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Easing Constipation for Children

Constipation is the condition in which an individual has reduced frequency of bowel movements, or finds difficulty in having bowel movements or clearing the bowels. It is uncommon in young breastfed children, but relatively common in children during toilet training period and school-going age.

Constipation can affect your child in many ways. They may refuse to eat and miss out on essential nutrients, among other undesirable effects. Worried? Read this article for more information, and learn more about the causes, symptoms, and remedies for when your child has constipation.

Causes of constipation

There are many reasons why constipation can happen, including diet, medications, activity, diseases and disorders. It can sometimes occur in young children, making it difficult to distinguish from colic. Children can also suffer from intentional stool retention, which is constipation due to stress when they’re not ready for toilet training.

An unbalanced diet is a key cause of constipation. Excessive intake of soft drinks, fatty foods, carbohydrates, or even protein can cause your child to become ‘backed up’. Insufficient intake of drinking water, fruits, and vegetables will also affect digestion.

Formula milk can firm up feces more than breast milk, making it easier to get ‘stuck’. Cow milk protein and lactose found in some formulas can also be constipating for some children, so soy alternatives might help.

Taking some medication – Antipyretics, analgesics, cough medicine, diarrhea medicine could be a cause of dry stools and difficult bowel movements. Prebiotics, while often effective for certain forms of constipation, might actually worsen symptoms for others. Even vitamin supplement products containing calcium and iron can be a contributory factor.

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.

Intentional stool retention

Some children under the age of 5 have problems controlling their fecal excretion reflux, or have a fear of sitting on the toilet. This causes difficult bowel movements, which can lead to them intentionally holding back their stool, causing it to build up in their body. Such a habit can cause constipation. Keep this in mind and observe your child’s behavior.

Your child refuses to go to the toilet

This causes anal muscle spasms and squeezed buttock muscles

As a result, feces are 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 fecal cumulation, contributing to constipation and other digestive problems

Symptoms

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 or diaper is sometimes unknowingly soiled

Experiences anal pain, has uncontrolled bowel movements or blood in stool

Stool looks solid, lumpy, or generally abnormal

Refusing to eat, especially when presented with their favorite food or formula milk

Home fixes

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.

Change Your Formula

If your child is formula-fed, try a different formula. Research the ingredients found in the formula milk to understand its effects. Formula milk that is made with minimal processing (mild heat treatment) will be easier to digest, compared to heavily processed ones.

TUMMY RUB

Make your child feel more comfortable with a tummy massage. Use warm hands with gentle pressure and motion

MORE FRUITS

Eating apples, pears and prunes may help make bowel movements smoother

HYDRATE OFTEN

Make sure your child is drinking enough water throughout the day, not just during feeding times. Dehydration is a common cause for constipation and drinking plenty of water can often ease the symptoms.

HIGHER FIBER

Ingredients matter – a lot. Feeding them foods rich in dietary fiber such as bran flakes, corn, oatmeal, brown rice, and beans may help soften stools and aid in digestion.

WARM BATH

This can help to relax the anal muscles and help to pass the stool

RIGHT POSITION

Use a footstool to ensure that the feet are properly supported for better pooping posture

The Bristol stool scale

Interested to know what a ‘good’ feces looks like? The Bristol stool scale is a 7-point standard used for clinical practice and research, and a good indication of whether your child has constipation. Check your child’s stool content and compare it with the following guide. Normal feces should be the texture of Types 4 to 6, rather than dry and lumpy as shown in Types 1 to 3.

Physical constipation

In hard lumps or shaped like nuts

Functional constipation

Sausage-shaped or lumpy stools

Like a sausage but with many cracks on the surface

Normal bowel movements

Like a sausage or snake, smooth & soft

Soft blobs with clear cut edges

Fluffy pieces with ragged edges or mushy stools

Diarrhoea

Watery with no solid pieces or entirely liquid

Effects of prolonged constipation

If your child has experienced this condition for a prolonged period, it would be wise to call your doctor. Your healthcare professional may prescribe probiotics, laxatives, or even surgical treatment for critical cases or organic causes. Do seek medical attention if your child is suffering from any of these following symptoms.

Colon dilation (where the colon is unnaturally extended)

Rectocele (or rectum prolapse)

Poor appetite of your child, not accepting even their favorite treats or formula

Slow weight gain in your child

Persistent pain in the abdomen, especially when accompanied by crying

Vomiting

We hope this article has helped answer some of the questions you may have for child constipation. If in doubt, be sure to consult a medical professional for advice.

Reference:

1. NHS. Constipation - causes. Available at: http://www.nhs.uk/Conditions/Constipation/Pages/Causes.aspx 

2. Afzal NA, Tighe MP, Thomson MA, et al. Constipation in children. Ital J Pediatr. 2011;37:28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143086/

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.