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.