CONSTIPATION is a common problem among children. Parents usually become concerned when stool becomes hard, difficult to pass and when defecation is infrequent.

The guidelines of the North American Society of Paediatric Gastroenterology, Hepatology and Nutrition define constipation as “a delay or difficulty in defecation, present for two or more weeks, and sufficient to cause significant distress to the patient”.

BOWEL ACTION

The frequency of bowel action varies from child to child. Normal stool frequency ranges from four per day to two per day when the child is one year old. After age four, stool frequency ranges from three per day to three per week. In fact, breastfed infants have up to 14 days with no bowel movement.

Constipation commonly appears in children ages two to four years. This correlates with toilet training and at this time, there is also a change in the diet.

CAUSES

In children, constipation commonly has no known cause,

which is referred to as

functional constipation. Functional constipation can be related to diet, stool holding or emotional factors. Your child might not be eating enough fibre or drinking a lot

of fluids.

Stool holding is usually due to a previous painful experience, which will result in the child resisting the need to pass stool. The child might cross the legs together and squeeze the buttom muscles so that they can prevent another painful experience.

Emotional problems which may lead to functional constipation can include fear of change of surroundings, such as moving to a new house, potty training, or fear of using the toilet at school.

There are also medical illnesses that can cause constipation, for example, thyroid disease, some brain conditions and abnormal development of the bowel.

Other symptoms associated with constipation include recurrent abdominal pain, loss of appetite, abdominal distension, soiling of underpants, and in severe cases weight loss.

TREATMENT

Treatment involves dietary modification, dealing with emotional factors and the use of medication. Dietary modifications include eating fruits, vegetables and high-fibre cereals. Lots of fluids should also be included in the diet, such as water and

fruit juices.

Children who are being potty-trained should sit on the toilet for about eight to 10 minutes after eating meals. Also, positive reinforcement is always good for the child during potty training, so establish a good reward system. Do not punish accidents and try to relax, because you being stressed might make the toilet training more difficult.

Laxatives are used in treating constipation. Please be advised by your doctor which one will be best suited for your child. The best way to prevent constipation is to ensure that your child has a proper, balanced diet and that appropriate toilet measures

are used.

Dr Michelle Williams is a paediatrician at Kidz Klinik. She may be contacted at dr.michelle.williams2014@ gmail.com