DOES your child go to the toilet regularly? Are his bowel movements easy and comfortable? You most probably remember a time when your child enjoyed regular bowel movements, especially during his first year of life. Right now, getting your child to pass a bowel movement may seem like an everyday chore. Not only that, he may have difficulty passing stools. So what happened? What caused your child to develop constipation?

Your child has constipation if he passes stools less frequently than usual and has more difficulty passing them. The most common cause among children is stool withholding. Over the years, your child may have begun resisting the urge to go to the toilet on purpose. This habit might have started when he experienced pain for the first time while passing stools.

The pain may have been caused by a previous illness. Your child associated that pain with passing stools and now shies away from the toilet.
 

Make toilet time a pleasant time. It is important for your child to perceive passing stools as a pleasant experience, not a stressful chore. – AFP

Your child may also withhold his stools following a change in his normal daily routine, eg caused by travelling or moving to a new home. Also, there may be times when he simply wants to continue playing rather than “waste time” on the toilet bowl. And if your child has started school, he may withhold stools because he feels uncomfortable in his new environment, or dislikes or finds it inconvenient to use the school toilet.

Initially, your child may have to put in effort to withhold his stools. Eventually, however, his normal bowel reflexes may be affected, causing his stools to build up in his bowels, without him realising it. Withholding stools then becomes a natural habit that is difficult to break.

Although constipation does not severely harm your child’s health, it is important to help your child get his normal rhythm back as soon as possible. This is because constipation may cause your child to become lethargic, lose his appetite, and become moody. If your child is constipated, you can help him become happy and healthy again by taking the necessary steps to weave toilet time into his daily routine and make trips to the toilet as natural as possible.

Symptoms of constipation

·Fewer bowel movements than usual
·Stools are hard, dry and difficult to pass
·Abdominal discomfort

When to see a doctor

In some cases, constipation could be caused by an underlying medical condition. If in doubt, consult a doctor. Take your child to see a doctor if he experiences symptoms of constipation for more than two weeks, or if his constipation is accompanied by one of these symptoms:

·Fever
·Vomiting
·Weight loss
·Blood in stool
·A painful, distended abdomen

Get your child’s bowels moving

When your child is constipated, his stools have accumulated in his bowels and have become harder and larger. Try the following steps to stimulate his bowels and get his stools moving. Give it a week or two and his bowel movements may go back to normal.

·Establish a regular toilet routine. Since the main cause of constipation is stool withholding, the first thing you can do is start teaching your child good toilet habits. Get your child to wake up half an hour earlier in the mornings to give him extra time to use the toilet before school. The best time to encourage a bowel movement is after a meal, any time from immediately after the meal to about an hour after it. This is because mass peristalsis (a wave of muscle contraction that passes round the entire gut, pushing its contents forward) is stimulated at mealtimes. Encourage your child to sit on the toilet bowl for a while at about the same time each day, even if he does not have a bowel movement. Also, teach your child to go to the toilet whenever he has an urge to pass a bowel movement and praise him after he has done so.

·Make toilet time a pleasant time. It is important for your child to perceive passing stools as a pleasant experience, not a stressful chore. So don’t hurry your child when he is on the toilet bowl. On the other hand, don’t let him remain there for too long. Don’t force him to sit on the toilet bowl if he really does not want to and never scold him if there is no bowel movement.

·Get your child to drink up. Water helps to soften stools. Try getting your child to drink six to eight glasses of water a day.

·Feed your child fibre at every meal. Fibre is found in fruits, vegetables, and whole grains. It helps hold water in the stool, making the stools softer and easier to pass, and provides the bulk that the colon (large intestines) muscles need to stimulate the forward motion of the stools. Encourage your child to eat fruits and vegetables at every meal. However, too much fibre can also cause constipation. Your child does not need as much fibre as adults, so feed him moderate amounts.

·Help your child stay active. Staying active is an excellent way to keep your child’s bowels moving. Do something active with your child everyday if possible, such as cycling, playing ball in your garden, running around in the playground, or jumping rope. Encourage your child to stay active at home and at school too.

·Teach your child to relax. Too much stress may affect your child’s regular bowel movements. Help your child relax whenever he feels stressed out or overly worried. Learn to encourage your child to express his emotions.

It is not advisable to give laxatives or administer an enema to your child unless prescribed by a doctor. Laxatives can sometimes impair the normal functioning of the colon.

Know your child’s bowel movements

What is a normal bowel movement? There is no ‘normal’ frequency of bowel movements. For children, the number of bowel movements changes according to age and diet, and each child has his own pattern. It may be normal for one child to have a bowel movement once a day. For another child, it may be normal to have four bowel movements a week.

As long as your child is growing well, is energetic, and passes stools easily, the frequency of his bowel movements is not important. However, it is ideal to have a similar pattern of bowel movements every week.

Prof Dr Christopher Boey is a consultant paediatric gastroenterologist. This article is courtesy of the Malaysian Paediatric Association’s (MPA) Positive Parenting Digestive Health Initiative and the Malaysian Society of Gastroenterology and Hepatology (MSGH). The programme is supported by an educational grant from Vitagen Healthy Tummies Programme. For further information, please visit www.mypositiveparenting.org. For a free children’s digestive health booklet by the MPA in collaboration with the MSGH, please contact 03-5621 1408 or 03-5632 3301.