Original Article: http://www.mayoclinic.com/invoke.cfm?id=HQ00416
Children and constipation: Ways to cope and when to worry Does your child put off going to the bathroom because he or she is busy doing more important things? Or is your child avoiding the bathroom for fear of a painful bowel movement? This may be a sign of constipation. Parents often think their worries about their children's bathroom habits will end with the final diaper. But successful toilet training doesn't prevent occasional troubles with bowel movements. Constipation is among the most common. To the rescue If constipation is persistent, it can be difficult to manage. Fortunately, parents can detect warning signs and take early corrective action. So just as in those diaper-changing days, it's mom or dad to the rescue again. Constipation refers to infrequency or difficulty in passing stool, or the passing of hard stool at every bowel movement for two weeks or longer. If your child is constipated, he or she may have the following signs and symptoms: a.. Abdominal pain, gas and cramps. b.. Lack of appetite. c.. Increased irritability. d.. Soiled underwear. Some children, out of embarrassment, might hide or throw away their underwear. A large amount of stool leakage in your child's underwear may be a sign that your child has encopresis, a more serious type of constipation that you should alert your doctor about. a.. Large or blood-streaked stools. b.. More frequent urination because of pressure on the bladder. What's the cause? Here's a list of things that commonly contribute to constipation in children. Often, two or more of these factors in combination exacerbate the problem. a.. Eating mainly low-fiber, high-fat and high-sugar foods. b.. Drinking too little water. c.. Ignoring the urge to go to the bathroom. d.. Having a condition such as hypothyroidism or an illness that reduces hunger and thirst. Conditions associated with reduced muscle tone also may cause constipation. a.. Taking a tricyclic antidepressant medication, such as doxepin (Adapin, Sinequan) and nortriptyline (Aventyl, Pamelor), or taking iron supplements. a.. Being inactive. Children are most likely to become constipated when their routines change - for example, when they shift from pureed to solid foods or start school. Even changes in season can disrupt your child's bowel habits. To recognize the problem early, monitor your child's bowel movements during periods of adjustment to any changes. Tips for prevention and relief a.. Drink plenty of fluids. The first thing to consider when dealing with constipation is whether your child is getting enough fluids. Fluids of all kinds are important, although water is best. a.. Consume foods that are rich in fiber. The bulk in fruits, vegetables and whole grains, such as wheat bread and bran cereals, is beneficial. So are prune and pear juices. Diets high in fat, sugar, protein or dairy products may aggravate constipation. In general, foods from animal sources promote constipation, and foods from plant sources do the opposite. Because it can be difficult for parents to know what or how much their children are eating in school or child-care centers, the diet at home becomes all the more important. a.. Pay attention to your child's bowel habits. Encourage your child to go to the bathroom as soon as there's an urge to defecate. If your child is constipated, ask him or her to sit on the toilet after meals. It also may be helpful for you to record his or her bowel movements on a calendar or diary. a.. Encourage daily exercise. Just getting up and moving around is one of the best ways to conquer constipation. Staying active helps the digestive system flush waste from the body more quickly. a.. Help your child relax and loosen up. For constipation, doctors may recommend certain muscle relaxation techniques. For example, young children's feet don't usually reach the floor while they're on the toilet. Placing a footstool underneath their feet may take pressure off their pelvic bone and relax their muscles. a.. Laxatives. A doctor may also recommend a laxative or stool softener if improvements in diet and toilet habits don't ease your child's constipation. Check with your doctor before giving a laxative to your child. a.. Promote thorough wiping and cleanliness. It's important to keep the anal area clean to prevent skin irritation, which can lead to pain during defecation. If the anal area is sore, tell your child to clean it with lukewarm water and a soft cloth. Soap and other cleaning agents, such as bubble bath, may cause further irritation. a.. Talking with your child. Your child may be reluctant to discuss bowel habits, particularly after age 4 or 5, when all children become more modest. However, it's important to reassure your child, whatever age he or she happens to be, that mild constipation is bound to occur at one time or another. It's reasonable to wonder how often your child should be having bowel movements, but there's no definite answer. As a general guideline, though, at least three normal bowel movements a week is probably just fine. When to call the doctor In cases of persistent constipation, your doctor may need to rule out an underlying cause. Give your doctor a call if your child: a.. Goes over 10 days without a bowel movement b.. Has had recurrent episodes of constipation since birth c.. Has difficulty participating in daily activities because of frequent bouts of constipation d.. Develops anal tears or hemorrhoids a.. Has to strain in order to expel stool b.. Has blood in or on the stool c.. Has diarrhea, cramping or stool leakage along with constipation Remain compassionate Constipation is very common in children, and it can happen at any age. Frustrating as the problem may be, parents should do their best to keep it in perspective - it certainly shouldn't cost you any sleep. With your patience and support, your child will establish regular bowel habits in time. HQ00416
