Constipation in children (Part 1)
Constipation in infants and children is rarely caused by an actual medical condition. In many children, constipation is triggered by experience of painful bowel movements or caused by factors such as toilet training, change in routine or diet, stressful events, illness like viruses or delaying going to the toilet. Most of the time there is no need for medication like stool softeners; often lifestyle changes such as more fluid and fibre in the diet will ease the problem.
Constipation can present at three common stages of childhood: in infancy at weaning; in toddlers learning toilet skills and at school age. Signs of straining in infants less than one year do not usually suggest constipation because children only develop muscles to assist bowel movements gradually. Provided that they pass soft stools and are otherwise healthy there should be no major problem.
What is constipation?
Constipation describes infrequent bowel movement, often with hard, dry stool that is difficult to pass. It may be associated with bloating, straining and pain. It is caused by inadequate muscle contraction or under absorption of water.
Diagnosing in children
The general diagnosis criteria for constipation in adults and children must include 2 or more of the following: 1. less than 3 bowel movements per week 2. History of painful or hard bowel movements 3. At least 1 episode of faecal incontinence (diarrhoea) per week 4. Presence of large faecal mass in rectum 5. History of stool so large that may obstruct the toilet
These symptoms must be present for 4 weeks in children under 4 years and for 8 weeks in children over 4 years in order to enable diagnosis.
Risk factors for constipation in infants and children
*Many drugs - Antihistamines/anticonvulsants/iron supplements and many more *Intolerance to cow’s milk *Inadequate fluid intake *Poor diet including excess milk *Low fibre diet *Lack of exercise *Obesity
Aim is restoration of bowel habit so stools are soft and passed without discomfort. Constipation may be Acute (short term) or Chronic (long term).
Treatment of acute constipation
Acute constipation refers to short term constipation that lasts only one to three weeks (generally brought on by short term illness eg. viral illness). In this case, ensure the child has adequate fluid intake and a good diet. If still no improvement, the GP is the next port of call. The GP may consider prescribing lactulose or Movicol® for a short period of one week. Movicol® is brand name for macrogol (for this article I will refer to as Movicol). Lactulose and Movicol are called osmotic laxatives, they work by drawing water into the stool and are considered to be the safest type of laxative as they do not stimulate the bowel muscle like laxatives such as Senna. Laxatives if required are generally only required short term. If a child is prescribed laxatives, it is important a GP reviews progress regularly.
To be continued…. next week
Disclaimer: please ensure you consult with your healthcare professional before making any changes recommended
For comprehensive and free health advice and information call in to Whelehans Pharmacies, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).