too shy to approach an adult. Passing a hard stool can lead to anal fissures which are very painful, leading the child to involuntarily tighten the anal sphincter to prevent passage of stool.
This starts a vicious cycle of constipation, painful defecation and a lot of tears in both the child and the parents. When stool is held for long period of time the stool becomes even harder and the rectal passage stretches creating a sac like space. When the stool is eventually passed it tends to be very large and hence causes a lot of pain. Hence, the cycle continues.
6. What does the GI tract have to do with it all?
Functional GI disorders caused by issues with the functioning of the gastrointestinal tract have been linked to constipation. Children are particularly vulnerable during certain periods which include when infants transition from breast milk to formula or when they are weaned and solid foods are introduced for the first time into their diets. Changes such as potty training or the beginning of school where they may have to become comfortable with using a public toilet by themselves can also trigger a bout of constipation.
7. Lifestyle changes can help
When approaching the treatment of constipation, doctors may recommend parents implement changes in lifestyle particularly in diet and liquid intake. Juices with fibre-rich fruit such as papaya or bananas will help as will ensuring kids drink plenty of liquids throughout the day. Reduce or even eliminate overly refined and processed foods from your child’s diet and limit food low in fibre such as biscuits, and refined cereals while cutting back on treats like ice cream and on portions of meat. Behavioural changes can be supported, with children being encouraged to visit the toilet regularly after meals. Rewarding positive behaviour with a star or putting a coin to a till which is kept in the toilet can be used to reinforce good toilet behaviour. Use of force, threats and humiliation should be avoided as these lead to lower the self esteem of the child and make the problem worse.
If a child is nervous because of potty training, parents should consider taking a break and then returning to it later after the constipation has eased. Depending on the child’s condition and level of discomfort, a doctor may prescribe medication.