Sunday, 01 June 2014
Causes of constipation in kids explained
Constipation can cause great distress to your child and to you. Tamara Corin discovers the importance of fibre - and we're not talking broadband here!
There’s nothing that pulls on the heartstrings of a mother more than seeing your child in pain.
It’s in our maternal makeup to want to comfort and cherish our children, but unfortunately on some occasions love can’t heal – not even sore baby bums!
Constipation is a common condition, affecting up to one in three children in the UK, and in 25 per cent of cases it starts when the child is a baby. Because it’s becoming so common, in 2010 the National Institute for Health and Care Excellence published the first ever national guidelines on the diagnosis and treatment of constipation in children, available on its website.
While it’s primarily written for healthcare professionals, it also allows parents to better understand the condition and manage it appropriately. Constipation can develop for a number of reasons and does not normally mean there is anything physically wrong with your child – or that you’re a bad mum. The signs of constipation in children are rarely recognised soon enough but if they are spotted early, the right treatment can resolve the problem quickly and easily.
Cause and effect
The most common cause of constipation in children over 20 months is potty training. Ask any group of mums when it's best to tackle this and they'll debate it for hours. The truth is, it's very much an individual decision for both of you and is usually only a success when your child is ready, no matter how many chocolate buttons you offer as encouragement!
When you potty train a child, many mums will know, you'll almost always find they are more reluctant and far less relaxed about doing a poo than a wee. This could be because your child has picked up on the idea that doing a poo is 'dirty' – whether because of the smell or simply the embarrassment that's frequently associated with poo among children.
Toddlers can also be too busy playing to tell you they need to poo. And who can blame them? They have a nappy to catch their mess and someone is always on hand to wipe them clean.
When they reach nursery or early school age, they may be reluctant to do a poo because of the cleanliness (or not!) of the toilets, lack of confidence in wiping their own bottoms, or an absence of privacy.
'Over time, their brain learns to ignore repeated urges to go to the toilet,' explains consultant paediatric gastroenterologist Dr Warren Hyer. 'The longer the stool remains in the colon, the more water is absorbed from it, making it hard and dry. This makes it even more difficult and painful for the child and they end up holding in the stool.'
Just one painful experience can create a sense of fear in your child every time they feel the need to poo.
Mild constipation can be relieved by a change in diet and more fluids. But for children with a long-term problem, a different approach is needed. Emily
Kaye had suffered from constipation since birth. Her mum Miriam took her to several specialists but nothing helped. Then, when she was two years old, she was prescribed a preparation called Movicol.
'It changed her life,' says Miriam. 'Emily's consultant was very much against handing out suppositories because they just relax the muscles of the bottom. Movicol helped soften her poos, so she was straining less and this took away the fear of doing a poo.
'To this day if Emily doesn't drink enough she gets constipated. But more fluids and some Movicol instantly helps. If only I had known about it earlier. It would
have saved Emily from years of pain and me from feeling like a bad mother.'
Signs of constipation to look out for in your child
There are a number of early warning signs you can look out for in your child and act on quickly, to prevent constipation from becoming a long-term problem.
The most common are fewer bowel movements than normal (less than three per week in a child over three years of age) and discomfort and straining that causes your child to become anxious and upset while on the toilet.
If your child complains of tummy aches and cramps, that could also be a sign of a build-up in their bowels, making them feel bloated and probably irritable too.
Normal stools are about 70 per cent water, so if your child's are small, dry and hard this means they've been in the bowel too long. They may have done a small poo like this but still feel the need to push because some stools are so hard and dry they remain in their bowels.
The skin around their bottoms can tear and become sore with the strain of pushing. Your child may also pass wind more often – or perhaps they're just following their father's habits!
What early factors may contribute to constipation in my child?
Bottlefed babies are more likely to become constipated than breastfed babies. Breastfed infants will generally pass more stools each day, and there will be more variation in their frequency when compared to bottlefed infants. For example, breastfed infants can have anywhere between five and 40 bowel movements per week, whereas formula-fed infants will tend to have between five and 28. Changing the type of milk or formula your child is taking can cause constipation, so always try to stick to the same brand.
Aiden Posen was only 12 weeks old when he first became constipated. After a week without any bowel movements, he eventually managed to pass what looked like rabbit droppings. 'He was in excruciating pain and his stomach was very hard to the touch,' explains Aiden's mother Helen. 'After several visits, our GP prescribed glycerol suppositories, which are a bowel stimulant. This helped immediately but was only a short-term solution. Aiden then went through cycles of alternating diarrhoea and constipation for months. He was miserable and because he was my second child I knew he wasn't just a "demanding" baby. I asked our GP for a referral to a gastroenterologist and this is when he was diagnosed with a milk allergy and prescribed a special formula, Neocate.
'After two weeks on the new formula our unhappy baby who had struggled to sleep or even be put down became cheery and started sleeping well. Twenty months later and we still have to keep him off dairy foods but at least he isn't suffering from such terrible constipation anymore.'