Pediatric constipation is a year-round problem, but summer is a particularly good time to talk “kids and poop” because travel, camp and vacation bring about changes in a child’s environment and daily routine that can lead to constipation.
Constipation is often deemed a problem of middle-aged or older adults, but as pediatricians, we know poop troubles don’t discriminate by age. One of 10 visits to the primary care pediatrician is related to constipation. And although there is no research showing the number of constipated children is on the rise, nearly one-fourth of referrals to pediatric gastroenterologists are for constipation.
Nor is constipation always a minor nuisance. Trouble passing stool can interfere with quality of life and make a child cranky and miserable. Severe cases of constipation can cause serious abdominal pain and even send a child to the emergency room. In fact, research shows that chronic constipation is one of the most common culprits sending kids to the emergency room for belly pain.
The Basics of Constipation
Constipation is diagnosed when a child has a change in the frequency of bowel movement and the amount and consistency of bowel movements (smaller, harder or pebble-like stool), often accompanied by straining and pain during defecation, by periodic leakage of stool and by a sense of incomplete bowel emptying. Constipation often emerges around the age of potty-training when kids start to withhold poop.
[See: How Often Should I Poop, and Other Toilet Topics.]
How Often Should My Child Pooop?
Normal bowel movement patterns vary from child to child. For some kids, having bowel movement three to four times a week is perfectly fine. For others, a twice-a-day bowel emptying is the norm. Instead of focusing on a number, we look for a change in overall pattern, accompanied by discomfort, such as pain or abdominal distention and underwear soiling.
Triggers
Withholding stool. The main culprit behind constipation is poop withholding, which typically happens after a child has passed a large stool accompanied by pain. To avoid experiencing the discomfort again, a child may begin to “hold it in.” Premature potty-training can contribute to constipation because the child can see withholding stool as a positive behavior.
Another common reason for withholding stool is a child’s reluctance to use public toilets in an unfamiliar environment, such as new school, camp or during travel.
Withholding stool can precipitate constipation because it ignores the natural nerve signals that tell the colon it needs to be emptied. Thus, withholding poop dampens the colon’s ability to contract. Retaining stool also causes the colon to expand. As it does, stool accumulates and grows harder and more difficult to pass. Once the colon gets bigger, it doesn’t move as efficiently.
Diet/exercise. While diet may not be the primary cause of constipation, what a child eats, or does not eat, can have profound effects on bowel health. Generally, fiber-rich foods such as fruits, vegetables and grains help create bulk in the intestine and stimulate movement. Dehydration can also lead to constipation so drinking water is extremely important. Low activity can also contribute to constipation.
Underlying medical conditions. Nine out of 10 kids with constipation have “functional” constipation, which is not related to any underlying disease. However, a small number of patients may have a serious underlying disorder that can manifest in serious constipation. Examples include neurologic problems, disorders of the endocrine system and metabolism and anatomic problems, as well as a rare congenital disorder known as Hirschsprung’s disease, marked by missing nerve cells in the colon.
[See: What to Eat, Drink and Do to Relieve Constipation.]
How to Banish Poop Trouble
Make a poop schedule and stick to it. Habit and conditioning can play a powerful role here. If a child is already potty-trained, schedule toilet time after meals, at least twice a day. The child should spend 5 to 10 minutes on the toilet.
Watch out for the following signs of “withholding,” particularly among younger children:
— Squatting, rocking back and forth and shaking or scissoring their legs, a behavior we call the “poop dance.”
— Withdrawing quietly into a corner or under a table.
— If your child looks as if he or she is trying hard to pass stool but nothing comes out, chances are the child is withholding.
To counter the effects of withholding, encourage your child to spend time on the toilet if you see withholding behavior or if your child is having belly pain.
There’s a right way to poop. Yes, there is a right and wrong way to poop! To help colon emptying, a child should sit upright on a training potty or a toilet, with feet planted firmly on a flat surface (floor or stool). This posture allows a child to push more effectively.
Positive reinforcement. It’s common for parents to get frustrated with a child’s bowel habits, but creating fear and negative emotions around pooping only fuels the vicious cycle of withholding poop. Avoid showing frustration or anger if a child is constipated, has accidents or soiled clothing. Consider an incentive program that includes stickers or small rewards. This will help a young child see passing stool as a positive thing. Don’t push your child to potty-train too early, and don’t succumb to pressure from family and friends on timing of potty-training. Children potty-train at their own pace.
Eating and drinking their way to a healthier colon. Ensure your child’s diet is rich in fiber and includes plenty of water. How much liquid a child should drink varies by age and weight and should be guided by your pediatrician. In general, younger children should take in about 24 to 36 ounces of water a day, while older children and teens should follow the 8-glasses-a-day rule. Infants, whose primary source of liquid intake and nutrition is breast milk or formula, should not be given extra water.
Medication. Many children benefit from medications, particularly those with severe constipation and those in whom diet and behavioral therapy fall short. Usually, we start with over-the-counter osmotic products like polyethylene glycol-electrolytes, lactulose or milk of magnesia, which increase the amount of water in the colon and keep the stool soft and easier to pass. Stimulant medications that cause the colon to contract can also be used in some patients. In many cases, a combination of these may be needed. Treatment should always be done under a doctor’s supervision.
[See: Foods That Cause Bloating.]
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Coping With Childhood Constipation originally appeared on usnews.com
