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By: Dr. Michelle MD
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 The miserable symptoms of constipation can occur at any age. The problem
is defined as difficulty passing bowel movements. The symptoms can include
poor appetite, irritability, abdominal pain, rectal pain and bleeding. Here
is a basic course on this common problem.
Normal Digestion—How The Whole System Works.
When food or drink is swallowed it enters the esophagus which immediately
conducts it down to the stomach. The food does not fall down merely by gravity’s
pull. The muscular, rhythmic, serial contractions, known as peristalsis
make it possible to swallow food even if the person is standing on his head.
These contractions propel food all the way through the digestive tract from
entry to exit.
Once in the stomach, the liquid water that is swallowed is quickly absorbed,
 digestive juices are mixed with the remaining solid content and the food
is passed on to the small intestine. During the long trip through the three
areas of the small intestine, liquid enzymes are secreted by the pancreas
and liver to mix with the food and break it down to absorbable nutrients.
Proteins fats and carbohydrates are broken into their smallest components,
which are then absorbed. During this process all of the nutrition in the
food is extracted and transported into the blood stream through the complex
structures in the walls of the small intestine. Whatever is not broken down,
and absorbed is considered by the body to be waste. This is passed along
to the large intestine, the colon. At this stage, the consistency of the
waste is semisolid sludge.
In the colon, the waste is slowly pushed along by peristaltic contractions
while the water in it is slowly reabsorbed. During the passage through the
colon, water is absorbed, and the waste becomes solid. When the solid waste
reaches the very end of the colon (the rectum) the nervous system sends
signals to the brain to initiate abdominal pushing and relaxation of pelvic
muscles to help eliminate the waste and empty the rectum.
What Causes Constipation In Kids?
Newborn infants
It is normal for newborns to move their bowels during or after feedings
several times a day. As the infant gets a little older this reflex  decreases
to 1-2 times a day. Formula which produces thicker waste than breast milk
can sometimes cause constipation by turning hard in the colon if the bowels
do not move daily. For these infants it is sometimes necessary to add molasses
or brown sugar to the formula to soften the stools.
Exclusively breast fed babies never have hard stools but they sometimes
go several days without passing a bowel movement. This is acceptable after
the first month of life if the infant is not uncomfortable. If the child
is trying to push and no stool comes, some help is appropriate. The problem
is usually that he is tensing his buttocks and pelvic muscles while trying
to push.
It is reasonable to use rectal stimulation by glycerin suppositories or
Fleets Baby Lax to facilitate defecation. Babies do not become dependent
on rectal stimulation. It eventually teaches the baby to relax the right
muscles and move his bowels easily.
Babies and toddlers
The problem of constipation in babies and toddlers in diapers is usually
caused by certain foods in their diet which form very hard waste in the
colon.  The most common ones are milk and milk products, bananas, apples
and white rice.
A common source of toddler constipation is the fear of using the toilet
during training. There have been some interesting studies that suggest that
delaying the age of training increases the risk of this problem. Most of
the world’s children are trained at about 12-16 months of age, and
this age group is much less fearful of using the toilet.
If a child has a painful bowel movement he can become very afraid and he
will hold back when he has the urge to push. This can make the problem much
more difficult to overcome. Any stool that is not eliminated is likely to
get drier and harder with time. Each painful bowel movement reinforces the
fear.
These constipated children should be helped with laxatives. Glycerin suppositories
are sometimes helpful. Enemas are not ideal for children since there is
a potential problem with salt imbalance. Although mineral oil, prune juice,
Senekot, Metamucil and milk of magnesia have been used for years, they can
be difficult to administer and they all have side effects.
I find that the new osmotic prescription laxative, Mirilax, (Glycolax or
Polyethylene Glycol 3350,) is the best. It is a powder that disappears
totally into any drink, even clear water. It is tasteless and has no texture.
Given once a day, it is not absorbed at all, it simply travels through the
digestive tract and is eliminated totally with the waste. It mixes with
the waste material and does not allow it to harden. It has been shown to
be effective (using more frequent doses) in even the most constipated children
with minimal side effects. It is also safe to use it as often as needed
since it doesn’t affect the bowel function, it only softens the stool.
Good Eating Habits
The Fiber Story
 Insoluble fiber, which is found mostly in natural grains, vegetables
and fruits, is not broken down by the small intestine and it has no nutritional
value. The fiber maintains a soft solid consistency of the waste since it
absorbs excess water (even in diarrhea) and it does not allow much water
to be absorbed by the wall of the colon. It is the prevention and the cure.
Whole grains such as whole wheat, brown rice, oatmeal, and kasha are good
sources of fiber. All breads, crackers and cereals that are made from whole
grains and their brans are full of fiber. If the food has at least 3 grams
of fiber per serving it is a genuine high fiber food.
The vegetables with the highest fiber content are legumes like beans and
chickpeas, squashes, sweet potatoes, cabbage, broccoli and cauliflower.
(Lettuce, tomatoes and cucumbers have minimal fiber content.) Most fruits
and nuts are good sources of fiber. Dried fruits such as prunes and raisins
are just as good.
Problem Foods
For some children, apples, bananas, and white rice are constipating. They
have plenty of fiber, but they also have pectin which acts as a binder.
White rice tends to harden badly in the colon.
Milk products sometimes form very hard calcium complexes resulting in rock
hard stools. Eating a fiber food at the same time as the milk food can help.
The Importance of Good Habits.
Good eating habits are very important. When a child eats fruits and vegetables,
whole grains, and legumes from an early age he will very likely enjoy eating
these foods as an adult. We owe it to the kids to get them started on the
right track.
Exercise is a very good stimulator of normal bowel function. We must do
our best to make sure our children have a chance to get lots of activity. The body works to its own rhythm. The colon usually contracts and moves
waste along after meals. For this reason it is beneficial for the children
to become accustomed to allowing time for the bathroom after a meal.
It is important to contact the child’s doctor if constipation is persistent.
This problem can become chronic and lifelong. It may affect the child’s
whole personality and sense of wellbeing. |
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Constipation in Children 
