Constipation is when a child has hard poo (bowel movements) or does not go regularly to the toilet. There is a lot of difference in the firmness and frequency of Stools (poo) in normal children. Breast fed babies may have a poo following each fed or only every 7 – 10 days. Bottle fed babies and older children will usually have a poo at least every 2 -3 days. You only need to worry about the firmness or frequency of your child's poos if it seems to be causing a problem.
Constipation is quite a common problem in children, but with a good diet, improvement in bowel habits, and appropriate use of medications, it can usually be controlled.
Sign and Symptoms:
Stomach pains, doing a poo can become painful.
Not as hungery as normal.
Irritable behaviour.
Pushing to pass a hard poo can cause anal fissures (splits or cracks) and bleeding.
Constipation can increase the risk of urine infections.
If your child is very constipated they may lose some sensation in the rectum and may have trouble recognising the need to go to the toilet. This is one of the causes of a child soiling its pants. Soiling is sometimes called encopresis or faecal incontinence.
Causes of constipation Includes:
Natural tendency related to slower gut movement. A history of passing poos that are firmer than normal in their early weeks of life.
Diet. This is important, and a poor diet can aggravate constipation in children who already have this natural tendency. A poor diet will be high in animal fats (meats, dairy products, eggs) and refined sugar (rich desserts and other sweets), but low in fibre (vegetables, fruits, whole grains). There is little fibre in most convenience or "junk" foods.
Bowel habits, such as ignoring the urge to have a poo. Sufficient time should be set aside to allow for undisturbed visits to the toilet. Some children find it difficult to fully empty their rectum of poo when they go to the toilet. Some children with constipation lose sensation in the rectum and do not feel the urge to go.
Anal Fissures. Passing large hard poos can cause cracks (fissures) in the skin of the anus. These fissures can bleed and be painful, and this in-turn causes the child to resist going to the toilet. A vicious cycle is then in place.
Disease. In a very small number of children, constipation may be the result of a physical disease. Diseases such as the absence of normal nerve endings in parts of the bowel, defects of the spinal cord, thyroid deficiency, mental retardation, and certain other metabolic disorders can cause constipation. All of these are rare, but your doctor will check your child for them.
Treatment Plan
Treatment should continue for enough time to allow the bowel size and sensation to return to normal. Treatment should include the following subheadings:
Good bowel habits
It is important for constipated children to develop the habit of sitting on the toilet regularly. This should be for at least five minutes after breakfast and tea. They should sit on the toilet even if they do not feel the urge to go. They should stay on for the full five minutes, even if they have done some poo before then. Providing a footstool and a book can be helpful. Using a kitchen timer can avoid arguments about how long they have been sitting.
Children should learn to not resist the urge to go for a poo when it comes. You may want to find out if your child is worried about using the school toilets and see if anything can be done to help.
A high fibre diet
Fibre makes the poo softer and easier to pass. Giving your child more fibre in their diet can help prevent constipation. To add more fibre to your child's diet, you can:
Give at least 2 servings of fruits each day. Fruits with the peel left on, such as plums, prunes, raisins, apricots, and peaches, have a lot of fibre. You could give your infant strained prunes, up to 3 tablespoons a few days each week.
Give at least 3 servings of vegetables each day.
Give cereals high in fibre, such as bran cereals, shredded wheat, whole grain cereals, oatmeal. Avoid refined cereals, such as corn flakes.
Give whole wheat breads instead of white bread.
Give bran muffins, or blend bran cereal in a blender and add it to your child's regular cereal.
Fluids
Drinking plenty of fluids helps to prevent constipation. Encourage your child to have a drink of water, dilute cordial, or fruit juice with every meal and one in-between meals and before bed.
Treatment may need to include:
Laxatives
You may need to give your child a laxative if he or she is constipated. If you find that this does not work, or you need to give it repeatedly, then you should see your doctor.
Prune Juice
This is a mild natural laxative that works in some children. Prune juice may taste better if mixed with another juice, such as apple, apricot, or cranberry juice. You can freeze prune juice to make icy poles, which are fun for your child to eat.
Metamucil (psyllium husk)
This natural laxative helps soften the poo. It comes unflavoured, or orange flavour.
Senokot (senna)
This laxative comes as a tablet or granules, and works by stimulating the bowel to empty. The granules can be mixed with food, such as apple sauce or ice cream. Your child may have diarrhoea or stomach cramps if the dose is too high. Giving Senokot at night may reduce cramping.
Bisacoldyl (bisacodyl)
This laxative comes as a tablet, and also works by stimulating the bowel to empty.
Coloxyl (docusate / poloxalkol)
This laxative comes as a tablet or drops (which are most suitable for children under 3 years of age), and works by softening the poo.
Lactodil (lactulose)
This laxative comes as a liquid, and works by softening the poo and stimulating the bowel to empty. May taste better mixed with juice or milk.
Agarol (liquid paraffin and phenolphthalein)
This laxative comes as a liquid, and works by softening and lubricating the poo to make it easier to pass. It also stimulates the bowel to empty
This laxative comes as a liquid, and works by softening and lubricating the poo to make it easier to pass.
Suppositories
You may need to use a rectal suppository if you have given your child laxatives for two or three days and the constipation isn't any better.. The suppository should first be coated with a water-soluble lubricant, like K-Y Jelly, before inserting it into the rectum. Do not use Vaseline to coat the suppository; it is not water-soluble.
A poo will usually occur within 30 minutes of giving the suppository. If you need to use suppositories more than just occasionally, then you should see your doctor. Examples include glycerin suppositories, or Durolax suppositories.
Enemas
Never give an enema to your child unless your child's doctor has told you to.
There are some mini-enemas (e.g. Micronema) that are suitable for young children.
Bowel irrigation
A very small number of children get so constipated that they need to be admitted to hospital to have the bowel cleaned out. This is usually done with a fluid called Golytely, which can be given as a drink. The amount needed is quite large and some children will not drink it. It can then be given through a tube passed down to the stomach.
