Relieving, Managing Children’s Constipation

Resource persons: Dr Simon Foo Hee Wei, Consultant Paediatrician, Paediatric Gastroenterologist and Hepatologist, Sunway Medical Centre Velocity (SMCV); and Jillian Tan Foong Yinn, Dietitian at SMCV

Functional constipation (FC), one of the most common gastrointestinal disorders in children, is defined as difficulty passing stool for reasons other than organic causes. According to Dr Simon Foo Hee Wei at SMCV, the disease has a worldwide prevalence of 9.5% and accounts for 95% of cases of constipation in healthy children aged one year and older.

While constipation might seem like a minor issue, untreated FC can lead to serious gastrointestinal complications such as tears in the colon and urinary tract infections. These can significantly impact a child’s development and quality of life. Therefore, recognising and learning the best ways to manage FC promptly is crucial for ensuring a child’s overall well-being.

Children, prone to developing gastrointestinal disorders
While many factors contribute to FC, it is important to note that children are particularly prone to developing it during their key life stages, such as the introduction of solid foods (6 months to 1 year old), during the start of toilet training (2 to 3 years old), and even when beginning pre-school (3 to 5 years old).

Dr Simon explains that these developmental milestones can be critical periods; for example, a child may develop FC during toilet training due to the stress and pressure of learning new routines.

Beyond life events, psychological factors like stress, anxiety or trauma can also trigger FC. For instance, the anxiety that comes with a change of environment, such as the uncleanliness of school restrooms, can lead a child to avoid using the bathroom, resulting in stool withholding. This can create a cycle of increasing pain and worsening constipation, causing significant distress.

Lack of fibre, intake of cow’s milk can cause constipation

Constipation can also result from a lack of fibre and fluids in the diet or an intolerance to cow’s milk. Transitioning from breast milk to cow’s milk can cause constipation in some infants, leading to anal fissures due to the passage of large, hard stools.

To determine a cow’s milk allergy – or any other types of food allergies, clinicians often recommend the two-week elimination method, where parents remove the suspected allergen from the diet. If the child’s condition improves, it strongly indicates an intolerance to that allergen.

Occasional constipation is common and usually not a cause for concern, but parents should be alert to the warning signs of FC, such as persistent abdominal pain and bloating, changes in appetite, weight loss, or inability to control their bladder.

Jillian Tan Foong Yinn at SMCV, emphasises the role of a balanced diet in promoting good bowel movements and overall gut health. She said that fibre-rich foods like bananas, papayas, and steamed carrots or potatoes not only promote regular bowel movements but also improve gut health.

Alongside fibre, adequate hydration according to recommended amounts based on age is equally important. However, Jillian cautions against the misconception that introducing fibre- rich foods can alleviate FC symptoms immediately. She clarified that it should be introduced gradually to not only give your child’s digestive system some time to adapt but also help gauge their tolerance and prevent issues like gas or bloating.

Balancing a child’s diet with occasional snacks is also key to maintaining a healthy approach and fostering a positive relationship with food. Finding this balance ensures that children receive essential nutrients from their regular meals while still being able to enjoy occasional treats.

On top of that, parents are encouraged to instill positive lifestyle habits in their children from young, including consistent physical activity like walking, swimming, or even playing sports. Children learn by imitating their caregivers; hence, parents should set a good example by participating with their children.

Managing, preventing constipation in children

Understanding FC and its underlying causes is the first step for parents to manage this condition in their children effectively. Caregivers must maintain a collaborative approach, ensuring open communication not only with paediatricians but also with their children themselves. This fosters a better understanding of the child’s condition and any challenges they may be facing.

Such communication is invaluable for medical professionals in offering accurate advice and treatment plans tailored to each child’s needs. Monitoring symptoms also becomes more effective when all parties are well-informed and proactive.

While specifics may vary case by case, Dr Simon suggests a general guideline of ensuring the child has a regular defecation
frequency of at least three times a week, without experiencing painful, large, or hard bowel movements as described in the symptom-based ROME criteria which defines functional gastrointestinal disorders.

What we need to know about potty training

Potty training is a well-known developmental milestone that every parent undertakes with their child. It is essential not only for instilling a sense of good hygiene and independence in children but also for potentially preventing FC. Despite its importance, many young parents may question the right age to begin potty training and how to ensure it is a positive experience.

According to Dr Simon, the recommended age to start potty training is around 4 years, when children can walk on their own, stay dry for a few hours, and can understand and follow simple instructions. If children start potty training a little too early, with the lack of readiness and comprehension, they may associate going to the toilet with negative emotions, which
can lead to stool withholding and, eventually, FC.

To help ease children into it, parents should ensure their child is comfortable throughout the process. Small steps, such as dressing children in easy-to-manage clothing, can help in case of accidents or the need for immediate changes to avoid discomfort. On top of that, setting a fixed time in their daily routine for using the toilet with a potty chair or ring can help
build initial habits. Introducing a reward system, such as small incentives when they go to the toilet on their own within the set timeframe, can create a positive relationship with the process.

Patience is key to successful potty training. Parents should not pressure their children and give them constant encouragement without getting too upset if toilet accidents occur. Being a source of support for your child during this time makes them feel safe and secure as they learn to use the toilet independently, Dr Simon said.

Patience is not only crucial for potty training but also for managing FC. This can be particularly challenging when young children struggle to understand the situation. Parents should not feel discouraged and seek open conversations with trusted paediatricians for professional advice.

Sharing experiences and struggles with other parents can also help provide some form of support and relief. In addition to maintaining a routine or diet for their children, parents can incorporate interactive and creative approaches like involving children in meal preparation or making fun plating arrangements to help them view these changes positively.

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