For an easy movement

Dr Rajni Ahlawat  

Little Sakshi (5) avoids going to the bathroom in the morning which throws her pre-school morning routine totally out of gear. After lots of coaxing and cajoling when her mother is able to persuade her to go, many a time she comes out in tears complaining of pain. 

The most likely cause is constipation, a common problem among children. Worldwide, up to 4 per cent pre-school age and 2 per cent of school-age children suffer from this problem.

How to spot

It can be fairly safe to say that a child has constipation when he/she is having stools less than every two days. Even when a child passes stools more often than every two days but his/her stools are hard or painful to pass, then also it is a likely case of constipation. 

Symptoms

A child is constipated if he/she is passing infrequent (less than three times a week) or dry, large and hard stools. Sometimes, stools are so large that these may obstruct the toilet. When a child has constipation, he/she can complain of stomach pain and/or have flatulence or pain while passing stools. Sometimes passing hard stools can make cuts inside or outside of the anus which can cause blood in the stools. When a child is really backed up, he/she can develop stool accidents, during which liquid stool is noted in their underwear. Sometimes, parents confuse it with a child is having diarrhoea. 

Causes 

There are a lot of factors that can lead to constipation in children. Majority of children have “functional constipation” which means it can happen either due to change in their diet or daily routine, or due to stool-withholding behaviour. If your child is not eating fibre-rich foods or not drinking enough water, it may lead to constipation. Babies can develop constipation around six months of age when they are switched from an all-liquid diet and cereals and solids are introduced. 

Stool withholding is also common in children due to different reasons like when they travel or start school, as they do not want to use public toilets. It is also common to hold stool around the time of toilet training and sometimes to avoid pain from passing hard stools. The longer they hold it back, stools become larger and harder as the water gets absorbed by the lower intestinal track. Then it becomes even more difficult and painful for them to pass stool and this becomes a vicious cycle. 

Over time, the muscles of the intestines stretch due to the amount of stool stored in them and therefore, a child can go for days without getting the urge to pass stool. 

Sometimes, constipation can be a result of certain medical conditions such as low thyroid, celiac disease, anatomical problems of intestine, neurological conditions or as a side-effect of certain medications.

Treatment 

Constipation is treated in different ways. The majority of the time no testing is required. However, depending on your child’s condition, sometimes blood tests or X-rays can be required. 

Mild constipation can be treated with diet and behavioural changes alone. A high-fibre diet such as whole grains, legumes, nuts, fruits and vegetables should be given. Processed and junk food should be avoided. Fibre supplements can also be helpful if a child is not able to take adequate dietary fibre. The American Academy of Pediatrics recommends that children between the age of 2 and17 years should take the daily amount of fibre, which equals the age of the child in years plus 5. For example, a 5-year-old child should consume 10 gm of fibre daily. It is encouraged that children should drink more water, at least half to two litres daily depending on the age. For children more than one year, milk intake should be limited to only two glasses daily and the rest should be substituted with water. 

If a child has severe constipation, medications can be used to help regulate stools or make them soft. Medicines can also help to control symptoms but the best practice should be to make the child develop good bowel habits, as it is important to prevent constipation in future. 

After a person eats, the intestines squeeze to move the food along, benefit of this natural urge can be used to help the child. Therefore, it is recommended to ask children to sit on the toilet for at least 5 to10 minutes within 30 minutes of finishing meals. 

If your child has constipation or stool leakage, it is important to maintain a positive attitude. Getting angry or making your child feel ashamed can only make the problem worse. Rewarding a child with a favourite activity for just sitting on the toilet or passing stool is also recommended. 

How long is the cure

Constipation takes time to develop and therefore it takes time to treat as well. It has been shown that if a child is treated sooner, there is a better chance of success. But if treatment is delayed for few years, then there are chances of the child to develop constipation even when they become adults. 

Prevention 

Encourage children to drink plenty of water and eat foods that are high in fibre. Help your children set up a regular toileting routine and encourage them to be physically active. Exercise, along with a well-balanced diet, is important for a healthy life. 

— The writer is a paediatric gastroenterologist, Marshfield Children’s Medical Centre, USA