Constipation in Children

Constipation in children is one of the commonest complaints that a parent has. Constipation is the bane of modern living with its focus on refined diets and stressful lives. As man has evolved (?), he has moved from diets rich in fiber to low-residue, processed foods. Additionally, his life has become increasingly hectic and stressful with futile attempts at meeting progressively tighter schedules.

The sight of the small child being rudely woken up early in the morning and made to rush through his ablutions to meet the deadline of the opening bell in school is all too familiar to all of us. We probably play out this scenario daily in each of our homes. I agree that we should move with the times but our body does not know all this and this results in all sorts of stresses and strains with our gastrointestinal tract taking the brunt. And so we have the all too common constipation in children.

Causes of Constipation

The primary causes of constipation are:

• Faulty Diet
• Poor Toilet Training

Whenever I consult the parents of a constipated child, I could almost write a script on his diet and tick off the specifics for that particular child!

The commonest exchange between the parent and me:

Parent: “My child doesn’t eat anything, doctor!”

Me: “So how much milk does he take?”

Parent: “That is about all he takes doctor! about 3-4 glasses a day (translated 750 ccs to 1000 ccs milk a day)”

Me: “And what else?”

Parent: “Nothing else, biscuits (on further inquiry at least half a packet), maybe some wafers and chips and Doc he likes cold drinks, chocolates, and ice-creams.”

Me: “Does he eat any vegetables or fruits?”

Parent: “No doctor, as soon as we give him vegetables he just pushes his plate away, and if we force him to eat some, he just brings it up!”

Me: “So what have you done about it?”

Parent: “Doctor we have tried everything and are at our wit’s end. Enemas, suppositories, laxatives, we have tried everything! Nothing works! We are apprehensive! What should we do?”

If your child is constipated then you will own up to some version of this scenario.

To beat this chronic problem ( a few months duration is quite common) let us identify the perpetrator of this whole sequence. The answer, unfortunately, is you, the parent and the grandparents too in good measure!. You have acquiesced to your child’s whims and fancies, suited your convenience and led to this sorry state of affairs, and it is you who will have to work the hardest to correct it.

• CUT DOWN ON MILK AND MILK PRODUCTS:
  You should do this first and foremost. A child greater than one year of age does not need more than 200 ml of milk a day. This limit includes milk in the form of tea, coffee, lassi, buttermilk, curd, etc. Man is the only species of animal, which voluntarily seeks out the milk of other species. (Maneka Gandhi is undoubtedly going to approve!) While it is true that milk is highly nutritious and provides a balanced meal, it lacks two essential ingredients, iron, and fiber. Plenty of milk in the diet certainly makes the child look chubby and plump, but he is most likely anemic and constipated too.
• The other precaution to take is to BREAK THE BOTTLE. Apart from the possibility of poor hygiene, drinking milk from the bottle allows a lot of air to enter the stomach, and this causes a feeling of fullness and prevents the child from eating other equally nutritious food. It is far better that the child drinks milk from a glass or a sipper or even a vati and spoon.
• CHANGE THE DIET: Your child must eat a portion of green leafy vegetables daily and four portions of other vegetables. Parents offer their children the same food items that are prepared for the whole family. We Indians love spices and the chilies, and we feel that our children too can manage this diet. No! Most children would much rather eat so-called ‘bland food.’ Now that is a myth! Food that is not highly spiced can also be incredibly delicious.
  She must eat at least one fruit once a day. Any fruit is good for the child. Please do not remove the thin peel of the fruit (like apples, chikoos, oranges, peaches, pears, etc.). Do not give more than two small biscuits to your child per day, not more than one chocolate per day, no aerated beverages at all! (Sorry, Pepsi and Coke!), ice-creams once a week and certainly no ready to eat fried foods like chips, wafers, snacks, etc. Please encourage your child to eat plenty of vegetables, snacks like poha, sabudana khichdi, cereals, upma, idli dosa, etc.(again more work for you, the harried working parent!).
• SET TIMINGS AND SET ASIDE TIME FOR THE CHILD TO DEFECATE:
  Do set aside two periods in the day, one in the evening and one in the morning where you encourage the child to sit on the toilet seat and try to pass stool. The chosen time may vary according to your schedule but do try and stick to the selected time. The child should be on the potty at least for 10 minutes. Now it is not enough to tell the child to sit on the toilet seat. The child will almost certainly not comply and quickly get bored especially if his bowels do not move. One of the parents must stay with the child and encourages her. See what I meant when I said that you have a tough job on hand!). We are trying to train the bowel to move and empty at those times of the day. It eventually should become a habit.
• A proper evaluation by a competent doctor is necessary. The examination should rule out anatomical and other pathological conditions. Hirschsprung’s disease or anus in an abnormal position are some of the abnormalities, which may cause constipation in children. However, these conditions are pretty rare as compared to the common habitual constipation.
• Take the appropriate medicines as prescribed by your doctor. In the initial evacuant phase, we try to evacuate all the accumulated stools in the bowel. We follow up by a maintenance phase until the child passes soft stools daily without any pain or straining. Do note the hierarchical position of medical measures, way after diet, and proper toilet training!
• Note:
  Some children who are very severely constipated may require manual evacuation to achieve complete removal or other procedures like biopsies or anal stretching.

These fiber-rich foods can help you kickstart your child’s high fiber diet. Eventually, of course, you should rely primarily on easily available fruits and vegetables as your primary source of dietary fiber.
You can easily buy any of these fiber-rich foods from your local grocer or you can always buy from Amazon – chia seeds, flax seeds, dried apricots, prunes, dates etc.

What I have outlined above is the skeleton of the treatment schedule. A minimum period of three months and up to one year usually beats habitual constipation permanently and, of course, a lifetime of healthy eating! If you have any more questions or doubts, do not hesitate to contact your attending pediatrician or feel free to contact me.