Monday, November 20, 2006

Help Doctor, my child is CONSTIPATED!

Constipation is one of the most common problems in Children. But, another common problem is Parent's expectation of how often the child should have a bowel movement.

I have many anxious parents who come into the clinic and tell me that their child is constipated. The child had soft stools the day before but no stools today. Before we get carried away with treating constipation, let's understand when we call constipation constipation.

When is constipation, CONSTIPATION?

  1. Less then 3 bowel movement a week, or not having bowel movement for 3 - 4 days
  2. If the stools are very hard and the child has difficulty passing the stools
What you can do

  1. Give lots of fluids. Water and naturally sweetened fruit juices are best. Avoid soft drinks and fruit juices which are artificially sweetened
  2. Give the child lots of fibre in the form of cereals and bran. Fruits such as papaya and even dried fruits like prunes and raisins are excellent for promoting bowel motion. Make sure they get their vegetables which are a good source of fibre
  3. Getting the child to be active and excercising. Bring the child to the playground and let them run around and jump up and down!
  4. Always make sure that the constipation is not due to other causes. The Doctor will help you determine that
  5. Use a bit of lubrication like wiping a bit of petroleum jelly on the anus
  6. Make sure the formula is prepared according to instructions. Some overenthusiastic parents and grandparents put more powder or compact the milk powder to help the child grow fat fat faster!
Don't let the child be Constipated too long!!

A real life example

I saw a 5 year old child who had been having chronic constipation for almost a year. The passage of stools is very hard and she usually goes to the toilet only twice a week. It all started with simple constipation, but after a while, the stools were so hard that the skin of the anus was stretched so much that it started to tear, resulting in an anal fissure. Because it was now more painful to pass motion, the child controls the motion to avoid the pain. This results in the stools getting harder and drier and more difficult to pass. And the cycle goes around and around...

A word on toilet training

It is important that you do not let the child start to develop this problem. So in addition to the measures outlined above, you should also:
  1. Put the Toddler on the Toilet Bowl at the same time daily, usually after a meal and leave him there for 10 minutes. Make sure that the feet are rested on the floor or a stool. Encourage him to Pang Sai (Pass Motion), but if there is no motion, don't worry too much about it. Just do the same routine everyday.
  2. See your doctor once the constipation is more than 2 weeks. The doctor may prescribe some medication to help soften the stools. He will also check for other problems that may cause the constipation
That's it from me.

If you have a question, please click on comments and leave your questions there.

For more information on constipation, click here


Dr Leslie said...

Best thing for you to do is to change to another soy formula and see if that works. Alternatively, you can try going back to cow's milk again and see what happens. (So long as the allergy was only skin rash) Kids grow out of the allergy at different stages. Most of them by the age of 2.

Anonymous said...

Juz to share..we had given our gal lactus over a week until her stool was no longer hard when she had constipation - din see any side effect except loosen the stool. Sometimes baby can be traumatised by constipation (bloatedness, pain, discomfort), their body will react by avoiding poo-ing completely and that might worsen the bowel movement. This is what my PD told me.
Maybe u can try to give her prune or pureen pear. Add fibre into her diet eg veg, let her drink barley water or apple juice to increase her fluid intake.
Food like oat, bran, cereals are good for digestion only if there is enuff fluid intake.
Now my gals are older - I gave them yogurt whenever they have no bowel movement for more than 3 days.

Anonymous said...

Hi, my 2yr old gal has constipation for months now, and there is blood every time she passess out the stools due to the tear of her anus. I tried giving 30mls prune juice daily, ocassionally yoghurt and fruits, but it just doesn't seems to help. What else should I do?

Dr Leslie said...

You should really see your doctor for an examination and possibly investigations.

Anonymous said...


my ger is now 14mons .. she has contispation for quite a while. She drink alot of water and i give her heinz fruit juice daily, but it does not help in her constipation. I even change FM from NAN3 to Nespray 1+ w/ honey. But until now, she still suffering from constipation, with bleeding in anus. Sometimes i just had to dig abit of her stool out. My ger really has to push very hard, till her whole face turn red and sometimes to the extend of bending her body to 90 degree.
Brought her to see you before, and your medi did help to soften the stool ... but once stop taking the medi, the stool was hard again. But we can't keep depending on medi right?
I need advise... what should i do now?

Dr Leslie said...

The medicine to soften the stool is safe for use and can be used long term. You have to be very careful at this stage as you do not want the child to develop a phobia to pass motion.

terter26 said...

can i give my 15mons old kid those Del Monte Prune Juice? I actually mix it up with water. Eg. 50ml prune juice + 50ml of water ... cos I not sure if she can take adult concentrate prune juice.
Also, how many times can she take the prune juice. I give her twice a day, everyday. Is it too much?
Pls advise. Thank you.

Anonymous said...

the last post is half year ago but i hope to help, whoever still readign this thread.

i am constipating myself from my third trimeter. I find drinkign porridge and eating prunes (instead of juice) helps.

perhaps the medications worked, but results came only after one week ++ ???

I'll continue the porridge (you know u need lots fluid, but have you thought drinking porridge? No, right?)and prunes, and stop medication incase of their side effects.

High fiber diet is important, but it didnt solve my constipation. nevertheless, stick to it coz its good for your health.