if your child has constipation

In order to diagnose your child’s constipation, your doctor or nurse will ask you how long their symptoms have been present and if they have any rectal pain or bleeding.If you think your child has constipation, it will help your doctor or nurse make a more accurate diagnosis if you fill in a Bowel Record Chart for one or two weeks before your appointment. Please download Bowel Record Chart from here and Children’s Poo Chart from here. The Bowel Chart records details about your child’s bowel habits.The doctor will also ask you for information on your child’s toilet training and habits, diet and general health and may need to feel the child’s abdomen.All of this information will help your doctor or nurse find out if constipation is responsible for your child’s symptoms as well as what might be causing it. Asking about your child’s symptomsYour doctor or nurse might ask you some questions (such as those below) to find out if your child has constipation.How often does your child usually pass a stool? Has this changed recently?What do their stools look like? Are they big or small, hard or soft, formed or loose? What colour are they? How hard is it for your child to pass a stool? Does your child strain? And how long does it usually take? Does your child say it hurts when passing a stool? Does he or she get upset? Does your child put off going for a poo? Does your child get a tummy ache in between bowel movements? Does it go away after your child has done a poo? When did the symptoms begin? Is there any blood on the toilet paper or in your child's stools or underwear? Does your child always have symptoms, or do they come and go? Is your child less hungry than usual? Is your child losing weight? Is he or she feverish or vomiting? Does your child ever leak very soft or liquid stools into his or her underwear? (If your child is out of nappies) Working out what's causing the constipation 
 Your doctor or nurse will then want to work out what is causing the constipation. He or she may ask questions such as this to find out.Do other members of your family have constipation? What's your child's diet like? Has your child's daily routine changed? For example, have they started a new school or been on holiday? Is your child taking any medicines or herbal remedies? What's your child's behaviour like? Sometimes, holding in stools may be a way to get attentionTo get even more information, your doctor may ask you to keep a diary of what your child eats and how often he or she does a pooExamining your childMost children do not require an examination other than a gentle feel of their tummy. However your doctor or nurse may want to look at your child's bottom to see if it is red or cracked and to check for signs of leaking stool. This should only be done with your child's agreement.Making the diagnosisAfter talking to you and examining your child, your doctor or nurse will probably be able to tell if your child has constipation and what is causing it. However, he or she may want to do some tests if he is not sure if your child has constipation, if your child has other symptoms (fever, vomiting or weight loss) or if he thinks that a medical condition could be causing the constipation. Referral to a hospital specialistThe majority of children with constipation can be treated successfully without having to go to hospital. However in some areas where there is not a service set up in the community for children with constipation your doctor may decide to refer him or her to the hospital.What will happen next?If your child's bowels become completely blocked with large, hard stools (called impacted faeces), he or she will need the stool to be removed first in order for the constipation to start to get better.In most cases this can be done by giving your child special medicine which will help soften the stool and enable it to be passed easily.

Constipation in Children - When to seek help

Most children get constipated from time to time. However, if your child has constipation that doesn't go away, he or she may need treatment to get back to normal. Sometimes, more serious symptoms may occur in children with constipation. If you notice these in your child, you should see your doctor.•being irritable•loss of appetite•soiling their clothes•bleeding from the back passage•feeling sick•stomach painsIn very rare cases, your child’s constipation may be the result of a medical condition. Your doctor will be able to investigate the causes at your consultation.

