This year, in conjunction with World Digestive Health Day on May 29, we shine the spotlight on a common gastrointestinal complaint amongst kids: constipation[i][ii]. Here’s the low down on what causes constipation in your child, and what you can do to prevent it.
Ouch, your child is crying again… and your heart aches. He tells you that it’s painful to “poo poo” and you are at a loss of what to do: should you rub his stomach or give him more water? Should you ask him to continue trying to push it out?
Sounds familiar?
Very often, a mother’s world revolves around her child’s bowel movements – Is he pooing regularly? Why is his poo so hard? Why does it cause him so much pain? Most importantly, what can I do to prevent it from happening again?
Understanding Constipation
Even though constipation is very common amongst children, it is not easy to pinpoint and is often a challenge to deal with. What counts as ‘regular’ bowel movement differs from one child to another hence it’s also easy to overlook.
Generally, constipation is understood to involve infrequent, difficult, painful or incomplete release of hardened stools. In young kids, it is most commonly caused by the child withholding bowel movement, because he wants to avoid the painful experience of passing hard stools. When this occurs, the stool remains in the colon for longer periods, becoming compacted and thus more difficult to push out. This in turn causes your child to strain, sometimes leading to bleeding as the hardened stools may cause small tears in the rectum. [iii]
Parents should be on the lookout for tell-tale signs of your child attempting to withhold bowel movement, such as squatting, rocking, stiff walking or crossing of the legs. [iii]
Self-Help Tips to Manage and Prevent Constipation
There is no quick-fix for constipation but like any other condition, prevention is better than cure. Here are some useful tips to manage and prevent constipation in your child:
1. Understand your child
Studies show that there are two transition periods in which a child is particularly prone to constipation; the first being at the time of toilet learning, and during the start of school. [iv] Toilet learning should not be a struggle, so be patient with your child if he soils his pants. Know that it may not be intentional and he is also learning to adapt.
2. Encourage regular “toilet times”
Train your child and encourage him to use the toilet at regular periods, such as after meals. [v] If your child is already suffering from constipation, introduce a routine scheduled toilet sitting for 3 to 10 minutes (depending on his age), once or twice a day. Use a footstool to support his legs so as to effectively increase intra-abdominal pressure. Don’t punish him for not passing motion during this time, but praise and reward him if he does. [vi]
3. Introduce fibre in his diet
A balanced diet that includes whole grains, fruits and vegetables is recommended for the management of constipation amongst children. The Malaysian Dietary Guidelines for Children and Adolescents recommends two servings of fruits and two servings of vegetables for children between 3 to 6 years old. [vii] Offer the child more wholegrain or wholemeal breads, unpolished rice, high bran cereals and high fibre biscuits instead of normal bread and cereals, polished rice and the common biscuits. Beans, legumes and nuts too are good sources of fibre.
4. Increase fluid intake
In addition, ensure your child drinks sufficient fluid, especially when he is active or unwell – children between 2-3 years old should drink 1-2 glasses of plain water per day while children above four years should consume 6-8 glasses per day. [vii] Remember, this should be practiced daily and not only when constipation is suspected.
5. Eating food that could promote growth of beneficial bacteria in the gut.
Prebiotics can help to improve the risk of constipation by improving the growth of beneficial bacteria in the gut. Prebiotics are food for the beneficial bacteria to grow and multiply. Prebiotics, mostly oligosaccharides, are ingredients that could be found in foods that cannot be normally digested by the digestive system. Common food sources of oligosaccharides include onions, garlic, banana, asparagus, leeks and Jerusalem artichokes. Prebiotics can increase bacterial mass and water content of the stool content in the colon. These actions increase stool mass, softening the stool, and could contribute to shorten the time the stool is being retained in the colon and reduce the risk of constipation. [viii] Based on the abundance of scientific evidence, the Malaysian Ministry of Health specifically allows the following claim on prebiotic mixtures: “Oligosaccharide mixtures containing 90%GOS and 10% lcFOS helps increase the beneficial bacteria and helps maintain a good gut environment.” [ix]
So moms, now that you understand constipation a little better, you can now take steps to help manage and also prevent it from happening to your child.
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This article is brought to you by renowned nutritionist Dr Koh Chu Sing in conjunction with World Digestive Health Day on May 29, a global health day dedicated to raising awareness about the importance and benefits of good digestive health.
[i] van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: A systematic review. Am J Gastroenterol 2006;101:2401-9.
[ii] Shah ND, Chitkara D, Locke R, Meek PD, Talley NJ. Ambulatory care for constipation in the United States, 1993-2004. Am J Gastroenterol 2008;103:1746-53.
[iii] A Rowan-Legg; Managing functional constipation in Children. Canadian Paediatric Society Community Paediatrics Committee, Paediatr Child Health 2011;16(10):661-5
[iv] North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Evaluation and treatment of constipation in children: Summary of updated recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2006;43:405-7
[v] Constipation in Children. National Digestive Diseases Information Clearinghouse (NDDIC)
[vi] A Rowan-Legg; Managing functional constipation in Children. Canadian Paediatric Society Community Paediatrics Committee, Paediatr Child Health 2011;16(10):661-5
[vii] Malaysian Dietary Guidelines for Children and Adolescents 2013
[viii] Binns N. International Life Sciences Institute (ILSI) Europe: Concise Monograph Series. Probiotics, prebioitcs and the gut microbiota
[ix] Guide to Nutrition Labelling and Claims, Food Safety and Quality Division, Ministry of Health Malaysia
