Constipation in children

CONSTIPATION IN CHILDREN

Constipation is a condition in which the bowel movements are too hard. The frequency of bowel movements is not a factor of constipation. Passage of six too-firm bowel movements a day is considered constipation. Passage of one normal or soft bowel movement every third or fourth day is not constipation. Many normal, healthy children have a bowel movement only every few days and are not constipated. The hardness of a stool is judged by appearance and by diameter. A stool greater than twice the usual diameter is probably too hard.
Over 95 percent of constipation cases involve no physical abnormality. This form of constipation can always be cured by changes in the diet or by using medications that soften the stools.
Constipation occurs in the large bowel (colon). The function of the colon is to store unabsorbed food waste and to absorb and hold water from the liquid material received from the small intestine. If the colon absorbs too much water, the stools become hard.
In children, there are two common reasons for constipation. The first reason is that the diet does not include enough roughage, which holds water in the stools. Foods that prevent constipation are all fruit juices and all fruits - particularly those eaten with their skin on - except bananas and apples; all vegetables, especially if eaten raw, except peeled potatoes; unrefined grains (whole-grain cereals and breads); and unrefined sugars (brown sugar, molasses, honey). All other foods, including milk and milk products, promote constipation.
A second common reason for constipation in children is that the child resists the normal impulse to move the bowels. This allows the colon to continue absorbing water out of the retained stools; it results in stools that are too hard. A common reason why children resist the normal impulse to move the bowels is that the parents are putting too much pressure on the child during toilet training. Once the stools become too hard, bowel movements become painful. Fear of such pain makes the child even more determined to postpone bowel movements. Constipation enlarges the colon, causing a loss of muscle tone, and the physical impulse to empty the bowel becomes weaker. This cycle can lead to chronic constipation.

Signs and symptoms
The major sign of constipation is stools that are too hard, too dry, and larger in diameter than usual. Constipation can cause pain in the anus during bowel movements. Red blood may appear on and around the stools. Other symptoms are cramps in the abdomen and an eventual loss of appetite.
If constipation continues for days and weeks, paradoxical diarrhea may develop. In this condition, loose, watery stools seep around the hard stool in the colon and are passed as diarrhea. When this happens, it can be difficult to tell whether the child has constipation or diarrhea.

Home care
For immediate temporary relief, use a glycerin suppository or disposable commercial enema. For a long-term cure, increase the amount of roughage and decrease the amount of constipating foods in your child's diet. If constipation occurs during toilet training, stop training efforts.

Precautions
• Check with your doctor before using laxatives in children. Laxatives may force passage of a hard stool and cause pain that leads to further holding back by the child.
• Enemas, suppositories, and laxatives are habit-forming. They should never be used on a regular basis.
• Do not assume that a child is constipated simply because bowel movements do not occur every day.

Medical treatment
Your doctor will perform a rectal examination and a careful examination of the child's abdomen. X ray studies of the bowel may be taken to look for possible physical abnormalities. Directions and follow-up by your doctor may be needed.

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GENERAL HEALTH

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