This post was written by WhiteCoat Partner Paediatrician, Dr LIM Yang Chern. You can find out more about WhiteCoat’s General Paediatrics service here.
What is constipation?
Firstly, we should define what healthy bowel habits are. Healthy bowel habits are when a child (or adult) has daily, or at most every other day, passes well-formed soft stool. The actual defecation should be painless, and rather effortless. The whole exercise should take no more than five or so minutes.
An example of a typical healthy bowel habit can be summarised as such:
- You feel an urge to go to the toilet
- You head to the toilet (the baby equivalent of the toilet would be diapers)
- Minimal strain is experienced during the process
- Excretion of soft stools
- Done! (Followed by cleaning up, of course!)
Constipation is the absence of that healthy habit. We can define constipation as the infrequent passage of stools, often 2 of less bowel movements a week. I like to also add on the further definitions: Constipation is also present when defecation is painful, or if the child passage large calibre stools often requires excessive straining.
Common causes of constipation
Firstly, constipation should not be a condition experienced by young babies and newborns. If your baby no passage of stools within the first 24-48 hours of life, please bring your baby to a Paediatrician to be examined for structural problems as soon as possible.
It is important to check with your doctor to ensure there are no dangerous causes of constipation. Having said that, for toddlers, the commonest cause of constipation is related to low-fibre/low-water diets.
Constipation often occurs during the weaning stage, when babies progress from liquid to solid diets. A transitional period ensues and after some time, the baby’s gut will be accustomed to the new solid norm and things will get better.
A common cause of constipation is poor intake of fibre and water. This is very frequently seen in families with a “picky eater”.
For good stools to form, our body needs fibre as well as water. The absence of either will give you problems with stools. For this group of patients, doctors can only assist. Parents need to take charge of the situation and ensure that high fibre foods and adequate water is taken by the child.
A vicious cycle often follows constipation. As the child feels pain on passing motion, they start fearing the act of passing motion and intentionally start holding it in. This starts the vicious cycle as the stools get progressively harder the longer the child holds it in. Eventually it has to come out and that often causes more pain, restarting the whole cycle.
This behaviour manifests often as standing still when the urge comes and often there is crossing of legs as the child tries to keep it in. There is also pain that happens as the body tries to expel the hard stools. The child will have intermittent bouts of abdominal pain, usually left-sided or around the belly button.
Parents can even observe the hard poo at the anal verge when the child strains. When the child relaxes, the poo will retract back into the rectum.
Remedies for constipation
Prevention is the best recourse. You should start your child on a high fibre and water intake once weaning starts.
Once chronic constipation sets in, the duration of the treatment often extends over weeks and even months. Parental perseverance and adherence to the treatment plan and a good diet is crucial.
Paediatricians will also prescribe oral medications improve the bulk of the stools. Sometimes, we may also need to “disimpact” the rectal end from hard stools with suppositories. However, medications are not the mainstay of treatment.
Parental guidance, love and care in ensuring a healthy diet that promotes good quality stools is the key determinant in treating constipation. Parents are the key factors that determine if the child will have chronic constipation.
How can teleconsulting a Paediatrician help?
The first visit often should be in person so that your doctor can examine the child physically to look for red flags that may indicate a medical problem for the constipation. After the diagnosis of functional constipation, parents can continue to do follow-ups via teleconsultation.
Should you observe persistent or even worsening symptoms, teleconsult a Paediatrician on the WhiteCoat app with your child. Experience the convenience of remote care for your child, and receive the required care and medication from the comfort of your own home. Click here to find out more about our Paediatrics service, or click here to go back to the blog.