Constipation
Constipation means hard
bowel movements which are difficult and/or painful to pass. It does NOT mean
infrequent bowel movements. There is a great deal of normal individual variation in
how often we move our bowels, and as long as the stool remains reasonable soft and easy to pass the length
of time between movements should not cause concern. On the other hand, even regular daily bowel movements
which are too hard may represent a problem. In young children the discomfort
associated with this can lead to a justified fear of moving the bowels, causing them to
try to hold it in rather than push it out when they feel the urge to go. This in
turn results in even harder stools the next time, and thus a vicious cycle is set up.
The child retains more and more stool inside, the intestine dilates and begins to
function less efficiently, and the eventual endpoint can be uncontrolled soiling, or
encopresis. Maintenance of normal stool consistency thus important, especially in
the early years of childhood.
Almost everyone experiences
occasional self limited bouts of constipation. These can be the result of a dietary
disruption, emotional stress, or acute illness. Don't worry, no one has ever
"burst" from constipation. While uncomfortable, it is not an emergency.
It
is best to avoid both stimulant laxatives and "rectal assaults" in young
children. Both can be dangerous and do more harm than good.
In particular,
"rectal assaults" such as enemas, suppositories, and manual dis-impaction are
quite frightening and impossible to adequately explain to a young child.
They may be
very emotionally damaging. Stimulants can induce dependence.
What CAN be done???
Try the following, but remember none of them can be expected to work immediately -
some patience will be necessary:
- In an infant (less than 1y) try
light Karo syrup 1 tablespoon mixed in 4 oz. formula once or twice daily.
You can also try adding an extra bottle of water or juice during the day. If the
baby has been started on strained foods, cut down on cereals and increase fruits - particularly peaches or
strained prunes.
- For older
children, try Mineral
Oil orally twice a day in a dose of 1 tsp. age 1-2, 2 tsp. age 2-4, 1 tbsp.
age 4-8, and 2 tbsp. over age 8. While Mineral Oil is tasteless, it does feel slimy
so children are
reluctant to take it. this can be minimized by keeping it cold in the refrigerator and
having food or
drink handy to wash it down. It can also be disguised by mixing with a semi-solid
food such as yogurt,
ice cream, oatmeal, or jelly.
- Prevention is best achieved by
increasing dietary fiber. It is the rare child who can do this by eating
green vegetables, however. Buy high-fiber cereals and breads, encourage prunes and
raisins as
snack food, and try to have your children develop a taste for Bran muffins. A very
useful product in
this regard is "Unprocessed Bran", available in the grocery store. This
can be added to many recipes - ranging from any kind of baked goods to hamburgers, meatloaf, and casseroles - without
changing the taste.
If you have given the above
measures a fair trial (at least several days) and have not met with success, please call.
More aggressive treatments are available but really require close medical
supervision.
Finally, some children are
prone to repeated or chronic constipation. This tendency often runs in families. It
is also sometimes the first sign of an underlying serious disease - especially if the
tendency first shows up during early infancy. Children with chronic constipation
deserve a thorough medical evaluation and an individualized long term treatment plan.
If your child falls into this category, please schedule them for a
complete physical and bring up this problem at that time. |
