When baby can’t go

MOST parents tend to watch their little ones like hawks, constantly obsessing over the way they sleep, resolving their hiccups, the number of hours they sleep and even their bowel movements — its pattern and consistency of its content. The latter, paediatrician Dr Anona Griffith said, is very important considering the possibility of conditions such as constipation. “Constipation refers to a change in the frequency and consistency of stools passed. When one is constipated what happens is that stools are passed less frequently and are generally hard and dry, with accompanying difficulty and pain in passing stool and may sometimes contain blood,” Dr Griffith said.

She explained that the problem, which is common in infants and children, occurs when the waste from the digestive system which enters the large intestine as a liquid substance from which water is absorbed in preparation for excretion remains for a prolonged period without expulsion. Then it becomes hard and difficult to pass.

“This is usually associated with major transitions or changes in routine such as from breast milk to formula, adding complementary foods, potty training, or when the child is first starting school, which is defined as functional constipation,” Dr Griffith underscored.

She notes that while most patients who present with constipation have had their cases linked to functional constipation, another culprit could be an existing medical condition.

“These include anatomical abnormalities involving the intestines such as Hirschsprung disease which usually presents shortly after birth and is characterised by the delayed passage of the first stool, disorders of the nervous system, or under-functioning of the thyroid gland or hormone (hypothyroidism),” Dr Griffith outlined.

Since poop can be such a tricky matter when it comes to children, Dr Griffith has shared signs that indicate your child may be suffering from constipation: • Decreased bowel movements.

• Hard, dry stools may be large and bulky or pellet-like.

• Painful bowel movements.

• Abdominal pain.

• Faecal soiling – soiling of underwear with soft stool that has passed around the hard portion.

• Blood coating stool, or present on wiping.

When pain is associated with bowel movements, Dr Griffith said that the child may present with behaviours such as ignoring the urge to have a bowel movement, crossing of legs, twisting of the body, squeezing or clenching of the bottom and raising body on tiptoes in response to the urge to pass stool. This pattern developed by the child is likely to further develop into chronic constipation.

“Chronic constipation occurs when there is persistent avoidance of bowel movement. What happens is that it sets up a cycle of events in which the process becomes increasingly unpleasant and painful as well as the stool in the rectum becomes harder and more difficult to pass and in most cases require medical intervention to make the process less painful for the child,” Dr Griffith advised.

Treatment of constipation is often a prolonged process, with two aims in mind – one to help the child to return to his/her normal regular bowel habits, which is ideally one to two soft stools per day, and secondly, to overcome the fear and anxiety associated with the unpleasantness of the process. This, Dr Griffith said, requires patience and consistency.

Getting to this place will require a number of natural and sometimes medicinal support depending on the severity of the condition. Below, she shares how and what exactly will be required for successful treatment:

•Dietary adjustment — increasing dietary fibre, including fruits and vegetables, prunes, prune juice and apples which are known to be high in soluble fibre.

• Increase water intake.

• Schedule time for bowel movements, ideally within 30 minutes of a meal, in order to establish a routine.

• Consistent support.

• Encourage physical activity as this promotes peristalsis or the movement of the intestines. In the case of infants try the bicycle legs.

• Relaxation techniques such as deep breathing to decrease anxiety associated with the process. This also aids in relaxation of the pelvic muscles. Other forms of distraction may work better with infants.

• Gentle massage of the abdomen to help promote bowel movement.

• Natural remedies that have been used and include aloe vera and senna, and are incorporated as part of many over the counter (OTC) preparations, but must be used under a physician’s guidance.

• Some common OTC preparations used as laxatives include mineral oil, milk of magnesia, fibre products.

Some cases require more than combined natural methods of intervention.

“Medical attention must be sought if the child shows signs of distress and pain, if he or she is ill-looking, and once there is any other concern. It is also essential to rule out those conditions that require medical or surgical intervention. Medical intervention may be required to disimpact or free the bowels of the stool,” Dr Griffith advised.