What is constipation?
There is a range of bowel habits that can be considered normal in children. Some kids regularly pass stool several times a day and there are others for whom is it normal to go to the bathroom only once in a few days. This is why there is no consensus on the medical definition of constipation. But practically, children are considered constipated when:
- They are passing stools less frequently than they normally do
- They have to strain because their stools are harder and usually larger than normal (sometimes they are only able to pass small pellets of stools)
- They have pain and sometimes bleeding because they develop a tear around the anal opening while trying to force out stools
- They start avoiding the bathroom as it is uncomfortable and painful
Why does constipation occur?
1) Most of the time, constipation occurs when there is not enough fiber and/or water in the diet.
Dietary fibers are carbohydrates found in plant-based food that the body cannot digest. These fibers are not broken down in the gut and are excreted in the stools. In the gut, these fibers help draw water into the stools therefore making the stools soft and easy to remove. Constipation often occurs when
- Children start weaning and shift from milk to solid foods
- Children fall sick- they eat and drink less and also lose more water during fever resulting in harder stools
- When children are stressed such as when they change schools
2) The longer the stools remain in the gut, the more water is pulled out from it resulting in very dry and hard stools. Children usually withhold stool
- During toilet training (particularly when toilet training is started early before 24 months)
- When children avoid going to the bathroom either because younger children are too engrossed in their play to take a break or older children do not feel comfortable using bathrooms outside of their homes.
3) Certain medicines also cause constipation such as oral iron, cough syrups, and antispasmodics that are given to relieve tummy aches
4) Rarely, constipation may be due to medical conditions.
Red flags that point out to medical conditions causing constipation that need medical consultation include:
- Delayed passage of the first stool (more than 48 hours after birth)
- Constipation starting in early infancy (before one month of age)
- Vomiting and abdominal distention (bloating/swelling)
- Poor growth and lack of weight gain
What can you do about it?
1) The key to managing constipation is diet modification. Increasing dietary fibers and water intake usually solves the problem (more on dietary fibers below). Children between the ages of 1 to 3 years need approximately 4 cups of water/milk per day, 4-8 year olds require around 5 cups, and older children need 7-8 cups.
2) If the constipation does not improve, it is advisable to seek medical advice. Depending on the degree of constipation, oral medication to soften the stools may be prescribed or if the child’s stool is impacted (stuck) in the lower gut, an enema may be given to empty out the bowel.
3) Watch out for the precipitating factors and address as necessary (for example, stop medications, manage stress, regularize stools habits)
How to increase dietary fibers?
Dietary fibers are found in foods such as whole grains (whole-wheat bread, brown rice, and oatmeal), beans/lentils, fruits, vegetables, nuts and seeds.
You can:
- Aim for 5 servings of fruits and vegetables every day. Apples, pears, mangoes, carrots, peas, cauliflower, broccoli, green leafy vegetables like spinach (palung), yam (tarul), sweet potatoes (sakar khanda), taro (pindalu), avocados and dried fruits (raisins/ prunes) are some of the richest in fibers. Concentrate on the ones your child likes.
- Avoid peeling fruits such as apples and pears.
- Switch to whole grain rice/ cereals/ bread/ pasta. Oats are excellent and can be made in different ways both sweet and savory. For flour, use atta instead of maida.
- Introduce varieties of beans – rajma, chickpeas, different dahls, soybean (bhatmas). You can even add in besan (ground chickpea) and masyaura in your recipes.
- Add nuts (almonds/peanuts/ sunflower seeds/ pumpkin seeds). You can grind them and add them to different dishes as long as your child is not allergic to nuts.
- Popcorn! But avoid in babies and toddlers.
Be creative! Experiment a bit and see what works for your child.
Note: Too much fiber at once can cause bloating and tummy aches. Also, fibers need to absorb water from the gut to make the stools soft, so children must drink enough water along with increased fiber intake.