The common stages in life when a child might get constipation include the time when a child goes through a change in diet and when a child enters a new environment (for example, going to school for the first time). Adding to that, consultant paediatrician Dr. Cheah Cheong Wooi says, "60 to 80 percent of cases of older kids who come to see me complaining about stomach pain or discomfort, have constipation. I normally see such cases in two age groups: at about 1-2 years old and at kindergarten age (5-6 years old)."
DETECTING CONSTIPATION IS TRICKY
Among older children who no longer wear diapers (going to the toilet on their own), it can be difficult to detect the problem. Dr. Cheah explains, "I have to be very specific when asking questions during a check-up. Most times, parents assume everything is going fine because they see the kids going to the toilet every day. But on many occasions, although the child does go to the toilet, they don't evacuate completely. Children who are constipated are likely to pass out small hard lumps of separate stool (like pellets) and they don't fully evacuate because they have to strain to get it out, it can be very painful. When I see them, I ask them when they last went to poo and how much of it was released."
As for the symptoms, Dr. Cheah says that most times, kids who are constipated do not cry. They would only complain occasionally about abdominal pain. "One of the tell-tale signs is when the child is looking angsty and uneasy. Those who have had chronic constipation would have stomach discomfort."
FREQUENCY AND CONSISTENCY GO HAND IN HAND
Less than three bowel movements a week may be a sign of constipation, but there's more to it. According to Dr. Cheah, frequency and consistency of stool go hand in hand when it comes to identifying constipation. "Constipation is multifactorial. If a child has bowel movements three times a week but the texture and consistency of poo are normal, it isn't a problem. But if a child poos every day but is letting out hard pellet-like stools which are hard to pass out, I would still treat them for constipation."
Besides asking about bowel habits, Dr. Cheah refers to the commonly used Bristol stool chart. "I would ask the child to point out what his or her stool looks like. Normal stool should look like type 4 of the stool chart (a smooth sausage, soft in texture). Type 3 (sausage shape with cracks on its surface) or type 5 (soft blobs with clear-cut edges that can be passed easily) may be normal too, but it depends." If parents are unsure or concerned, they can bring their child to a paediatrician for further checks.
Parents can play a role in identifying constipation in their kids too. For this, they have got to keep track of their kid's stool. Dr. Cheah elaborates, "Parents can keep a stool diary to document the frequency and consistency of poo. For the bigger kids, parents can ask their kids to describe their poo instead."
Color doesn't matter as much as people think. "Stool can be brown, green or yellow and that's perfectly normal, color of excrement is dependent on the child's diet. However, if a child's stool is dark colored and has mucous or blood, you have to bring him or her to see a doctor.
EASING CONSTIPATION
Dr. Cheah reveals that a common misconception is that constipation is only treated by medicine to soften the stool. While those medications do help sometimes, a change in diet and nutrition is more effective in long term prevention of constipation and its recurrence. According to Dr. Cheah, we can help our kids prevent constipation by:
- Giving them a balanced diet
- Pre-and probiotic supplementation
- Proper potty training
He stresses the importance of potty training and has concerns that the process is often delayed or not done properly due to parents' and caregivers' increasingly busy schedule. "Parents need to realize that children who start well tend to have better outcomes. The best time to train is when the child is ready," Dr. Cheah said.Having the right potty is important when training, a proper potty gets the child to squat. "The ideal position which allows young children to poo comfortably is the squatting position. Train your children to squat so that they build the muscles that help them poo (at least until a certain age when they can push well). Once they are well trained, parents can promote them to the adult toilet bowl. Timing for toilet trips depends on the child, but you usually get bowel movements after food."
On the topic of diet, it's all about achieving that balance. A healthy plate normally consists of vegetables, fruits, whole grains, protein and dairy. Include pre-and probiotic supplementation as this helps build a healthy digestive system in children by promoting the growth of good bacteria. Sufficient fibre and adequate water intake are also required to form healthy stool. "By the age of one, a child needs three meals a day, given in a healthy portion according to their age. If a child is getting healthy balanced meals and are additionally given some fruits as snacks, they almost never come back again complaining of constipation," Dr. Cheah reassures.
TAKE HOME MESSAGE
- Constipation is very common among children
- Parents can use a stool diary to keep track of their children's poo. The diary also documents stool frequency and consistency
- Prevention is the most effective way of managing constipation. The best ways are: helping your kids achieve a balanced diet, pre- and probiotic supplementation and proper potty training.
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