The World Health Organisation recommends exclusive breastfeeding for the first six months of life. Unnecessary introduction of bottle feeding or other food and drinks will have a negative impact on breastfeeding. After six months of age, infants should receive age appropriate foods while breastfeeding continues for up to two years of age or beyond. Consult your doctor before deciding to use infant formula or if you have difficulty breastfeeding.
There are many causes of constipation, including diet, medications, activity, diseases and disorders. Children can also suffer from intentional stool retention, which is constipation due to stress when they’re not ready for toilet training.
Insufficient water and fibre – A diet that includes an excessive intake of soft drinks, with insufficient drinking water, fruits, and vegetables
Taking some medication – Antipyretics, analgesics, cough medicine, diarrhoea medicine could be a cause of dry stools and difficult bowel movements
Anal fissure – Difficult and painful bowel movements
Inactivity – That causes inactive peristalsis
Emotional disorders – Being in a stressful home or family atmosphere, with divorced parents, etc.
Diseases – Development of disorders related to the colon, rectum, nervous system, blood, etc.
Some children under the age of 5 cannot control their faecal excretion reflux, or have a fear of sitting on the toilet which could cause difficult bowel movements. As such, they choose to intentionally hold back their stool, a habit that can cause constipation.
Your child refuses to go to the toilet
This causes anal muscle spasms and squeezed buttock muscles
As a result, faeces is pushed up to the rectum valve
In turn, this causes constipation in your child
Leading to colon dilation and decreased rectal sensitivity
This results in prolonged faecal cumulation, contributing to constipation
Constipation is generally difficult to define, as there are no clear indications of what is ‘normal’ in terms of the frequency of bowel movements, and symptoms may vary from child to child. Here are some signs if you’re concerned that your child could be suffering from constipation.
Difficult and infrequent bowel movements
Refusal to go to the toilet
Underwear is sometimes unknowingly soiled
Experiences anal pain, has uncontrolled bowel movements or blood in stool
Stool looks solid, lumpy, or generally abnormal
Child has abdominal pain and a poor appetite
Not all constipation incidents need medical attention. Before you rush to your medical practitioner, you may want to try these tips at home to ease the situation.
Massage your child’s tummy with warm hands using gentle pressure
Apples, pears and prunes are great for making bowel movements smoother
Make sure your child is drinking enough water throughout the day
Bran flakes, oatmeal, brown rice, and beans can help to soften stools
This can help to relax the anal muscles and help to pass the stool
Use a footstool to ensure that the feet are properly supported
The Bristol stool scale is a good indication of whether or not your child is suffering from constipation, as normal faeces should be the texture of Types 4 to 6, rather than dry, lumpy pieces in Types 1 to 3.
In hard lumps or shaped like nuts
Sausage-shaped or lumpy stools
Like a sausage but with many cracks on the surface
Like a sausage or snake, smooth & soft
Soft blobs with clear cut edges
Fluffy pieces with ragged edges or mushy stools
Watery with no solid pieces or entirely liquid
If your child has experienced this condition for a prolonged period, it would be wise to call your doctor. Do seek medical attention especially if your child is suffering from any of these symptoms.
Colon dilation (where the colon is unnaturally extended)
Rectocele (or rectum prolapse)
Poor appetite of your child
Slow weight gain in your child
Persistent abdominal pain
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3. John Hopkins Medicine. Constipation in children. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/pediatrics/constipation_in_children_90,P01986/
4. Ali SR, Ahmed A, Qadir M, et al. Fecal Incontinence and Constipation in Children: A Clinical Conundrum. Oman Med J. 2011 Sep; 26(5): 376–378.
5. Mayo Clinic. Constipation in children. Available at: http://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/dxc-20235978
6. Mayo Clinic. Self management. Available at:http://www.mayoclinic.org/diseases-conditions/constipation-in-children/manage/ptc-20236058
7. NIDDK. Treatment for Constipation in Children. Available at:https://www.niddk.nih.gov/health-information/digestive-diseases/constipation-children/treatment
8. Continence Foundation of Australia. Bristol stool chart. Available at:https://www.continence.org.au/pages/bristol-stool-chart.html
9. Chao HC, Chen SY, Chen CC, et al. The impact of constipation on growth in children. Pediatr Res. 2008 Sep;64(3):308-11.