Constipation can happen at any age but is particularly common in children. Let’s look at the science first. The food we eat goes through our stomach, into our small intestines where lots of the nutrients are absorbed, then into our large intestines (or colon) where most of the water is absorbed. After all these processes, you are finally left with stool. In the simplest terms, the less we drink, the harder and drier our stools are.
So why does this matter more in children than adults? Well, as adults we have far more control over when we push out stool, and we accept that sometimes this can come with a bit of discomfort or pain. For a child, the pain of doing a poo is scary. They don’t understand it and they don’t like it. Therefore – like many learned habits at that age – they shy away from anything that causes discomfort and pain. This leads to a fear of going to the toilet, which leads to a vicious circle: more constipation, which, in turn, brings more discomfort.
Fibre is very important in helping and preventing constipation. It acts to bulk up the stool, helping your body move it through the intestines. Foods high in fibre include fruits, vegetables, cereals and wholemeal bread. Including these in a child’s diet can sometimes be tricky, but two easy tricks are blending extra vegetables into sauces or soups, and using dried fruit such as raisins or prunes as snacks.
Children need time to do a poo, and a space free of interruptions or feeling pressured. Getting in the right position can help. The squatting position, where the knees are above the hips, makes squeezing a poo out just a bit easier. You could try sitting them on the loo with their feet on a stool or upturned bowl.
If your child is going less than three times per week, is complaining of tummy pain, their poo is very hard or like little rabbit droppings, if they feel like they still need to go afterwards, or they are straining very hard to get a poo out, it's likely they have constipation. This can even cause a little bit of bleeding in the bowl, as hard stool can tear the anus, causing a painful little crack or anal fissure. They may also soil their pants with runny poo, indicating they have lots of older and more solid poo that can't be shifted.
If this has been for a couple of weeks without resolving itself, book an appointment with your doctor. It's a good idea to go with a diary of food, drink and poos (and their consistency) for the last week or so. They may examine your child and either consider more investigations, give advice or prescribe laxatives.
You should be aiming for a soft stool that's easy to pass at least every day, but it can take a bit of time and perseverance to get there.
Laxatives are medications that help loosen stool and increase the frequency of bowel movements. They fit into two categories: stimulants and osmotics. Stimulant laxatives like senna encourage the bowel to contract and push stool through the body. They are more commonly prescribed to adults than children.
Osmotic laxatives such as Movicol or lactulose seem to suit children better. These work to soften stool by keeping it hydrated. Imagine the stool is a sponge - usually the colon's job is to reabsorb water from stool back in the body, but the osmotic laxative prevents this, keeping the stool like a big squishy sponge, passing easily through the digestive system to the rectum and softly out the other end. It requires children to drink plenty of water to aid this process and needs to be taken for a few days to see results. This medication is widely used and considered very safe. Some children require daily osmotic laxatives for an extended period of time - months to years - to support normal bowel movements as they grow up.
Children often get distracted with the wonderful things in the world around them, so it's easy for them to forget to drink. Keeping a cup or glass filled with water nearby will dramatically increase the chance of them drinking small amounts throughout the day. Schools have got much better at allowing children to have water in lessons, but as school makes up such a large part of their week, make sure that your child is in a position to drink through the day.
Laxatives can be difficult to get down children. Flavoured versions dissolved in water do entice children, but it is still hard for parents. Using juice can be a good way to disguise the flavour, but the best advice is to try to stay relaxed. Your child will read your cues, so if you are anxious and desperate to get them to take it, they will feel the pressure and become reluctant. Give it time, and your patience will be rewarded with success.
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