CONSTIPATION IN CHILDREN

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CONSTIPATION IN CHILDREN

Constipation is a common problem in children of all ages. A child with constipation may have bowel movements less frequently than normal, hard bowel movements, or large, difficult, and painful bowel movements.

Functional constipation is the commonest one.

Most children with constipation do not have an identifiable underlying medical problem causing their symptoms. Constipation generally resolves with changes in diet, behavior, or sometimes with medicine.

WHY CONSTIPATION DEVELOPS

Constipation is particularly common at three times in an infant and child’s life(a) after starting cereal and puréed foods,(b) during toilet training, and(c) after starting school. Associated factors are

Pain — When the child does have a bowel movement, it can be painful and lead them to withhold (avoid going) in an effort to avoid more pain.

On occasion, a child may develop a tear in the anus (called an anal fissure) after passing a large or hard bowel movement. The pain from the tear can lead to withholding

Unfamiliar surroundings — A child may delay moving his or her bowels if they do not have a place where they feel comfortable having a bowel movement, or if they are busy and ignore the need to use the toilet. This can happen when the child starts going to school and avoids having a bowel movement because of hygiene concerns or being embarrassed about using the toilet at school to pass a bowel movement.  

Teach your child that it is a good idea to have a bowel movement when his or her body tells them it is time to do so, and reassure him or her that it is OK to use the bathroom at school. This type of training from early childhood may prevent development of constipation when your child starts school.

Medical problems — Medical problems cause constipation in less than 5 percent of all children.

? what should be done if child continued to pass hard/painful stools.
Treatment goals are to educate the child and family about the problem, to use medication to assure painless defecation, and to provide continuing availability for guidance and effective reassurance.

Medication helps to make the stools soft and take away the painful experiences. It takes repeated painless bowel movements before the patient loses the fear of defecation.

As directed by a physician, non-stimulant softeners such as mineral oil, milk of magnesia, lactulose,  and polyethylene glycol are appropriate for softening the bowel movements. The choice of medication depends on the ease of administering the medication to the child. The dose of medication needs to be adjusted to produce soft, narrower stools.

By softening the stools, the child will experience painless defecation. Over time the fear resolves and the child learns to relax the pelvic floor. The fear of a painful bowel movement may last several months despite having soft stools. Also, relapses are common. It is important for parents to be consistent with giving daily medications because just one painful bowel movement may trigger a return to withholding.

Other interventions may benefit the child, including:

A small reward for sitting on the toilet, or for informing the parents when they have the urge or a successful bowel movement.

Anorectal biofeedback may be required for some children .

A brief trial of stimulant laxatives, to help train patients to recognize and respond to the urge to defecate.

Dietary recommendations
  • Fruit juice – Certain fruit juices can help to soften bowel movements and can be added in children 6 months and older.
  • Fluids – It is not necessary to drink large amounts of fluid to treat constipation, although it is reasonable to be sure that the child drinks enough fluid.
  • Food recommendations – Offer your child a well-balanced diet, including whole grain foods, fruits, and vegetables. Praise your child for trying these foods and encourage him or her to eat them frequently, but do not force these foods if your child is unwilling to eat them. You should offer a new food 8 to 10 times before giving up. You may want to avoid giving (or give smaller amounts of) certain foods while your child is constipated, including cow’s milk, yogurt, cheese.

A fiber supplement may be recommended for some children. Fiber supplements are available in several forms, including wafers, chewable tablets, or powdered fiber that can be mixed in juice.

  • Milk – Some children develop constipation because they are unable to tolerate the protein in cow’s milk. If other treatments for constipation are not helpful, try having the child avoid all cow’s milk (and milk products) for at least two weeks. If your child’s constipation does not improve during this time, you can begin giving cow’s milk again.

If the child does not drink milk for a long time, ask your child’s doctor or nurse for suggestions about ways to be sure that he or she gets enough calcium and vitamin D.

Stop toilet training — If your child develops constipation while learning to use the toilet, stop toilet training temporarily. It is reasonable to wait two to three months before restarting toilet training. Reassure your child that it will not hurt , and praise the child for sitting on the toilet, even if he or she does not have a bowel movement. Avoid punishing or pressuring the child.

Establish regular toilet time — If your child is toilet trained, encourage him or her to sit on the toilet for 5 to 10 minutes once or twice a day after eating. The child is more likely to have a bowel movement after a meal, especially breakfast. Reward the child with praise or attention for sitting, even if he or she does not have a bowel movement. Reading to the child or keeping him/her company while in the bathroom can help to keep the child’s interest and encourage cooperation.

 

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