Constipation in children

Constipation is the passage of ‘Hard stools’ or very infrequent passage.
Constipation is becoming more common in children, which could be due to changes in food habits like replacing breastmilk with formula milk, excess fast food intake, decreased fruit consumption and replacing drinking water by colas.
All these could pose a risk factor for causing constipation.

How does the digestive system in my child work?

The success of using the toilet regularly depends on 2 factors.
One is that the food should have high fibre content to help easy movement through food pipe, and the food pipe should regularly contract to move the food products forward.
It’s important to remember this as the treatment for constipation works in above manner.

How do I know my child is constipated?

Constipation may be overtreated as it is less understood by some medical professions.
Any tummy pain in your child may be diagnosed with constipation by unskilled medical professionals.

The definition of constipation is as below.

Less than two stools per week
If child passes very hard stools that could cause pain or even bleed
Tummy pain leading to child crouching holding their tummy
If the child goes to toilet but does not pass stool or doesn’t go the toilet at all

Remember your child should have any two following features. Always talk to your doctor for confirmation.

These features should be present for weeks together before constipation is diagnosed.

How would my child with constipation present?

Children with constipation may have pain that is constantly present during the day which appears as tummy cramps.
During these episodes, the child may hold their tummy and have to posture (like bending forward)
The child may have pain while using the toilet as they pass hard stools instead of soft ones.
This hard stools may cause bleeding and severe pain. Due to this pain, the child may avoid using the toilet and it only complicates the matter even more.

What are the causes of constipation?

Diet variation plays an important role.
Decreased consumption of fruits, vegetables cause constipation as the fibre in this help soften the stool.
The child should drink plenty of water (see water section) to have regular bowel movements.
There are various other causes like hormonal changes (example thyroid hormone), allergies like cow’s milk allergy, surgical causes of obstruction and brain or spine deformities.

How can I help avoid constipation in my child?

Prefer breast milk to formula feeds in your newborn child.
Give adequate quantities of fibre in the diet with fruits and vegetables in older children.
Consume adequate water
Make a regular habit in your children to use the toilet every day.
Avoid your children postponing going to the toilet.
Remember to always reward your child when they maintain good habits. Never scold them as it leaves a bad impact on them.

How is constipation treated investigated?

Just by pressing your child’s tummy, the doctor may feel for stool mass.
Some doctors may insist on X-ray, but it’s not always necessary.
If more serious causes are suspected, they may need to do various blood tests, urine tests and surgical procedures to find the reason.

How is constipation treated at the hospital?

Other than diet changes, a fibre product(macrogol or movicol) is given every day to soften the stool.
Along with the fibre, stimulants like picosulfate and senna are given to stimulate the evacuation of stool.
Enemas- Enema is when a liquid to dissolve the hard stool is given to your child through the bottom. It is a relatively safe method and effective. Your child may need more than one session of an enema.
Colon cleansing- The child is asked to drink 3 to 4 litres of the medicine over 4 hours to clean the intestines

Remember

This treatment should go on for months together and only be stopped after seeing your child’s doctor in a few months time.

What are the danger signs?

See a doctor immediately if any of the below features-