By Dr Nishantadeb Ghatak, Pediatrics
One of the most difficult things as a parent is to witness your kids experiencing pain and discomfort. And while most kids are often healthy, many of them will experience constipation at one point or another. Constipation is a very common cause of pain and discomfort in kids, but for some, it can become a chronic issue, creating a great deal of frustration for both kids and parents.
The most common cause of constipation in kids is not an anatomical abnormality or organic problem, though–it’s often behavioral and/or diet-related. So let’s tackle some solutions in today’s episode.
What is Constipation?
First of all, how can you tell if your child is even constipated? There’s great variation in bowel movement frequency, so just because your child doesn’t stool every day, it doesn’t necessarily mean they are constipated.
Plus, stool frequency decreases with age: infants often stool multiple times a day, but by the time your child is a preschooler, his stool frequency will be similar to an adult’s. About 90% of kids do have a bowel movement at least every other day, however.
What is not considered normal?
- Painful bowel movements
- Abdominal pain
- Blood in the stool
- Feeling of incomplete evacuation
- Hard stools
- Fecal soiling
- Weight loss
- Problems with growth and development
What Causes Constipation?
Organic disorders causing constipation are rare, but include:
- Hirschsprung Disease
- Cystic Fibrosis
- Metabolic diseases
- Thyroid disease
- Spinal cord abnormalities
- Malformations of the anus or rectum
- Celiac disease
- Lead toxicity
How to Treat Constipation in Children?
Unfortunately, as with everything else, when something becomes chronic and requires a change in behavior, it becomes time-consuming to treat.
Treating chronic constipation in kids may not be “easy,” and there’s no “magic pill.” It will require some time, patience, and effort on your part to get your child to overcome constipation and get passed it–but the good news is, it is very achievable.
There are 3 main components in “retraining” your child’s bowel: evacuation of the plugged up poop, softening all future poops, and changing their behavior patterns:
Step 1 – Unplugging the Colon: First, you need to treat the more immediate issue: you’ve got to get them to poop out what’s plugging up the pipes right now. Here’s how doctors often do this:
- Polyethylene glycol (otherwise often known as “Miralax”): this is a powder you can mix into liquids your child consumes and is often well-tolerated (meaning tasteless and odorless.) It’s taken daily, or even twice daily until the colon is evacuated.
- Mineral Oil: given at 15 to 30mL per year of age per day (not quite as tasteless, so kids don’t like it.)
- Enemas: this may be the most invasive and discomforting for the child, and perhaps used as last resort for most. There are various preparations on the market, so ask your doctor what’s best for your child before you go this route.
Step 2: Maintenance Dietary Changes: Now, you got junior to poop–now what? If he returns to his previous habits (nutritional and/or withholding behaviors,) the same issue will recur, and before you know it, you’ll simply feel too pooped out to deal with it once again. So, here are some dietary do’s and don’ts that doctors often recommend instilling in your child’s daily routine:
- Dietary fiber: have 5 servings of fruits and/or veggies a day; kids may also need supplemental OTC fiber (like Metamucil or Benefiber)
- Fruits/Veggies with higher sources of fiber: pick apricots, prunes, plums, raisins, peas, beans, broccoli
- Avoid bananas: they can be more constipating for some
- 100% whole wheat products (bread, pastas, tortillas, etc.)
- Fiber-fortified cereal
- Use brown rice instead of white rice
- Non-absorbable carbohydrates (meaning, they stay in the gastrointestinal tract and take water along with it to keep the poop softer): prunes, pears, apple juice
- Drink more water
- Increase physical activity: this helps get the colon moving, too.
- White carbohydrates and simple sugars (sweets, white bread, sodas, etc)
- Fast food: limit to no more than once a week
Step 3: Behavioral Modification: So, now that your child emptied out the rectum, and you’ve revamped his diet completely, and may be continuing the Miralax for the time being, there’s still one more vital step: you’ve got to get him to change some of the poop-holding behavior. This may be the most challenging step, but here’s what I’d recommend:
- Create a big chart and hang it up somewhere visible to your child.
- Find a reward system: For every poop, he gets a star on the chart. And if he gets x number of many stars, he gets to pick out a new toy at the store. Or something similar–you get the idea.
- Then have him sit on the toilet for 10 minutes after every meal and after bath time. If he poops, reward him with a star. If he doesn’t, pat him on the back or give him a high-five for giving it a try (whatever you do, don’t punish.)
- Results will be gradual, so please don’t expect an overnight success story. Avoid any negativity, and stay positive throughout the process. There may be relapses along the way, so please don’t get discouraged–and don’t discourage your child.
Once you’ve reached success, and your child is having normal, soft stools daily, then we typically recommend weaning off of the Miralax rather than abruptly halting its use. Talk to your doctor about the best way to go about this.
A referral to a gastroenterologist can be considered if the child has any red flags for possible organic causes of constipation, and/or if using the above treatment tips do not improve symptoms.