Constipation, the passage of infrequent, hard and painful stools, is a common problem, affecting three per cent of pre-schoolers and one to two per cent of school-aged children. Pooing once every few days is not abnormal if that is your child's usual pattern. In fact, 96 per cent of children aged three to four show tremendous variety in pooing patterns: anywhere from three stools a day to three a week.
What causes constipation?
The original cause of constipation might have been any one of these:
- Diet. Not enough fibre-rich foods.
- Behaviour. Your child may have attempted to control evacuating during the period when you began toilet-training.
- Response to pain. One painful bowel movement can cause your child to fear passing stools and to withhold further movements.
Whatever the original cause, stool sits in the rectum, becoming larger and harder. Each passage hurts, and the problem starts to perpetuate itself as the child resists relaxing and letting nature take its course.
When constipation persists for a while, sometimes soft stool coming down the pike leaks out past the old, hard stuff. Smears of semi-liquid stool or even what appears to be diarrhoea may turn up in your child's underwear. This diarrhoea-like condition, known as overflow incontinence, is not a legitimate bowel movement, nor is it in your child's control. It is, however, a sign that something needs to be done, especially if the soiling is affecting your child socially.
What to do about constipation
Since there are some physical and medical problems that can involve constipation, it’s a good idea to consult your paediatrician or healthcare provider just to rule those things out. Your child probably won't need extensive tests; mainly the doctor will review the history of the problem and check your child's height and weight and do a general physical examination. Your healthcare provider may want to check inside the rectum with a finger, but if she does it gently, it need not be traumatic or painful.
Re-educate the bowel
The first step is helping the hard stool to come out. There are a variety of options. Your paediatrician may start with a simple glycerine suppository or suggest a paediatric enema preparation. To maintain soft stools, she may want your child to take a stool-softening agent for a few weeks or even months. The goal is to re-educate the bowel: to establish a regular schedule of bowel movements so that the stretched and lazy intestinal walls regain their strength and tone.
Examine your child's diet. Children who drink excessive amounts of milk or who avoid fruits, vegetables and whole-grain cereals and breads may simply have too little fibre in their diet. Add fibre in any way you can: apples and pears instead of bananas, cereal bars instead of chocolate bars, oatmeal biscuits instead of ordinary biscuits and whole-wheat bread rather than white. Snacks of raw vegetables with a yummy dip is also a good trick to get some vegetables down. For fussy eaters, your paediatrician may suggest a fibre supplement.
Focus on reward
Resist punishing your child or expressing anxiety or dissatisfaction when you see her withholding stools or being reluctant to try. Instead, establish a series of rewards when she does produce. Although some cramping and small amounts of blood may be a part of constipation and are nothing to worry about, be sure to consult your healthcare provider straight away if your child's abdomen swells suddenly, if she is both vomiting and constipated, or if there is a significant amount of blood or pain.
Finally remember that constipation is a common problem in young children, especially the fussy eaters. Tweaking your child’s diet might resolve the issue more easily than you'd think!