Health concerns: Constipation

Sarah Scotland addresses a commonly encountered condition that can cause distress to both children and their families…

Constipation in children is more common than you might think – it is a condition that causes them unhappiness and discomfort, and their families concern, so it is important to know that you can tell parents that they are not alone. Hopefully, understanding some of the signs and being aware of some advice on how to help alleviate the problems will provide confidence and reassurance; but if you have any reason to think that any children in your care child may be constipated, do not be afraid to seek help.

Causes

Constipation is caused by a variety of factors, some of these may be nutritional, for example:

• too little dietary fibre and fluid;
• too much milk in the diet;
• overfeeding in infancy;

Other factors that may cause constipation are the child ignoring the urge to go to the toilet, or a lack of exercise.

Potty training is a big milestone in a child’s life and it is important to get it right, as when mistimed or mismanaged it may cause constipation. Ensuring that children are eating a healthy and balanced diet with plenty of fluids (preferably water) will help. Talk to parents about being aware of signs that children are ready; it is not something to be rushed. Explain the importance of a regular routine: a few minutes on the potty after a meal, then have fun washing hands.

Make the point with parents that although it can be difficult sometimes, they must try not to make a fuss about accidents – always try to be positive.

Signs of constipation

Indications that a child is constipated may include:

• no bowel movement for three or more days;
• lots of hard stools being passed;
• using avoidance techniques, such as dancing around or hiding;
• generally unhappiness and/or a lack of energy.

Soiling is when a child is constipated, and their bowels are very full, but they cannot go to the toilet. They may have little ‘dribbles’ – these will be noticed in the child’s pants, night clothes or bedding. These are accidents; the child is not being naughty – it is sign that help must be sought.

Preventative measures

1 Drinks

It is important that children are drinking sufficient fluids. Toddlers should ideally have around 6–8 drinks every day, each drink being around 3–4 fl. oz. Water is the best drink – try to encourage toddlers to drink more of it at meal times and in between. Diluted fruit juice may be given at mealtimes. Milk should be limited to a maximum of 120ml a day, as any more limits children’s ability to consume foods containing dietary fibre.

2 Eating

When talking to parents, explain the importance of encouraging their child to eat the same as them, which is, hopefully, healthily! Interaction at mealtimes is really important, so try to push the point that meals should be eaten together around a table and without the telly. At nursery these rules must be followed too, and it is important that practitioners sit down at mealtimes and eat with the children and provide a family atmosphere.

In order to ensure adequate fibre is being eaten, present the children in your care with a variety of fruit and vegetables as well as cereals. Each meal and snack should be nutritious (fruit and vegetables rather than crisps and sweets). Remember that the more fibre eaten, the more fluid (water) that needs to be consumed.

3 Exercise

Physical exercise is another great way to try to get children’s bowels moving. Encourage parents to take their children to the park, go to soft play or walk to the shops.

When the children are in your care, you can play games to encourage activity, and if you have a garden try to get them playing on bikes, play equipment and generally being active.

Being aware that a child is constipated is not a trivial matter, and it is not simply a matter of increasing fibre in the diet. The child affected may well be in pain and discomfort, and it is important to seek professional help so they can start on a road to free bowels. This may mean laxatives will be prescribed, but don’t worry – this is normal and important for the child to begin having regular movements.

About the author

Sarah is a freelance nutritionist who runs her own company, Wise about Food, and works with parents and childcare providers to promote their awareness of eating a healthy diet. Visit www.wiseaboutfood.co.uk