A while ago, I wrote an article about constipation in babies under the age of 6 months. In this article, we will discuss the possibly less cute, and sometimes, slightly more smelly, poos of older children.
Constipation is a problem that will affect one in three children at some point in their lives, so it is not unusual for it to be a reason children are brought to see us. Generally, you only need to worry about the consistency of your child’s poo and how often they are going if it is causing an issue for them, such as causing tummy pain or pain in the bottom. It is less well known that in some cases, constipation can cause soiling of underpants, or new day or night wetting.
As children get older, several things can happen which can contribute to a change in bowel habit and lead to constipation, these include;
- Ignoring the urge, for example if they are too busy playing
- Holding on, after a painful or frightening experience opening their bowels, possibly after passing a large stool after they have been ignoring the urge!
- A change in toilet environment, for instance, after changing day care or starting school
If your toilet trained child becomes constipated, it is important to encourage them to sit on the toilet at least three times a day, setting a timer to encourage them to stay for between 3-5 minutes and rewarding them with a suitably exciting reward or sticker chart! Sometimes boys need reminding to sit to poo every day if they have started to wee standing up.
The position your child adopts to sit on the toilet can make a big difference. Their feet should be resting flat, maybe on a stool, with their knees above the level of their hips. They should be encouraged to lean forwards and to push their tummies out, which helps them relax their muscles, helping the poo find its way out.
Diet is less of a factor in treating constipation in children than adults, but increasing fibre intake is important and can help stop it recurring. This can be done by trying to encourage at least three serves of vegetables and two serves of fruits a day, wholemeal bread in place of white bread, and offering less processed cereals for example Weetbix or porridge in place of Cornflakes or Rice Bubbles. High intake of cow’s milk, and not drinking enough water can also contribute to constipation.
If these strategies don’t help, or your child is distressed by their bowel habits, it may be time to seek professional help, which may be in the form of your GP or an Early Childhood Health Clinic. Very rarely do we need to arrange an x-ray or other investigations to diagnose constipation, usually we are able to do this by listening carefully to the history and feeling your child’s tummy.
Sometimes a laxative will be recommended. There are many, many different types, and the specific one right for your child’s situation will be decided by your health care professional. These medications are very safe and will not cause a ‘lazy bowel’. They may need to be continued for weeks, and maybe even months, and it is important that they are not stopped too soon or too suddenly, or there is a high chance the constipation will return.
So, in summary, constipation is a very common issue that will affect one in three children at one time or another. Usually, it will respond to simple strategies that can be tried before seeing your GP. If medication is needed, it may need to be used for some months, and it is important to be aware that these medications are very safe for children and must not be finished too soon or too suddenly or the constipation may recur.