Childhood Constipation

Tom was five years old and had problems with constipation since he was a baby. Tom is now six years old and the situation has improved. We have found a medication that has cleared Tom’s bowel without any side effects (such as severe stomach ache and vomiting) and Tom is both physically and emotionally a happier and healthier child. He has started school and is making excellent progress, albeit with support.What started off with a ’problem with constipation’ has resulted in Tom having a dysfunctional bowel. This seems to be the result of poor gut motility that led to constipation as an infant. The resultant faecal loading has caused an enlarged colon, a mega rectum and paradoxical contractions of the sphincter muscle, all of which have compounded the original problem.Tom has endured a range of interventions including multiple medications, three x-rays and a gut transit study, a number of failed enemas under sedation and an eventual referral to Dr. X, consultant paediatrician with an expertise in the field of childhood constipation. And during this time, for a period of three years, Tom has had to cope with severe stomach ache, vomiting and constant overflow soiling. He has had a poor appetite, disturbed sleep patterns, and has been prone to severe temper tantrums as a result of feeling so unwell.We have become experts on childhood constipation and we have had to become advocates on Tom’s behalf, taking over his case management from the professionals. We have learnt not to be embarrassed when our child poos or is sick in public or throws an enormous tantrum because he is feeling poorly. We have learnt to keep things in perspective, knowing that Tom’s condition is not life threatening. We now know this is a long term problem and we accept there are no magic solutions.We look forward to the day when we can take our two boys swimming together, where they can run on the beach and into the sea without Tom needing to be changed or embarrassed in front of other people, when we no longer have to leave the house with sufficient supplies to ’march on Moscow’: and when Tom can happily go for a visit to a friends without us, his parents, in tow, just in case he needs his bottom changing.

Constipation in Children - Preventing Constipation

There are various things you can do to help keep your child’s bowels healthy. Don't let your child wait to do a poo Give your child enough time so they don’t feel rushed. Set aside a time each day for your child to sit on the toilet. A good time for this may be after breakfast or lunch, when their bowels are most activeEncourage your child to eat more high-fibre foods such as wholegrain bread, wholegrain breakfast cereals, fruit and vegetables. For babies, try giving puréed fruit and vegetablesMake sure your child drinks lots of fluids to keep the stools moist e.g. 6-8 water based drinks per day. For babies, try giving cooled boiled water in between feedsEncourage your child to get lots of active play to increase bowel activity
Make sure your child sits on the toilet properly. This means sitting up straight so that the small tube just before the anus (the anal canal) will also be straight. This makes it easier to push stools out. Your child may need to put his or her feet on a footstool in front of the toiletYou can make going to the toilet more fun by keeping special treats reserved for the toilet, such as a favourite book or getting them to blow bubblesIf your child says that it hurts to poo, tell him or her to stop trying, and then try again laterEating more fibreEating a diet low in fibre is known to cause constipation. Most doctors would advise that if your child is constipated, it's worth trying to encourage him or her to eat more fibre. Fibre cannot be digested by the body so passes straight through your child's digestive system and becomes part of your child's stools. Eating foods that are high in fibre increases the bulk of the stools and makes them softer (by helping them retain water) so they are easier to push out.How to calculate how much fibre (in grams) your child should be eating per day Child’s age in years + 5 grams in children older than 2 years E.g. If your child is 7 years old, the calculation would be 7 + 5 = 12They should therefore be eating 12 grams of fibre per day. To put this into perspective, it is recommended that adults should eat about 18 grams of fibre a day.Choose foods that are higher in fibre and aim to include them at each meal time. One should aim for a variety of foods including wholegrain cereals, wholemeal / granary breads and fruit and vegetables. Include dried fruit and fruit eaten with skin on as well as vegetables particularly beans, peas, sweetcorn and pulses such as lentils. Reading labels on food can help to identify their fibre content The child will need to see other family members eating the same sort of food or they will, understandably, view the enforcement of this type of diet as a punishment with predictably negative results. It is therefore important that the whole family is involved with any dietary improvements.Drinking more fluidsIt is important to increase your child’s fluid intake. Aim to get the child to drink 6-8 glasses of fluid each day (approx. 2 pints / 1 litre). Suitable fluids include water, squash and fruit juices. By increasing the fluid intake you will increase the water content of the stools making them softer and easier to pass. If a child drinks an excessive amount of milk, this may need to be reduced to approx., 1 pint / 500mls per day + 500mls of water based drinks as discussed above.