Constipation – What is concerning? Why are so many kids constipated?

Constipation – What is concerning? Why are so many kids constipated?

CONSTIPATION – What is concerning?  Why are so many kids constipated?

Constipation is a very common issue amongst toddlers.  Being a picky eater and loving carbohydrates, bananas, apples and milk is a very common trend in this age group.  This diet, however very easily causes children to become constipated.  Constipation is defined in a variety of ways, however in general terms if the stool is hard, the child is straining (pushing very hard while stooling), the child is in pain while stooling, the child is stooling infrequently (every 2-3 days) then they are constipated.

Constipation is a difficult issue to manage as many toddlers and children are very picky eaters making it difficult to get them to eat less constipating foods.  It is important however to get a good handle on their stooling pattern as constipation can become very difficult to treat if it is present for a long time.  Chronic constipation can lead to:

1) Dilatation of the rectum/lower bowels which causes a loss of sensation for the need to stool;

2) Further worsening of the constipation due to retained stool;

3) Overflow diarrhea (when liquid stool from above passes around the retained hard stool and comes out); and

4) Occasional accidents

The first step towards dealing with constipation is dietary management.  A diet rich in fibre and water is the main step towards improving constipation.  Generally foods that are non-constipating are fruits and vegetables.  There are a few fruits to be aware of that are constipating.

Bananas and apples in particular are constipating and often these are the two most loved fruits among kids.  With the picky eater, you can often offer a smoothie in the mornings rich in fruits and vegetables to try and increase their intake.  Putting some prunes, or prune puree into this smoothie is also very helpful for constipation.

The next step is to have a regular stooling routine.  Make your child sit on the toilet for 10 minutes at the same time every day to allow them adequate time to attempt a stool.  It is often best to schedule this time after a meal as your bowels are pushing food along after a meal and this helps with the process of stooling.

There are over the counter medications that can help soften stools for your child.  Talk to your medical professional for information regarding these medications as not all of these are safe or suitable for kids.

The goal for your child is regular, daily, soft, non-straining, non-painful stools.  I often tell parents that poop should be soft like toothpaste.  i.e. It has a shape when you squeeze it out of the tube, but it is soft and pasty in texture.  If your child has been constipated chronically (for a few months now), then it will take at least 6 months to retrain the dilated rectum/bowel back to its original state.  This means maintaining 6 months of regular, soft, non-straining, non-painful poops through diet and other means.  If there is even 1 day in that 6 months of a hard or infrequent stool, then that 6 month count restarts.

**Disclaimer – Any information found in these blog posts is only for informational purposes and not intended to replace the diagnosis and care of a physician.  Should you have any specific concerns about your child, please consult with your family doctor or pediatrician.

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For The 12 Month Old

For The 12 Month Old

FOR THE 12 MONTH OLD

Your child is a whole year old now!  At this point they are starting to be able to walk a few steps independently.  Watch them carefully though, as this new mobility could lead to an increased risk of falling into things.

They will now start saying a few actual words like “mama” or “dada” or “baba” (to ask for the bottle).  Many parents will talk about their baby’s first word and associate it with a definitive date or time that it happened.  However, it is not uncommon for parents to not know when their baby said their first real word.  This is because babies will often start babbling nonsensically at 7-9 months with “mamama” or “bababa”, etc.  However, real speech is generally considered to occur when a child says words predictably, and with purpose and meaning.  So if your child says “mamama” to pillows and pieces of furniture, chances are those are not real words.  You will know when they actually are calling for you with “mama” and “dada”, when they only use those words to refer to you rather than stuffed animals, vacuums, and other inanimate objects.

At this age, babies should be anxious or nervous around strangers as they become more aware of the world.  They will always want to cling to their parents and start making good eye contact with people.  They will point at things they intentionally want, and can clap and wave with prompting.

Baby will now be able to start feeding themselves with utensils.  It will be messy, but they can do it.  Without the utensils, feeding themselves with hands should be an easy task.  They should be able to pick up small things like pieces of food with their well-developed pincer grip.  As we mentioned last week, a pincer grip can be best visualized by imagining a small crab picking up an object.

Food-wise, baby should now be eating whatever the rest of the family is eating.  No special meals are necessary.  Just make sure the food is chopped up into small enough pieces that they will not present a choking hazard.

Milk should no longer be provided in a bottle.  They can safely drink homo milk, but no more than 2 cups of milk total per day.  Your child may insist on milk from a bottle rather than a sippy cup, because that’s what they’re used to.  But despite their crying and protests, you can rest assured that they will eventually get over it even if you cut them off cold turkey.

**Disclaimer – Any information found in these blog posts is only for informational purposes and not intended to replace the diagnosis and care of a physician.  Should you have any specific concerns about your child, please consult with your family doctor or pediatrician.

