What is normal and what is constipation in children? Normal poop should be soft and easily passed and if it occurs less often than every other day then constipation is likely or could be starting. In babies who are breast fed the poo is paler and yellow and more liquid than formula fed babies. In babies who show signs of constipation the first line of treatment is to supplement boiled and cooled water in between feeds and check their temperature as the most common reason is a degree of dehydration.
Constipation in children under 5 years old seems to be becoming a much more common and worrying problem. It can affect their behaviour, their appetite and their concentration and it can cause them tummy ache and to feel sick. First actions should always be to get them checked out by their Doctor especially if they have any other symptoms like swollen tummy, severe pain, excessive thirst, weight loss or any blood in their poo. It is important to rule out any underlying disease or condition. If no cause is found then it is called idiopathic constipation and it may respond to increase in fluids, fruit and vegetables and a little prune juice or pure apple juice but in 1 in 3 children it becomes persistent and long-term. Persistent constipation in children can be a symptom of gluten intolerance and /or Dairy intolerance.
So what goes wrong and why is it worrying? We now know that within the digestive tract we have a huge amount of good bacteria that are essential for our well-being. These bacteria make up what is called our microbiome and it is our own internal ecological system that supports our digestion, nutrition and immune system. We start life with just a few species of bacteria that we acquire from our mothers, in the womb, when giving birth and when breast feeding. Even though our knowledge about the microbiome is fairly recent it has been acknowledged for centuries that the first breast feeds give the baby colostrum and that is very important for the immune system. In the first 6 months the baby will only have about a dozen different species of good bacteria in their gut but by the after the age of 2 years the number of species increases rapidly as the baby interacts with the environment and starts to eat more foods. An adult should have about a thousand different species of good bacteria but this is increasingly not the case and the main reason is antibiotics.
The younger you are when you have antibiotics the more damage they will inflict. Some antibiotics when taken for a 5-7 day course will alter the microbiome for a couple of years or it may never be the same. If your child has had antibiotics (or the mother has while breastfeeding), or had a severe case of gastroenteritis, it is vital that you try to repair the damage. The main symptoms may be constipation, excessive crying and wind, poor skin (dry or eczema), poor immune system, failure to thrive and fatigue. Worse and the symptoms may be severe allergies, Asthma or Attention deficit disorders.
So what are your treatment options? In many cases your Doctor may say that the child is ‘stool holding’ and because it has hurt when they have been to the toilet then they resist the urge to go and it just gets worse. The problem with this is that it doesn’t occur without constipation being a problem in the first instance so it is not a helpful diagnosis on its own. If the Doctor feels that the constipation is severe he may prescribe a laxative. The most frequently used for children are:-
- Lactulose, an artificial sugar that absorbs water and changes the acidity also discouraging the growth of some of the bacteria in the bowel.
- Movicol Paediatric plain or Miralax which are osmotic laxatives made of polyethylene glycol, a petroleum derivative similar to ethylene glycol (anti-freeze). These are not approved for children, or adults for more than 7 days use. The FDA has received over 7000 reports since 2001 of adverse symptoms of neurological disturbances and kidney problems.
- Glycerine Suppositories that have to be inserted into the rectum with a lubricant and the glycerine acts as a stimulant/irritant plus lubricant to make it easier to pass hard stools. This may not work if the suppository is not pushed far enough in or if it is not held in the rectum for at least 20 mins. It can be quite painful and cause some gut spasms. If it does work you still need to follow up on other treatment to get the stools moving down from higher up or it may only be a short-term fix.
Safer treatments that have the benefit of increasing the immune system are :-
- Milk of Magnesia for ages 3-12 with a maximum of 30 ml in 24 hours and not for more than 3 days (only use for children under 3 on the advice of your doctor.
- Prune juice, pure Apple juice & pure Pear juice are well tolerated.
- Syrup of Figs for children over 1 yr. old following dosage on bottle.
- Magnesium oil spray on the skin or Magnesium Flakes added to a warm bath before bed and peppermint or fennel warm tea that may help ease wind discomfort and contains natural poly-phenols that also help feed good bacteria and
- Probiotics – there are good ones available for babies and infants (and breast feeding Mums) by companies like OptiBac and Saccharomyces boulardii that is a specific probiotic that can help kill bad gut bacteria and yeasts.
- Effervescent Vitamin C drinks of 500 mg -1500 mgs can also be a way of softening and speeding up elimination as the body has a tolerance level of about 2-3 grams for adults and the dose should be lower for children.
At the same time adjust the diet according to age and stage of weaning by leaving out gluten grains, bread, pasta, processed foods, sugar and increase fibre like porridge, brown rice, freshly ground flax seeds, fruits separate from main meals – especially raspberries, strawberries, blackberries, cherries, plums and prunes. Vegetables like sweet potato, jacket potatoes with skin, peas, olives, cucumber, broccoli and Olive oil, coconut oil and ghee or butter and live yoghurt if tolerated, and chocolate/cocoa. Encourage plenty of sugar free drinks like water, herb or fruit teas, as well as pure fruit juice diluted with water a couple of times a day. Re-introduce gluten grains, bread and pasta gradually when bowel movements are normal and if constipation or other symptoms return try omitting them for longer.
Exercise is always beneficial – get them to learn to Hula Hoop! Specific Yoga moves like doing the Cat and pulling in stomach muscles or lateral twists where you lay on the floor with your arms out to the side and then draw up your knees together and roll them from side to side, while keeping your shoulders on the floor, are good and can be made into a game. Gentle massage to the abdomen is beneficial but only if you start in the bottom right-hand corner and work up in circular movements then across under the ribs and down the left-hand side.
Most of this advice is just as appropriate for adults with constipation and I will cover digestive well-being for all in a other posts.