THE DOCTOR IS IN

Con­sti­pa­tion in tod­dlers can lead to an un­happy lit­tle one, so learn how to keep them reg­u­lar and happy

Oi Vietnam - - Contents -

Con­sti­pa­tion in tod­dlers can lead to an un­happy lit­tle one, so learn how to keep them reg­u­lar and happy

CON­STI­PA­TION IS A COM­MON

prob­lem that al­most ev­ery child will ex­pe­ri­ence at some point in time. It is a con­di­tion where a child in­fre­quently passes hard painful stools over a long pe­riod of time.

Un­for­tu­nately, in many cases this prob­lem goes un­no­ticed. Re­cently a mother brought her three-year-old child to the clinic. Her con­cern was her child’s loss of ap­petite. He would of­ten start eat­ing and then sud­denly stop and refuse to con­tinue. When I ex­am­ined the child, I no­ticed hard masses in his belly. He hadn't passed stools for three days, and the mother told me that when he did, they were usu­ally hard and painful.

Con­sti­pa­tion can cause ab­dom­i­nal pain and loss of ap­petite in chil­dren. Nor­mally when we eat, a bod­ily re­ac­tion called the gas­tro­colic re­flex will cause the colon (large in­tes­tine) to con­strict, cre­at­ing the urge to defe­cate. If a child’s colon is filled with hard stools, this re­flex will cause pain, and the child will stop eat­ing. Even­tu­ally, he will refuse eat­ing al­to­gether to avoid this painful sen­sa­tion.

Con­sti­pa­tion has a sig­nif­i­cant im­pact on a child, both phys­i­cally and psy­cho­log­i­cally. A child who has passed painful stools will try to avoid going to the toi­let again to pre­vent pain. That cre­ates a vi­cious cy­cle that will cause the re­ten­tion of more stool in the colon, stretch­ing it to a point at which the colon doesn't func­tion prop­erly and the con­sti­pa­tion will get worse. A child that suf­fers from long-stand­ing con­sti­pa­tion may lose the abil­ity to con­trol his anal sphinc­ter and may suf­fer from "leak­age" of small amounts of loose stools and

stain­ing of his un­der­pants.

This prob­lem has a great emo­tional im­pact on a child. It causes the child to be afraid of the toi­let. It will cause a child to feel em­bar­rassed, to try to avoid cer­tain so­cial si­t­u­a­tions (avoid­ing public toi­lets at school, avoid­ing vis­it­ing friends) and to suf­fer from low self-es­teem.

Con­sti­pa­tion In Babies

Con­sti­pa­tion is a com­mon con­di­tion in tod­dlers and chil­dren, but it’s quite un­com­mon in lit­tle babies. Some­times, nor­mal phe­nom­ena might be mis­taken for con­sti­pa­tion:

• Breast­fed and for­mula-fed babies can pass stools any­where from six times a day to even once a week. Usu­ally, when they do pass a stool, it is soft and not painful.

• A baby might seem to be strug­gling to pass stools, grunt­ing and strain­ing, even turn­ing red, even­tu­ally passing soft stools. This is a re­sult of un­co­or­di­na­tion be­tween the ab­dom­i­nal mus­cles push­ing the stool out and the squeez­ing of the anal sphinc­ter, which makes it dif­fi­cult to defe­cate. Even­tu­ally, the baby learns to re­lax his sphinc­ter and the strain­ing sit­u­a­tion is re­solved.

Rea­sons

If a baby does suf­fer from true con­sti­pa­tion, we need to search for a cause:

• Con­sti­pa­tion may be the only sign of milk al­lergy in lit­tle babies. Some­times there can be blood in the stool.

• Anatomic con­di­tions such as bowel ob­struc­tion, Hirschsprung dis­ease, or her­nia.

• Hy­pothy­roidism (Low thy­roid hor­mone)

• De­hy­dra­tion, Mal­nu­tri­tion • Bot­u­lism (from ex­po­sure to honey) • Rare meta­bolic dis­or­ders.

Treat­ment

The treat­ment of con­sti­pa­tion in­volves three as­pects:

1. Nu­tri­tion

• Avoid sug­ary sweet foods and drinks (in­clud­ing fruit juices); fatty foods; large amounts of white rice; and ba­nanas. Th­ese may worsen con­sti­pa­tion.

• It's bet­ter to blend the whole fruit than to pro­vide only the juice; your child will get more vi­ta­mins, min­er­als and fiber this way.

• Give your child foods rich in fibers (whole rice, ce­re­als such as oats, whole fruits and veg­eta­bles, whole grain bread).

• Blended prunes (es­pe­cially dried prunes) can some­times help with con­sti­pa­tion.

• Adding 1–2 spoons of olive oil to your child’s food may help.

• Make sure your child drinks plenty of wa­ter (not juice!).

2. Stool Soften­ers

If nu­tri­tional changes don't help, the next step is to use stool soften­ers. There are dif­fer­ent types on the mar­ket: I usu­ally rec­om­mend Dupha­lac or Lac­tu­lose. This is a special type of sugar that is not ab­sorbed, re­tain­ing wa­ter in­side the gut and loos­en­ing the stool. I pre­fer not to pre­scribe sup­pos­i­to­ries (such as mi­cro­let or glyc­er­ine) as they are less ef­fec­tive, and some­times may even be trau­matic for the child.

The goal is to get stools as soft as tooth­paste—not firm, and not too loose. Start with a low dose (0.5–1 sa­chet) and grad­u­ally in­crease ev­ery 2–3 days un­til you reach the de­sired goal.

Con­tinue this dose daily for at least 3–4 months. The treat­ment usu­ally lasts for sev­eral months for a cou­ple of rea­sons:

• It takes time for the di­lated rec­tum to get back to its nor­mal size and func­tion.

• It takes even longer for the child to for­get the pain of passing hard stools.

• There is no risk of "ad­dic­tion" or "getting used to" this treat­ment.

3. Be­hav­ioral Plan

• En­cour­age your child to sit on the toi­let twice a day af­ter break­fast and af­ter din­ner. This way you can take ad­van­tage of the gas­tro­colic re­flex that oc­curs af­ter eat­ing. Let the child sit there for a few mo­ments even if noth­ing hap­pens, just to get him fa­mil­iar with the sit­u­a­tion.

• Re­mem­ber, when your child is on the potty or the toi­let seat, make sure his knees are higher than his hips. Squat­ting is even bet­ter. This po­si­tion makes it eas­ier to pass stools.

• Make it fun—in tod­dlers and preschool chil­dren, pre­pare a cal­en­dar. Ev­ery time your child suc­cess­fully passes stools, put a lit­tle sticker there. Let him choose a lit­tle gift as a re­ward for ev­ery sev­enth sticker. This will mo­ti­vate the child to "make an ef­fort"!

Dr. Jonathan Halevy re­ceived his de­gree from the Sackler School of Medicine of Tel Aviv Univer­sity, and then un­der­went his res­i­dency in the Pe­di­atric De­part­ment of the Wolf­son Med­i­cal Cen­ter in Is­rael, earn­ing his cer­ti­fi­ca­tion as a spe­cial­ist in

pe­di­atrics.

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