For the 9 Month Old

For the 9 Month Old

FOR THE 9 MONTH OLD

Congratulations!  Your baby is now 9 months!  They are getting more and more fun, interactive and their personalities are surely developing and surprising you daily.  Now, you are likely noticing a lot of exciting new milestones.  Your little one is likely commando crawling or even crawling on all fours.  They are reaching for everything and moving around the room like never before.

Be aware, they can now grab things that you do not notice at first sight.  They have a pincer grasp (i.e. pointer finger and thumb grasp) and can pick up even the smallest of items.  Be careful!  This means they are at an increased risk of choking on items as they are finding things while they roam around.  Rule of thumb, if an item can fit through a toilet paper tube, it is a choking hazard.

Your baby is likely now also more scared or nervous around strangers.  This is normal.  Expect it and love the fact that you are the one they turn to for love, comfort and security.  Your baby should also be babbling by 9 months.  A lot of Mamama, Bababa, Papapa, and Dadada should be expected.  Don’t worry, you are not alone – most parents have a hard time telling if their baby is saying Mama or Dada to them or just in general.

Your baby should be eating solids 3 times per day.  They are also likely transitioning from purees to more textured foods (foods that are chopped up finely into small pieces).  They also can be eating snacks throughout the day.  It is appropriate to be drinking formula or breastfeeding multiple times through the day still.

Remember to give solids before milk because it is important to transition baby to a diet where most of their calories are coming from solids.  Water throughout the day from a sippy cup is also important to promote hydration and prevent constipation.  By 12 months, they should be eating the same foods as their parents (i.e. 3 meals per day, 2-3 snacks per day and 2 cups of milk per day).

Enjoy watching your baby’s discovery of the world around them as they get more mobile and more curious!

**Disclaimer – Any information found in these blog posts is only for informational purposes and not intended to replace the diagnosis and care of a physician.  Should you have any specific concerns about your child, please consult with your family doctor or pediatrician.

GERD – Is it Spitting Up? Is it Vomiting? Should I be Worried?

GERD – Is it Spitting Up? Is it Vomiting? Should I be Worried?

GERD – IS IT SPITTING UP? IS IT VOMITING? SHOULD I BE WORRIED?

All infants from 0-6 months have a certain amount of gastroesophageal reflux (milk coming back up after reaching the stomach).  A large portion of infants spit up milk after they are fed.  Often milk comes up when being burped or sometimes a mouthful of milk spills out of baby’s mouth within an hour after feeds.  Occasionally if there is a large air bubble in the stomach or if the baby is overfed, they can also forcefully vomit after a feed.  These are all events that are not out of the ordinary for a normal baby.

When to worry?  Not uncommonly, babies can become uncomfortable after feeds because of the reflux.  It is thought that the acidity of the stomach contents causes irritation of the lower esophagus making baby uncomfortable.  Often if this is occurring, babies will arch their backs, turn red in the face and cry within the first 1-2 hours after a feed.  They may or may not be a baby that spits up.  If it is really bad, they may appear uncomfortable amidst the feed and not appear keen to continue feeding.  In this situation there are non-medicinal and medicinal management options.

These include:

1) Burping the baby frequently.  In the middle of the feed, pull baby off the breast or bottle and burp them to help get any extra air out.  Too much air in the stomach will promote reflux of stomach contents during and after a feed.  Continue to burp baby after a feed as per usual.

2) Put baby on their tummy for a few minutes before a feed.  This can help expel extra air already in the stomach before a feed.

3) Keep baby upright for 20-30 minutes after a feed.  This will allow time for the milk to move past the stomach and into the upper intestine and leave less volume to potentially reflux up into the esophagus.

4) If your milk flow is very fast at the beginning of your breastfeeding, then consider pumping off the first few milliliters of milk before feeding or leaning back while you breastfeed to slow the flow of the milk.  This will help decrease how much air baby swallows while trying to feed from the fast rate of your milk flow.

If all of these measures do not appear to improve baby’s discomfort after feeds, you can speak to your physician about prescribing an acid reducer such as ranitidine for your baby.  Babies usually grow out of reflux by 6 months of age.  Anatomically they have less reflux of stomach contents, they are starting solids at this time and they are starting to spend more of the day upright and less on their backs.

When to worry about vomiting?  If your baby is vomiting persistently with increasing force, severity and frequency, they must be seen immediately by a medical professional.  If the vomit ever contains blood or bile this is an abnormal event.  Bile is army green in colour and it is not normal for an infant to produce vomit this colour.

I hope this information is helpful to you but of course if you have any concerns you should be sure to schedule a visit with your doctor or pediatrician.

**Disclaimer – Any information found in these blog posts is only for informational purposes and not intended to replace the diagnosis and care of a physician.  Should you have any specific concerns about your child, please consult with your family doctor or pediatrician.