When children become constipated it can be a very trying time for parents indeed. We feel frustrated and helpless at these tormented tots whose daily ablutions start to become a major performance. So how do we know if our youngsters are truly constipated, or whether we are being conned into an attention seeking façade that will usually send most parents into a flurry of deliberation? And what is true constipation anyway?
Constipation is the passing of a hard bowel action (stool or poo) with pain and discomfort. A baby is constipated if the stools are dry and crumbly or like pellets. A breast fed baby is hardly ever constipated. After the first few weeks of life, breast fed babies may not pass a stool for several days or up to a week and when they do go the stool will usually be soft. Many babies and children do not pass a stool every day. If a baby or child does poo only once or a couple of times a week, this is not constipation unless the stool is also hard.
CONSTIPATION IN BABIES
Causes
- If a breast fed baby has hard, crumbly poo, the baby might not be getting enough milk. Check with your doctor or community child health nurse.
- Sometimes the baby’s milk formula is not made up correctly, so there is too much formula powder for the amount of water. For example, the formula may have been tightly packed into the scoop or heaped up (rather than the formula being scooped out of the tin and levelled off with a knife) or the wrong scoop used (different types of formula need different size spoons) or the powder may have been put in the bottle before the water, so not enough water is added.
- Changing the milk formula, especially to ‘follow-on’ formula, or cow’s milk, or starting solids may cause constipation for a short while.
- Not enough drinks, especially on a hot day, or when the baby has a fever.
- Sometimes a hard stool can cause a little tear around the anus and it hurts the baby. The baby seems to know it hurts to do poo, so holds on. Then the poo becomes harder and as a result it will be more painful to go. This can become a vicious cycle if it is not addressed. The baby relates passing a stool with “pain” and so holds on for as long as he can. This in turn causes more constipation, and more pain and so on and so on
Signs of constipation
- A baby who has hard poo which causes pain and discomfort is constipated.
- Breast fed babies can go for a number of days without a bowel action but they are not constipated. When the child has a normal bowel action it will still be soft. If the bowel action is hard, the baby is constipated.
- Many babies strain and go red in the face when doing a normal poo. This is not a sign of constipation unless the stool is also hard.
What you can do
- If the baby is bottle fed, check the formula tin to make sure the formula is being made correctly. Measure the water first, then add formula powder.
- Offer extra drinks (water).
- Give brown sugar, one half to one teaspoon mixed in a small amount of water (30 mls) separate from milk at the beginning or end of feed 3 or 4 times a day until the stool softens.
- For babies 5 months and older, offer fruit juice (especially prune juice) 1 part juice mixed with 3 parts water.
- For babies 5 months and older who are already having solids, give your baby stewed prunes, stewed apricots, or steamed vegetables.
- For babies 9 months and older, offer your baby cereals which contain bran.
- You should only give laxatives (stool softeners) to babies if they are prescribed by a doctor.
- If these simple treatments do not work, or there is blood in the poo, have the baby seen by a doctor.
- Remember that some straining (going red in the face and grunting) is normal when babies pass a stool; this usually does not mean constipation.
- Tummy massage (clockwise) and a warm bath can help the muscles relax.
CONSTIPATION IN CHILDREN
Causes
- The most common cause of constipation in children is not enough fibre or bulk in the diet. This can occur when a child is drinking too much milk and not getting enough solids.
- A hard stool can cause pain and sometimes a small tear in the skin around the anus, so the child tries not to do poo again, leading to worse constipation.
- Sometimes medicines can cause constipation including some cough medicines.
- Some children ignore the feeling of needing to go to the toilet because they are too busy playing and as a result the stool becomes harder and it is more difficult for the child to go.
- Some children do not want to use school or preschool toilets for any of these reasons:
- the toilets may be smelly
- they may not be private
- there may be no toilet paper
- sometimes children are teased in the toilets
- if children are not allowed to go to the toilet when they need to go, they learn to hold on and may become constipated.
Signs of constipation
- Children may sometimes say that it hurts when doing a poo, or cry, and will try to do their poos less often.
- They may show lots of signs of holding on, such as crossing legs, running around, crying or refusing to sit on the toilet.
- They may complain of abdominal (gut) pain which comes and goes, usually around the belly button (navel, umbilicus).
- Some children will start to soil their pants with ongoing constipation.
What you can do
Hard poo hurts when it is passed so it is ‘normal’ and logical for a child to try to stop it when he is constipated. Find ways of making the stool softer, so that stool does not hurt and the child is no longer afraid to go.
- Give more fresh fruit and vegetables.
- Offer cereals, rice, dried fruits, breads and biscuits with high fibre (eg bran, prunes, dates) in them.
- Encourage children to have lots of drinks, especially clear drinks. Water is the best; although fruit juice helps some children (you could try apple, prune or pear juice).
- Encourage them to exercise more.
- If the toilets at school are a problem, try taking this up with the school.
- Unless your doctor recommends laxatives, they should not be used for more than a few days as they do not solve the underlying problem and they may change the way the bowels work, so the child is less able to have a normal stool when the laxative is stopped.
- Laxatives which increase bulk and fibre in the gut may be the best for the short term.
- If the constipation lasts a long time or keeps coming back, get advice from your doctor.
- For long term use in ongoing constipation, laxatives which contain paraffin oils, or which increase fibre, are sometimes prescribed by a doctor. These should only be given after the child has been seen by the doctor and the cause of the problem worked out. The treatment may be needed for several months.
“ Kim Patra is a qualified Registered Nurse and Midwife
that has been living and working in Bali for almost twenty
years. She now runs her own private practice and medical referral
service from her Kuta office. Kim is happy to discuss any
health concerns with you and she may be contacted via e-mail
at info@chcbali.com”.
