Constipation is no laughing matter for children, especially when their carers are unaware of it, says Maggie Jones
Even adults find it difficult to admit to constipation, so it's not surprising that it often goes unnoticed in children. This is partly because parents are too shy to mention it to carers, partly because children pick up on the embarrassment of the subject and partly because of the wide variation in the frequency of passing stools.
Some children may pass stools three times a day and others once every two days - both are normal. But parents and carers may not realise that a child has not been to the toilet and the child may say that he or she has, when it isn't true. Parents may think that a child is going to the toilet at playgroup, nursery or school, while carers may think they are going at home. So it may be difficult to spot a change of pattern.
Tell-tale signs
Signs of constipation include pain on passing stools, severe straining, wanting to pass a stool but being unable to do so, and 'overflow', where liquid stools leak out around a hard mass which cannot be expelled.
Constipation is rare in breastfed babies but it can occur in bottle-fed babies if they do not get enough fluids, so it is vital to offer bottle-fed babies water in between feeds. Once the child is on a solid diet, constipation can always be remedied by introducing more fibre, roughage and fluids into the diet. Fresh fruit, vegetables and whole wheat breads and grains are essential and adding more of these should solve the problem. Fibre prevents constipation because the cellulose within it holds water in the stools and makes them softer and easier to pass.
Vicious circle
Children can become chronically constipated once the stools have been allowed to become so hard that they are painful to pass. This can lead the child to think of passing a stool as painful, and so clings on to the stools to prevent the pain from occurring again.
A second common cause of chronic constipation is when the parent or carer is fussy about going to the potty or toilet and causes the child to feel over-anxious. Sometimes a child is slow or reluctant to become potty trained, and insists on passing stools only into the nappy, which can lead to problems when the child does not wear a nappy at playgroup or nursery.
Other children do not like the idea of using strange toilets or the school toilets, especially if the room is smelly or if there has been teasing or bad behaviour going on in the toilets.
Constipation can also occur when a child is ill, because of the change in diet and loss of fluids when running a temperature. This kind of constipation almost always clears up when the child goes back to a normal diet.
Remedies for constipation
Diet The first remedy is always to change the diet, adding more fluids and fibre. Prunes or stewed apricots are usually a sure-fire success but children don't always like the texture. Chop them and add yoghurt or offer the juice. Any fruit should help - try sweet seedless grapes.
Routine If a child hanging on to stools all day is a problem, parents can be advised to encourage the child to get up earlier, have a good, high- fibre breakfast (wholemeal bread or toast or porridge), and then have plenty of time, at least 20 minutes, to go to the loo before leaving for school. The urge to defecate is usually strongest after meals. Finding a regular time to go to the loo can help, but it's better not to insist on this.
Keep calm Carers and parents should take a relaxed approach as it is very important to avoid turning the whole question of bowel movements into a self-conscious issue which could make matters worse.
Medication If a child experiences pain, medication such as lactulose is available to soften the stools. Senna is a safe laxative which can be used occasionally for children. If these do not work, an enema can be given to clear the bowel. A doctor's advice should always be sought if the child has repeatedly hard stools which are painful to pass, as this can result in an anal fissure. Children should never be given laxatives on a regular basis unless prescribed by a doctor.