I swear we need to put a stool softener in Park City's water supply! Everybody in town seems to be constipated! Constipation can occur even in those who have daily bowel movements. It is caused by inadequate emptying of the rectum. Stools don't have to be hard and painful for a child to be constipated, and many kids who poop regularly are still backed up!
Constipated children most often complain of intermittent, crampy stomach aches, especially with eating. The pain can be located anywhere on the tummy, especially the left lower area or under the ribcage. The pain is typically intense, sharp, and comes and goes over several minutes. Kids may have a poor appetite or feel full after several bites. The culprit is twofold: insufficient fiber and fluid in the diet, and delaying stooling when you get the urge.
Fiber is contained in fresh fruits, veggies and whole grains. Add 5 to your child's age in years, and that's the number of grams of fiber he should eat every day. For example, my 8-year-old daughter should be eating 13 grams daily. If she has a raspberry smoothie for breakfast (5.5 grams), a sandwich with whole-wheat bread and an orange for lunch (2 grams for each slice plus 3 for the orange), and tops it off with some carrots at dinner (2.5 grams) then she's gotten her fill. For the fiber content of various foods, click here and scroll down for a useful chart: Fiber Content of Foods. How can you boost your child's fiber intake? Choose 100% whole wheat breads, cereals and crackers, serve her fruit rather than fruit juice, toss some lentils or beans into your meals, and let her snack on popcorn, raisins or nuts. For some other tips, click here: Tips for Increasing Fiber
Another culprit is not drinking enough fluid. A typical child requires roughly half of her body weight in ounces. So my 56-pound 8-year old daughter needs to drink about 28 ounces per day. When she is sick or exercising or hot she needs more. She also needs extra just for living in our dry climate! Water is the best fluid to drink. Caffeinated or sugary beverages can contribute to dehydration. And while some milk is good, too much causes constipation. To encourage your child to drink more water, keep some water-containing sports-top bottles in the fridge. Kids may enjoy fruit slices in their water, or ice cubes with fun colors or shapes. Above all, the best way to encourage your kids to drink water is to drink water yourself.
Another major cause of constipation is not pooping when you get the urge, or not taking the time to poop completely. Your body is programmed to send you regular poop signals, usually after breakfast or dinner. If you wait and don't use your window of opportunity to empty your bowels, the urge disappears. Very constipated kids don't get the normal poop signals because their rectums are chronically over-stretched.
Even in those kids who follow their urge to poop, they frequently don't sit long enough to allow all the peristaltic waves to empty the entire rectum. You can imagine that retained poop builds up even with daily BMs. That retained poop, day after day, week after week, and month after month, can silently accumulate and cause trouble. The more time the stool stays in the colon, the more it dries out and hardens. Passing a hard, large stool can be a lengthy and painful process. A vicious cycle can ensue as kids withhold stool to avoid the pain. This is especially true during potty-training.
Some constipated kids even have diarrhea. (If you're easily grossed out, skip the next sentence.) If there is enough overflow pressure trying to force out a large, hard BM, the softer stuff squishes around the sides, leading to diarrhea and sometimes loss of control. One imaginative mother described this to me as "skid marks" in her son's underwear. An overly full colon can also lead to urinary frequency, urgency and accidents. A recent study linked constipation with bedwetting. Passing lots of gas is another telltale sign.
How do doctors diagnose constipation? We consider it in every child with abdominal pain, whether they have regular BMs or not, particularly if the pain originates with eating. Often details of the story clue us in, such as prolonged toilet-sitting, or passing huge or painful stools. Frequently we can feel hard stool in the abdomen on physical exam. Sometimes we order an abdominal X-ray as well.
So what's a parent to do to keep things moving?? For mild cases, improvements in diet and bowel habits are sufficient to turn things around. Sticker charts and other incentives can be key. (Printable Chart) If not, adding a bit of the over-the-counter powder Miralax to beverages will loosen the situation. Miralax is safe and non-addictive. For those kids who are packed to the gills, we use a clean-out protocol borrowed from our pediatric GI colleagues at Primary Children's. Frequently those kids need multiple clean-outs to empty out completely, and the risk of relapse is unfortunately very high.
An ounce of prevention is worth a pound of cure. Here are more miscellaneous tips:
* Have regular meal times. Avoid grazing.
* Encourage regular exercise.
* Have your child sit on the toilet for 10 minutes once or twice a day after meals. Incentives and bathroom-specific books/toys can make your life easier.
* Your child may require a small, daily dose of a stool softener long-term to keep the bowel moving.
* Limit dairy intake to 2-3 servings per day.
* Send your child to school with a water bottle and encourage frequent sips.
