Constipation

Constipation is a common condition that affects people of all ages, but is particularly common in babies and young children. In Ireland, almost one in three parents has reported constipation at some point in their child’s life.

 

Constipation occurs when your child is unable to pass poo regularly or completely empty their bowl. Your child’s poo can become hard and bulky, as well as unusually large or small.

 

In cases of chronic constipation, your child may experience soiling. Soiling is common place with constipation and occurs when loose poo seeps out around the hard poo. This scenario can often be an embarrassing and upsetting experience for the child, so it is important to help your child understand why this is happening and more importantly that it not their fault.

 

Other signs of constipation include:

• loss of appetite,
• lack of energy,
• being irritable, angry or unhappy,
• foul-smelling wind and stools,
• abdominal pain and discomfort,
• soiling their clothes, and/or
• feeling unwell.

 

Most childhood constipation is idiopathic. This means that no disease or illness has caused constipation. However, there are several factors that may contribute to the development of childhood constipation, or possibly make it worse. Poor diet, fear about using the toilet, poor toilet training and a lack of understanding on how bowels work can all be responsible for constipation in children.

 

We are here to help you understand and manage your child’s constipation. As a parent, there are many things you can do to help alleviate their condition. Treatment for constipation requires a committed and positive approach as more than half of children suffering constipation will relapse and may need repeated doses of clear-out medication. Together, we will create a plan to ease your child’s worry, discomfort and pain.

Top Tips for Parents

 

Understanding constipation

Take the time to explain to your child how their body works. Help them understand how and why poo is made and why it is important to go to the toilet. The following two videos can help you explain the pooping process and constipation to your child.

 

Video for older kids: https://www.youtube.com/watch?v=SgBj7Mc_4sc

Video for younger children: https://www.youtube.com/watch?v=Mq4bAVhvGHw

 

Balanced diet

Providing your child with a balanced and healthy diet can significantly ease your child’s constipation. Begin by keeping a food diary of what your child eats and drinks over a few days. This diary will help you gain a greater understanding of meals/foods you need to change. A high fibre diet and water intake can make a big difference to your child’s constipation. Children can be fussy eaters so changing to a high-fibre diet may be much easier said than done. But any change is a good change.

 

Fibre

Fibre comes in two forms: (1) soluble fibres which dissolve in water and help to slow your child’s digestion and absorb nutrients in food and (2) insoluble fibres which add bulk to your child’s poo, helping the poo to pass more quickly through the intestine. Fibre-rich foods include:

• fibre-rich cereals,
• dried apricots, prunes or figs,
• baked beans,
• black beans,
• porridge oats,
• brown bread,
• sweet corn, and

 

For children over two years, you can calculate the amount of daily fibre they need by adding the child’s age in years to 5 grammes. For example, if your child is eight years old, then you calculate it as 8 + 5 = 13. Therefore, an eight-year-old should be eating 13 grammes of fibre a day.

 

Water

Dehydration is one of the most common causes of chronic constipation. As explained in the videos above, the large intestine soaks up water from the food passing through. If your child is dehydrated, this will lead to a hardening of the food waste (poo) and increase the chance of constipation.

 

Recommended Fluid Intake
Age	For Girls	For Boys
4 – 8 years	1 – 1.4 litres	1 – 1.4 litres
9 – 13 years	1.2 – 2.1 litres	1.4 – 2.3 litres
14 – 18 years	1.2 – 2.5 litres	2.1 – 3,2 litres

To encourage your child to drink more water why not get them a special cup and straw to make it more fun. Fruit juice such as prune, apple or pear juice may be useful from time to time as they have a laxative action and may loosen the bowel.

 

Make a reward chart for your child and give them a sticker at the end of the day if they reach their daily target of fluid and fibre intake, and passing a poo (see below). Again, it is important to explain to your child what you are doing and how to play along. At the end of the week, if they reach their goals, reward them with a treat.

 

Toilet training and habits

Some children can feel stressed or anxious about using the toilet. Toilet training too early, painful pooping or constant intervening when they are trying to go, can increase stress when using the toilet. Constipation can also happen if your child ignores the urge to poo (withholding) because he or she is afraid of the toilet. In other instances, they may simply not want to break away from play, or maybe they feel uncomfortable using public toilets, for example, at school.

 

Timed toileting is an essential part of the treatment for childhood constipation and must be carried out as a daily routine. It is vital to help your child to feel relaxed and at ease about using the toilet during this time.

 

Guidelines for timed toileting

• Use the body’s natural abdominal reflex, which is strongest in the morning and about 20-30 minutes after main meals
• Although it’s important to keep a routine, always encourage your child to go when they feel to urge to use the toilet
• 5-10 minutes is usually long enough
• Keep your child company and teach them how to position themselves on the toilet to poop properly
  • Ensure your child feels relaxed and comfortable. Smaller children may need an add-on seat or a footstool to help them feel supported
  • When sitting, help them to lean forward and rest their elbows on their knees. Their knees should be higher than their hips
  • Always discourage straining
• After a poop, encourage your child to look at their poo in the toilet and use the Bristol Stool Chart to help them identify and understand different types of poo.
  • The goal is poo type 3 and 4 which are generally easy to pass without being to watery
  • Poo type 1 and 2 generally indicates constipation
  • Poo type 5 and 6 generally indicates diarrhoea
• Promote good hygiene habits by encouraging them to flush the toilet and wash their hands after using the toilet.
• Avoid computer games, mobiles or anything that may distract them from concentrating on making a poo.

Medication

In cases of chronic constipation, medication may be necessary to clear out the build-up of poo in the bowel. This medication may cause cramps, and your child will poo a lot, but that’s the outcome we are looking for.

 

After the initial clear-out of poo with a high dose of medication, maintenance medication is required. Maintenance medication may need to be taken regularly for some time before your child’s bowel return to normal. At this point the maintenance medication can be slowly reduced, but not stopped suddenly.

 

Please do not stop using the medication until you have discussed it with your GP who will advise you how to reduce the medication.

 

We are here to help you to understand and manage your child’s constipation. We are happy to discuss any worries or questions you may have. The links below provide evidence-based guidance and care, and are particularly useful for helping you to understand your child’s condition and how best to manage it.

Useful Links:

• NHS Living Well – Constipation in young children
• Patient – Constipation in children
• ERIC – Let’s talk about poo game