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Constipation commonly starts around potty training. Discomfort during bowel evacuation leads to avoidance, which in turn leads to retention and harder bowel motions, causing more discomfort. This cycle, known as “functional constipation,” is often seen in infants during weaning or when children start school and avoid using school toilets.
While most children with constipation do not have any underlying diseases, some conditions like Hirschsprung’s disease can cause chronic constipation. This disease occurs when part of the nervous system to the bowel does not develop fully, and is present in about 1 in 5000 newborns. In babies with Hirschsprung’s disease, the first poo (meconium) is often not passed within the first 48 hours of birth. The condition may also appear in older children.
Here are some strategies that can help manage constipation in children:
Utilize the "gastrocolic reflex," which causes a natural urge to go to the toilet after a meal. Sit the child on the toilet after meals. If the child is old enough to understand, reward them for sitting on the toilet, rather than focusing solely on the result. Consistent praise and reward systems, like using stars, can help. It's important to avoid punishing the child for accidents.
Children aged 1 to 3 years should drink around 1.3 liters of water daily, while children between the ages of 4 and 8 need about 1.7 liters per day to help prevent constipation.
Maintaining an adequate fiber intake is crucial for preventing constipation. Foods rich in fiber, like fruits, vegetables, high-fiber bread, baked beans, and wholegrain breakfast cereals, are beneficial. However, processed bran can sometimes cause bloating and should be consumed in moderation.
The position of the child on the toilet is important. The child should lean forward with their knees above their hip level and feet flat on a foot stool or pile of magazines/books to ensure proper bowel evacuation.
In addition to rewarding the act of sitting on the toilet, parents can also reward behaviors like checking underwear, drinking enough water, and taking required laxatives. But the focus should start with encouraging sitting on the toilet regularly.
