Your child passes stool after every feed. You are worried it may not be normal as it does not happen in adults. Sometimes, there isn’t one stool in the entire day. You then thought the child was constipated. You should know what actually constipation in a child is and how this can be prevented and treated.
More About Constipation In Children
Constipation in a child needs more attention than it does in adults. Before knowing what it means for a child to be constipated, it is important to learn about what is normal and abnormal about the bowels in babies and children. A new born in the first week of life may pass around four soft stools per day. The frequency of stools may reduce to around three per day in the first three months. The frequency further reduces as the child grows to around one to two formed stools per day by the age of around 2 years. Babies who are breastfed are rarely constipated, and have more and bulkier stools as compared to the formula-fed babies. The smell, color, consistency, and frequency of stools are different in the formula-fed babies and in children who are transitioned to solid foods. No two kids are alike. Few times a day to once in few days is normal, if the stools are usual in consistency and can be passed without discomfort or straining.
A change from the usual, depending upon the age and the feeding habits of the children may suggest a problem if the stools are difficult to pass. A baby who cries while trying to pass stools may be constipated. Constipation is likely, if the stools are hard or pellet-like. Missing bowels on any day when the usual frequency is once in two days and the stools are easy to pass is not constipation. A child with constipation may adopt different posture when trying to pass stools. Babies may tighten their backs and buttocks, toddlers may arch the back, squat, or stand on tiptoes, and still elder children may shy away from going to the toilet. These may actually be suggestive of the child having fear to pass stools due to the distress and pain experienced while trying to do so.
A child is likely to be constipated, if there are no bowel movements for several days, stools are hard and difficult to pass, are blood streaked, and very different from the usual stools despite of the similar feeding habits in children. A child who has a change in stools along with pain in the abdomen, refusal to feed, disinterest in favorite foods, or a feeling of vomiting may be constipated. Children develop a cranky behavior when constipated.
Causes
Constipation can have many causes. It may be because the child, who does not want to interrupt playing or knows that it is going to hurt to pass stools, tries to withhold the bowel. Constipation may also develop if parents exercise an over ambitious plan for toilet training and begin training too early. Change in diet and routine is a common cause for constipation. It is important to feed the child with enough water, fruits, and vegetables. Introduction of a new food may cause changes in the bowel. Travel, too hot or too cold weather, or change in school or day care is other factor that can cause constipation. Constipation may be caused by some other medicines that the child may be taking like cough syrups containing codeine or due to other medical illnesses like an under functioning thyroid gland, malformations in the stomach or intestines, spinal cord abnormalities, or dehydration.
Taking care of your child
A child with constipation can be helped by offering plenty of fluids and fiber rich foods. The diet of the child should contain lots of fluids, adequate water, juices that the child likes, and milk. Children should not be given tea or coffee. Fiber rich fruits and vegetables, whole grains, and beans add bulk to the stool and facilitate bowel movements. A fiber supplement available over-the-counter may help. Besides these changes in diet, it is important to help the child at toilet. The child should be escorted to the toilet and encouraged to attempt to move the bowel for few minutes. This may be attempted after every meal or at least twice or thrice a day. The child should be rewarded for following proper toilet habits. A diary can be maintained to keep a record o f the bowel habits.
Diagnosis
The doctor may enquire about the regular and current bowel routine and then pass a gloved finger up the anal opening to check for presence of any hard stools in the lower intestine. An X ray may be done to check the shadows of hard stool in the intestines. A contrast dye called barium may be pushed up the anal opening before the X ray. The doctor may like to study the motility of the intestine by passing a small catheter up the anal opening. In the resistant and severe cases, a flexible cord with a mounted camera may be inserted through the anal opening to take a look at the intestines from inside. A piece of tissue may be snipped off the wall of the rectum which is the store house of stools in the intestines. This enables examination for adequate nerve cells in the tissue in the laboratory. Transit studies may be done to study the movement of the bowel. This is done by allowing the child to consume a capsule containing markers that show up on X rays taken over the next few days.
Treatment
Constipation can be helped by paying attention to diet and toilet habits. If persistent for long, the doctor may advise some fiber supplements or stool softeners. If the hard stool gets impacted in the rectum, a laxative may be prescribed to facilitate intestinal motility. An enema or a pill may be placed high up through the anal opening to allow emptying of bowels. This is called ‘cleaning’ of the bowels. Surgery is rarely required. It may help if the constipation is due to obstructions and malformations in the intestine or due to spinal cord abnormalities.
Prevention
Constipation can be prevented by following a routine in toilet habits and by checking the dietary habits. The child should be made to participate in following a toilet routine. They should be allowed ample time to spend in the toilet and should never be rushed. Toilet should not be missed when getting late for school. Fiber is an important component in diet that makes the stool bulky and easy to pass. Vegetable soups, beans, High fiber cereals, porridge, and fruits should be given in plenty. Bran may be added to flavored yogurt that the child enjoys. A mashed banana or pureed fruit may be added to rice for feeding the smaller children. Meat, cheese, and butter should be avoided in diet. The child should be allowed to drink lots of water, and the favorite juices and soups. A fussy child may be offered flavored milk or yogurt. The child should be encouraged to play and run around and keep active. Training your child to adopt healthy routine for toilet can regularize the bowels and prevent constipation.
