What is it?
Constipation is when your child has hard poo or does not empty their bowel regularly. There is a lot of variation in the firmness and frequency of poo in normal babies and children:
- breastfed babies may have a poo following each feed but some breastfed babies only have a poo every seven to ten days
- bottle-fed babies and older children will usually have a poo at least every two to three days
- If your child over one year of age has a poo less frequently than every three days and the poo is firm, they are likely to be constipated.
What are the signs and symptoms?
- your child’s poo is hard and “pebble-like”
- your child has not had a poo for four days or more
- your child complains of pain or cries when having a poo
- there is bright blood around the poo due to tears in the anal skin (anal fissures)
- your child complains of tummy pain, especially if it is relieved by having a poo
- constipation can increase the risk of urinary tract infections, leaking urine (urine incontinence), and bedwetting
- there are soiling accidents
What causes it?
Constipation in children is common.There are many possible reasons for your child’s constipation. Often, it is a combination of factors:
- a natural tendency to having a slower gut movement
- a poor diet can aggravate constipation in children who already have this natural tendency; a poor diet will be high in animal fat (meat, dairy products, eggs) and refined sugar (rich desserts and other sweets) but low in fibre (vegetables, fruits, whole grains). There is little fibre in most convenience or “junk” food
- less activity and not eating and drinking as much, for example when your child is unwell
- not drinking enough fluids
Bowel habit can also be important. Your child can become constipated if they:
- ignore the urge to have a poo or
- fail to fully empty the bowel of poo when going to the toilet
How a vicious cycle can be established
Constipation often starts after one hard poo has caused pain. The natural response to a painful experience is to try and avoid or escape it in the future. Therefore, the next time the child feels the urge to poo, they “hold on” in an attempt to avoid passing another painful poo. This results in the poo becoming firmer, larger and even more painful when it is eventually passed and the child becomes even more reluctant to poo in the future. In this way a vicious cycle is established:
hard poo – pain – try to avoid pain by “holding on” to poo – hard poo – pain etc.
What if constipation continues for a long time?
If constipation continues for a long time and the bowel is not emptied regularly, the bowel becomes overloaded and stretches. The overloaded and stretched bowel means the sensation to pass a poo is lost and can make soiling accidents more likely.
Could childhood constipation be due to an abnormal bowel?
Constipation is hardly ever due to an abnormal bowel. Most bowel problems show up in early life and are diagnosed within the first few months.
If your child passed meconium (the green / black poo newborn babies pass) within 24 hours of birth, it is unlikely your child has a bowel problem causing constipation.
What can I do to treat it?
Try simple measures first:
- increase the water your child drinks daily – ensure they have a good drink at each meal time and extra drinks when it is hot
- increase fruit and vegetables in your child’s diet
Fibre makes the poo softer and easier to pass. Giving your child (aged over 15 months) more fibre in their diet can help prevent constipation and also treat short-term or very mild constipation. Fibre is also important long-term for regular bowel functioning. If your child has had constipation a long time, just increasing fibre without other treatment is unlikely to resolve the problem.
To add more fibre to your child’s diet, you can:
- give at least three servings of fruits each day; fruits with the peel left on, such as plums, prunes, raisins, apricots, and peaches have a lot of fibre as do kiwi fruit and corn
- give at least three servings of vegetables each day; this includes potato, pumpkin, kumara
- give cereals high in fibre, such as bran cereals, whole grain cereals, porridge; avoid refined cereals, such as corn flakes, rice bubbles or those with added sugar
- give wholemeal breads instead of white bread (except in children under 15 months old)
- try adding bran to muffins and other baking, or add it to your child’s regular cereal
- try adding one to two tablespoons of ground flax seed / linseed meal to cereals, soup or mixed into a smoothie
- give legumes (beans and peas), including baked beans, hummus, lentils
- give strained prunes to babies, up to three tablespoons a few days each week
It is also important to increase your child’s intake of water with the increase in fibre.
- Try giving your child one glass of undiluted apple juice or kiwi fruit juice daily – do not give undiluted juice to infants under six months of age
- Consider natural bulk laxatives. Remedies such as linseeds (flaxseed), slippery elm and psyllium aid in moistening and adding bulk to the stool. For stubborn cases herbs such as dandelion root, butternut, yellow dock, chamomile and licorice work exceptionally well
- Encourage a regular toileting habit:
Encourage your child to develop a regular toilet habit by sitting on the toilet for five minutes once or twice a day preferably after a meal (breakfast is best). Even if they don’t do a poo, still encourage this habit.
- make sure your child is comfortable on the toilet
- get a stool for them to rest their feet on to make sure your child’s knees are higher than their hips
- the use of a toilet seat inner can be very useful for little bottoms. If your child is not relaxed because they’re worried about falling in to the toilet they tend to tighten their pelvic floor muscle and this makes it difficult to have a relaxed successful poo
- encourage your child to lean forward and rest their elbows on their knees
- teach them to push their stomach (abdomen) out when pushing
- make the toilet child-friendly and fun with books, toys, a blackboard etc nearby; it’s a lonely place and children get bored
- incentive or ‘star’ charts are useful to reward your child for sitting on the toilet and doing a poo, and can help keep track of progress
- for bottlefed infants, consider experimenting with various infant formulas to find the one that makes the poos softer and easier to pass
- encourage exercise
If these measures do not work or you would like to come and discuss and sort out treatment with a health professional then contact Sheena Hendon Health