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A Parental Guide to Effectively Managing Constipation in Children

To put it mildly, constipation can be a difficult and uncomfortable ailment to deal with. This is doubly so when caring for a child that is suffering from constipation, especially when the benefits of treatment options aren’t necessarily understood by the young person in question.

Constipation in Children

So, how do you go about managing and alleviating constipation in children? Before we answer this question, we must first discuss what it is, as well as signs and symptoms to look out for prior to seeking treatment.

What is constipation?

Constipation is loosely characterized by hard bowel movements, going to the toilet less regularly than normal, or feeling pain or straining when attempting to pass stool. With that said, what is considered to be a normal bowel movement in children?

This will depend on how old your child is and what they tend to eat. During the first three months of life, infants will have around three soft bowel movements per day. As they get older, however, the number of bowel movements will steadily decrease.

By two years of age, most children will have at least one bowel movement per day. Assuming healthy bowel function, these stools are soft but solid. However, this will vary from child to child and you only need to think about constipation if it seems that passing stool is causing problems or discomfort for your child.

Signs that your child may be constipated

  •       Stools are hard, dry, and look like nuts.

     

  •       Pains in the belly or bottom.

     

  •       Pain when passing a stool.

     

  •       Leaks small watery stools into the underwear (soiling), if he or she is already toilet trained.

     

  •       Avoids going to toilet or consistently resorts to hiding and unusual movements, such as rocking backward and forwards while stiffening their bum and legs. Alternatively, they may squat or get into an unusual position. These movements may look like your child is trying to pass stool, but it is often the opposite and they may be trying to avoid doing a poo for fear that it is going to hurt.

     

  •       Another way to see if your child is constipated is to look at their stools. Stools that look like small, hard nuts or like a cracked, lumpy sausage are signs that your child is likely constipated.

Why does constipation develop?

Constipation can occur at any time, after a change in diet or a change in the child’s environment. For some children, it occurs because they ignore the urge to have a poo because they are too busy playing. If this happens often, the brain starts ignoring these urges and soon your child may not be aware that there is a poo to pass. This then leads to a gradual build-up of poo that becomes dry, hard and difficult to pass.

Some children will hold back (also called ‘withholding’) from using the bathroom as they have previously felt pain when doing so. This can form a nasty cycle, as when the child eventually passes the poo it is larger, dry and causes more pain, which causes more fear of passing a poo and the nasty cycle continues.

The nasty cycle of pain and withholding and worsening constipation

Times when constipation is more likely to develop

There are three stages of the children’s development when constipation is more likely to develop: when they first start eating solids, during toilet training and after starting school. While the parents know “what’s happening” with their young children, both through nappy changes and supervising toilet training, constipation can be “out of sight” with older children, especially if they have started school.

The school-aged child

Some children do not want to use the bathroom at school as it is unfamiliar or is ‘too public’, which can lead to withholding. Often, your child will not raise this problem with you, but they may become constipated and soil their pants. If your child suffers from constipation for an extended period of time, the muscles in the bottom (rectum) can become stretched and your child may lose the ability to feel the urge to pass stool.

Soiling can be due to overflow diarrhea, where small amounts of poo squeeze past the large hard stools and leak out of the anus. If your child develops constipation or starts soiling themselves around this time in their life, treat constipation, monitor how often they pass a poo at home and ask about what happens at school. Then, if you think there is an issue at school, raise it to see how it can be addressed. You can also try eating breakfast earlier to give your child time to pass a poo before they leave for school.

Constipation in children younger than 4 years needs special care. If your toddler or infant is constipated, please consult a doctor.

Treatment options

If you believe your child may indeed be suffering from constipation-related symptoms, luckily, there are a variety of options for alleviating or lessening the issue. These can include:

Regular toilet sitting

It is important that children with constipation develop the habit of regularly sitting on the toilet. The best time to go to the toilet is after eating a meal, as the act of eating will start a movement within the whole gastrointestinal tract.

Encourage your child to sit on the toilet (for 3 to 5 minutes) within half an hour of eating breakfast and/or dinner. Provide a footstool that your child can place their feet on to feel stable and secure while sitting on the toilet. You may want to give them a book or cartoon to read, as this can help pass the time, while potentially distracting them from any bathroom-related anxieties. Use a timer to avoid arguments about sitting times.

Rewards can be helpful for your child to encourage sitting on the toilet (he or she does not have to pass a poo to receive a reward). For pre-schoolers, try stickers or a song as a reward. For older children, it may be doing an activity book or computer time.

Healthy diet

Increasing fiber and fluids gradually in your child’s diet can help prevent constipation in some cases.

However, for a child with repeated constipation, drinking extra fluids and eating a high-fiber diet are often not enough to treat constipation and a laxative is needed. You can add more fiber into your child’s diet with:

  •       2 serves of fruit each day (leaving the skin on).

     

  •       3 serves of vegetables each day.

     

  •       high fiber cereals, such as brans, oats, whole grains.

     

  •       wholemeal or grainy bread, or white bread with added fiber.

Keep a “poo diary”

Keeping a record of your child’s bowel movements can help your doctor or nurse better understand and treat your child’s constipation.

Laxatives

Laxatives can make toileting less painful. A number of laxatives are available in the pharmacy and they work differently.

For children 4 years of age and above, osmotic laxatives, like OSMOLAX Relief, are a good option after trying to increase fiber and fluid intake and encouraging regular toileting.

Just remember to always read the label, use only as directed, and if symptoms persist, see your healthcare professional.

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